Pneumocystis carinii pneumonia in a non-HIV patient on steroids

Ly, Hue; Thermidor, Marjorie; Cunha, Burke A.

doi:10.1016/j.hrtlng.2003.11.003

Cited by 4 publications

(8 citation statements)

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“…It was first noted in malnourished children during World War II, and subsequently rose to prominence during the AIDS epidemic of the 1980s 4 6. It is typically noted in AIDS patients with CD4+ T-lymphocyte counts <200 cells/mm 3 , and follows a more indolent course due to the presence of fewer inflammatory cells.…”

Section: Discussionmentioning

confidence: 99%

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FatalPneumocystis jiroveciipneumonia in a HIV-negative adult

et al. 2015

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SUMMARYPneumocystis jirovecii is responsible for P. jirovecii pneumonia (PJP) in immunocompromised individuals, with a recent rise of cases noted in non-HIV patients. A middle-aged man presented with new-onset cough, fever, hypoxia and tachypnoea. He was on a tapering course of dexamethasone for amiodarone-induced thyrotoxicosis. He developed worsening airspace disease necessitating mechanical ventilation. Bronchoalveolar lavage (BAL) fluid was positive for P. jirovecii and he was managed with trimethoprim/sulfamethoxazole and pentamidine, but succumbed to cardiorespiratory arrest. One-third of PJP cases occur in non-HIV patients, and have a higher morbidity and mortality. Most immunocompromised patients typically exhibit PJP during a corticosteroid taper. The accurate dose, duration or frequency of steroid use in not well established. Diagnosis of PJP in this population is more challenging due to lower BAL yield with alternate modalities such as serum/BAL β-D-glucan and PCR enhancing the yield. Further studies are needed to highlight PJP prophylaxis in patients with steroid use. BACKGROUND

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Section: Discussionmentioning

confidence: 99%

“…These include patients with prior organ transplant, haematological cancers, solid organ malignancies, collagen vascular diseases, organ rejection, primary immunodeficiencies and inflammatory bowel disease 6 8–10. Typically, these patients are more often older, with males being more commonly affected than females 8.…”

Section: Discussionmentioning

confidence: 99%

FatalPneumocystis jiroveciipneumonia in a HIV-negative adult

et al. 2015

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“…A variety of reports over the last several years have shown that these medications are able to suppress the immune system to a level where a patient may become susceptible to infection with PJP. [6][7][8][9][10][11][12][13][14][15][16][17][18][19] There have also been reports in the literature about PJP occurring during reversal of immunosuppression, occurring as part of the immune reconstitution syndrome in the AIDS population. 20 Interestingly, there have also been reports of PJP infection occurring in individuals without any predisposing illness at all, suggesting perhaps that immunosuppression is not the sole risk factor.…”

Section: Pneumocystis Pneumoniamentioning

confidence: 99%

Fact or Fiction: Does the Non-HIV/AIDS: Immunosuppressed Patient Need Pneumocystis Jiroveci Pneumonia Prophylaxis? An Updated Literature Review

Grewal

Brassard

2009

J Cutan Med Surg

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“…Infecções atípicas (Herpes zoster) ou com organismos oportunistas (pneumocistis carinii) são 40 vezes mais freqüentes em pacientes em corticoterapia (80). Quando associados a outras drogas imunossupressoras, também pode ocorrer a reativação de uma infecção latente.…”

Section: Sistema Imunológicounclassified

Síndrome de Cushing exógena e retirada de glicocorticóides

Romanholi

Salgado

2007

Arq Bras Endocrinol Metab

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RESUMOGlicocorticóides são amplamente utilizados na prática clínica para o controle da atividade de doenças auto-imunes, inflamatórias, alérgicas e outras entidades nosológicas. Doses terapêuticas de glicocorticóides são muita vezes administradas inapropriadamente e isto é um problema particular, pois a terapia crônica tem muitos efeitos colaterais que se estendem desde a supressão do eixo hipotálamo-hipofisário-adrenal e síndrome de Cushing até infecções e alterações do status mental. Fatores que influenciam tanto nos efeitos adversos quanto nos terapêuticos dos glicocorticóides incluem propriedades farmacocinéticas do glicocorticóide, dose diária, diferenças individuais no metabolismo esteróide e duração do tratamento. Quando utilizados para o controle da atividade destas doenças, quatro aspectos da retirada de glicocorticóide merecem atenção especial. Primeiro, a doença tratada pelo esteróide pode recorrer. Segundo, o eixo hipotálamo-hipó-fise-adrenal pode permanecer suprimido por um longo período. Terceiro, muitas vezes desenvolve-se dependência psicológica a esses hormônios. Quarto, uma síndrome de retirada inespecífica pode desenvolver mesmo enquanto os pacientes estão recebendo doses de reposição fisiológica de glicocorticóides. A gravidade da síndrome de retirada depende da fase e o grau de dependência e inclui sintomas tais como anorexia, náusea, vômitos, perda de peso, fadiga, mialgias, artralgias, cefaléia, dor abdominal, letargia, hipotensão postural, febre e descamação da pele. ABSTRACT Exogenous Cushing's Syndrome and Glucocorticoid Withdrawal.Glucocorticoids are widely used in clinical practice to control the activity of autoimmune, inflammatory, allergic diseases and other nosological entities. Therapeutic doses of glucocorticoids are often administered inappropriately and it is a particular problem because chronic therapy has many side effects, ranging from suppression of the hypothalamic-pituitary-adrenal axis and Cushing's syndrome to infections and changes in mental status. Factors influencing both the therapeutic and adverse effects of glucocorticoids include the pharmacokinetic properties of the glucocorticoid, daily dosage, individual differences in steroid metabolism and the duration of treatment. When used to control the activity of these diseases, four aspects of glucocorticoid withdrawal deserve special attention. First, the illness treated by steroids may relapse. Second, the hypothalamic-pituitary-adrenal axis may remain suppressed for a long time. Third, psychological dependence to these hormones often develops. Fourth, a nonspecific withdrawal syndrome may develop even while patients are receiving physiological replacement doses of glucocorticoids. The severity of the withdrawal syndrome depends on the phase and degree of dependence and includes many symptoms as anorexia, nausea, emesis, weight loss, fatigue, myalgias, arthralgias, headache, abdominal pain, lethargy, postural hypotension, fever, and skin desquamation.

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Pneumocystis carinii pneumonia in a non-HIV patient on steroids

Cited by 4 publications

References 9 publications

FatalPneumocystis jiroveciipneumonia in a HIV-negative adult

FatalPneumocystis jiroveciipneumonia in a HIV-negative adult

Fact or Fiction: Does the Non-HIV/AIDS: Immunosuppressed Patient Need Pneumocystis Jiroveci Pneumonia Prophylaxis? An Updated Literature Review

Síndrome de Cushing exógena e retirada de glicocorticóides

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