Pneumocystis carinii infection: current treatment and prevention

Abstract

Pneumocystis carinii is a common cause of pneumonia in individuals who are immunosuppressed by HIV infection. Use of molecular biological techniques show that P. carinii is a fungus and that infection in man is not a zoonosis. Invasive tests such as sputum induction or bronchoscopy are used to make the diagnosis of P. carinii pneumonia. Life long primary prophylaxis is given to HIV positive individuals with CD4+ lymphocyte counts < 0.20 x 10(9)/L or a CD4: total lymphocyte ratio of < 1.5, constitutional symptoms, or with other AIDS defining diseases. Secondary prophylaxis is given after a first episode to prevent a recurrence. First choice for primary and secondary prophylaxis is oral co-trimoxazole 960 mg od or three times a week. In patients who are intolerant to co-trimoxazole, nebulised pentamidine or dapsone (with or without pyrimethamine) are second and third choices. In a patient with acute PCP disease, severity should be assessed using clinical, radiographic and blood gas criteria as those with moderate or severe disease will benefit from adjuvant glucocorticoids. Co-trimoxazole (120 mg/kg/day in divided doses for 21 days) is first choice therapy for PCP of all degrees of severity. In patients who fail to respond to co-trimoxazole or who are intolerant to it, second line treatment is iv pentamidine in those with severe disease and oral dapsone with trimethoprim, oral clindamycin with primaquine or iv pentamidine in those with mild or moderately severe disease.

Prophylactic Effect of FK463, a Novel Antifungal Lipopeptide, against Pneumocystis carinii Infection in Mice

“…However, conventional therapy such as that with trimethoprim-sulfamethoxazole or parenteral pentamidine is often complicated by adverse reactions in AIDS patients that may require termination of the therapy, and the mortality rate for first episodes of PCP is still 5 to 20% (8). Therefore, special attention is focused on the treatment and prophylaxis of PCP for the current management of human immunodeficiency virus infection (2,5,15).Since the development of alternative drugs that do not cause adverse reactions is necessary, a new strategy to develop an anti-P. carinii drug that interacts with a target not found in other eukaryotic cells has been attempted (4). Such a drug might overcome the adverse reactions caused by conventional chemotherapeutic regimens which act on fungi as well as mammalian cells.…”

“…However, conventional therapy such as that with trimethoprim-sulfamethoxazole or parenteral pentamidine is often complicated by adverse reactions in AIDS patients that may require termination of the therapy, and the mortality rate for first episodes of PCP is still 5 to 20% (8). Therefore, special attention is focused on the treatment and prophylaxis of PCP for the current management of human immunodeficiency virus infection (2,5,15).…”

Pneumocystis jirovecii Pneumonia in AIDS Patients

“…Since PcP can be rapidly progressive and the mortality rate remains high, early therapy is essential (Calderon et al, 2004;Roblot, 2005). Identification of patients having PcP into mild, moderate or severe disease allows to guide the choice of the drug for the treatment of PcP, as well as, to decide if adjuvant corticosteroids are indicated (table 1) (Miller et al, 1996). In AIDS-related PcP, the typical duration of therapy is at least 21 days because of the risk for relapse with shorter treatment duration.…”

Persistence ofPneumocystis cariniiAfter Effective Treatment ofP. cariniiPneumonia Is Not Related to Relapse or Survival Among Patients Infected with Human Immunodeficiency Virus

“…As shown in figure 1, there was no correlation between a positive second BAL and survival. Pneumocystis carinii pneumonia (PCP) is still an important Our study shows that P. carinii persisted in two-thirds of patients complication and cause of death among patients with AIDS [1,2]. who recovered from PCP and underwent BAL at the end of treatIt is known that bronchoalveolar lavage (BAL) can show that the ment.…”