Pneumocystis carinii Pneumonia in Human Immunodeficiency Virus-Infected Patients

Glatt, Aaron E.; Chirgwin, Keith

doi:10.1001/archinte.1990.00390140027007

Cited by 52 publications

(17 citation statements)

References 95 publications

(5 reference statements)

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“…Pneumocystis ccirinii pneumonia (PCP) is an important infection, causing morbidity and mortality in immuno compromised patients, especially AIDS patients [1 ]. Ad verse reactions to effective drugs such as trimethoprimsulfamethoxazole, clindamycin, pentamidine and trimetrexate have prompted a search for alternative therapeutic strategies [2].…”

Section: Introductionmentioning

confidence: 99%

Serial indium-111-labelled IgG biodistribution in ratPneumocystis carinii pneumonia: a tool to monitor the course and severity of the infection

et al. 1995

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Abstract. To study the effect of new therapeutic strate gies, we developed an animal model to monitor the course and severity of experimental Pneumocystis ccirinii pneumonia (PCP) in rats. P. ccirinii density scores in Giemsa-stained impression smears were used to follow P. ccirinii load. Indium-111 labelled IgG scintigraphy and biodistribution, histology of paraffin-embedded tis sue sections, lung/body weight (L/B wt) ratio and cell count and differentiation of broncho-alveolar lavage (BAL) fluid were used as parameters of host inflamma tory response. Statistically significant differences in L/B wt ratio, number of neutrophils in BAL fluid, P. ccirinii density score, histological extent of inflammation and m In-IgG accumulation in the lung were seen between the rats sacrificed at various time points. m In-IgG accu mulation in the lung correlated well with L/B wt ratio and P. ccirinii density score and correlated moderately with number of neutrophils in BAL fluid and with the histological extent of inflammation. To study the effect of new therapeutic strategies, we developed an animal model to monitor the course and severity of experimental PCP in rats. The outcome of in fection is determined by the balance between the offen sive power of microbial pathogens and the defences of the host. Sometimes the host succumbs because of an overwhelming invasion of micro-organisms, while at other times death is due to an overwhelming inflamma tory response. To evaluate therapeutic strategies, it is therefore important to monitor the growth of the micro organisms as well as the magnitude of the host response. P. ccirinii density scores in Giemsa-stained impression smears are a good method to follow P. ccirinii load, but do not provide information on the inflammatory re sponse of the host 13]. Histology of paraffin-embedded tissue sections gives a good impression of the extent of inflammation, but is time consuming and difficult to quantify [4,5].Indium-1 1 1 labelled IgG scintigraphy (IgG scan) and biodistribution are effective methods to identify local in flammation in PCP 16,7]. These methods detect disease activity early in the course of the infection and are easy to quantify. Here we describe a model to monitor the course and severity of experimental PCP in rats, using m In-IgG biodistribution.

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Section: Introductionmentioning

confidence: 99%

Serial indium-111-labelled IgG biodistribution in ratPneumocystis carinii pneumonia: a tool to monitor the course and severity of the infection

et al. 1995

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“…or aerosolized pentamidine are accepted alternative therapies available for PCP prophylaxis for PBSC transplant recipients. [7][8][9] However, TMP/SMX intolerance may predict intolerance of dapsone, making dapsone a less desirable option. 10 Prophylactic therapy with i.v.…”

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confidence: 99%

“…10 Prophylactic therapy with i.v. or aerosolized pentamidine, while better tolerated, may be associated with multiorgan toxicity including alterations in glucose metabolism 9,11 and has been associated with atypical breakthrough infections. 12 Aerosolized pentamidine also requires experienced personnel for administration and careful patient monitoring.…”

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confidence: 99%

A prospective randomized trial comparing the toxicity and safety of atovaquone with trimethoprim/sulfamethoxazole as Pneumocystis carinii pneumonia prophylaxis following autologous peripheral blood stem cell transplantation

Colby

McAfee

Sackstein

et al. 1999

Bone Marrow Transplant

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Summary:Pneumonia due to Pneumocystis carinii is an infrequent complication following autologous stem cell transplantation (ASCT) which is associated with a high mortality. Although administration of trimethoprim/sulfamethoxazole (TMP/SMX) is an effective prophylactic strategy for Pneumocystis carinii pneumonia (PCP), treatment-associated toxicity frequently results in discontinuation of therapy. We have conducted a prospective randomized trial comparing atovaquone, a new anti-Pneumocystis agent, with TMP/SMX for PCP prophylaxis following autologous peripheral blood stem cell (PBSC) transplantation. Thirty-nine patients were studied. Twenty patients received atovaquone suspension and 19 patients received TMP/SMX. The median ages were 44 (range 20-68) and 47 (range 32-63) years, respectively. A similar number of patients with solid tumors (14 vs 15) and hematologic malignancies (five vs five) were treated in each group. Either TMP/SMX (160/800 mg) or atovaquone (1500 mg) was administered daily from transplant day −5 until day −1, discontinued from day 0 to engraftment, then resumed 3 days per week until day +100 post-transplant. The median time to engraftment (ANC Ͼ0.5 × 10 9 /l) was similar in both groups. Eighty percent of the patients randomized to atovaquone prophylaxis completed the study. Four atovaquone-treated patients were removed from study; two patients (10%) did not receive a transplant and two patients (10%) were removed due to a protocol violation. None of the 16 patients treated with atovaquone experienced treatment-associated adverse effects. Of the 19 patients randomized to receive TMP/SMX, 55% completed the study. Nine TMP/SMX-treated patients were removed from the study; one patient (5%) did not receive a transplant and eight patients (40%) were removed due to drug intolerance (P Ͻ 0.003). The rate of intolerance to TMP/SMX led to the early discontinuation of this randomized trial. Intolerance of TMP/SMX included elevated transaminase levels

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“…Different causes have been implicated in the development of PTX in patients with AIDS, namely: P. carinii infection [6,7,[13][14][15][16]; HIV itself, which can cause (probably through different mechanisms) a destructive action on the lung parenchyma, with alveolitis and "premature emphysema" [17]; and aerosolized pentamidine for PCP prophylaxis [8,9]. It has been suggested that aerosolized pentamidine leaves the apical areas of the lung untreated, and, if PCP develops, there is a progressive apical disease with large subpleural cavities, which may rupture and cause PTX [8].…”

Section: Discussionmentioning

confidence: 99%

Pneumothorax in HIV-infected patients: role of Pneumocystis carinii pneumonia and pulmonary tuberculosis

Tumbarello¹,

Tacconelli²,

Pirronti³

et al. 1997

Eur Respir J

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Univariate analysis identified four risk factors for pneumothorax: 1) previous P. carinii pneumonia (p=0.01); 2) current P. carinii pneumonia (p=0.02); 3) pulmonary tuberculosis (p=0.01); and 4) cysts, pneumatoceles or bullae on chest radiographs (p<0.001). Multivariate analysis indicated that current P. carinii pneumonia (p=0.01) and pulmonary tuberculosis (p=0.04) were both independent risk factors for pneumothorax.In conclusion, our findings demonstrate that, in addition to Pneumocystis carinii pneumonia, pulmonary tuberculosis enhances the risk of pneumothorax in patients with acquired immune deficiency syndrome.

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Pneumocystis carinii Pneumonia in Human Immunodeficiency Virus-Infected Patients

Cited by 52 publications

References 95 publications

Serial indium-111-labelled IgG biodistribution in ratPneumocystis carinii pneumonia: a tool to monitor the course and severity of the infection

Serial indium-111-labelled IgG biodistribution in ratPneumocystis carinii pneumonia: a tool to monitor the course and severity of the infection

A prospective randomized trial comparing the toxicity and safety of atovaquone with trimethoprim/sulfamethoxazole as Pneumocystis carinii pneumonia prophylaxis following autologous peripheral blood stem cell transplantation

Pneumothorax in HIV-infected patients: role of Pneumocystis carinii pneumonia and pulmonary tuberculosis

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