Pneumocystis jirovecci pneumonia in connective tissue diseases: Comparison with other immunocompromised patients

Teichtahl, Andrew; Morrisroe, Kathleen; Ciciriello, Sabina; Jennens, Ian; Tadros, Susan; Wicks, Ian P.

doi:10.1016/j.semarthrit.2015.01.007

Cited by 20 publications

(12 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…1 Adjunctive glucocorticoid therapy is beneficial for PCP in patients with acquired immunodeficiency syndrome, but the role in patients with rheumatic diseases is debated. 2 Objectives: To investigate the prognostic factors of PCP in patients with rheumatic diseases.…”

Section: Referencesmentioning

confidence: 99%

Fri0238 risk of Thrombosis in Patients Receiving Steroid Pulse Therapy in Lupus Nephritisusing Japanese Health Insurance Database

Honda

Sakai

Suzuki

et al. 2019

Poster Presentations

View full text Add to dashboard Cite

BackgroundPatients with systemic lupus erythematosus, especially lupus nephritis (LN), have higher risk of thrombosis than the general population 1. Since use of corticosteroids also increase the risk of thrombosis 2, steroid pulse therapy (SPT) may increases the risk of thrombosis in patients with LN. However, few studies examined this association.ObjectivesTo compare risk of thrombosis between patients with and without SPT in LN.MethodsThis retrospective, propensity score-matched cohort study was conducted using claims data provided by Medical Data Vision Co., Ltd (Tokyo, Japan). We defined individuals as LN cases if they met all of the following: 1) were diagnosed as LN; 2) had a dose of corticosteroids (CS) over 30 mg/day during hospitalization between April 2009 and January 2018; 3) were 16 years old or over. Cases with central neurological lupus, alveolar hemorrhage, or pregnancy at baseline were excluded. Cases with plasmapheresis or antiplatelet therapies at the start of observation, warfarin within a year, direct oral anticoagulants within a month, major surgery or lower limbs operation within three months, past thrombosis within a year, and prophylactic treatment of thrombosis from the observation starting month were also excluded from the study population. LN cases were divided into 2 groups; receiving SPT (SPT group, n=692) or not receiving SPT (non-SPT group, n=525). The start of observation was defined as commencement of CS treatment during hospitalization. Observation stopped either on April 2018 or the month cases were withdrawn from the database or developed first thrombosis, whichever came first. Thrombosis was defined as follows: at least one of three disease names (thrombosis, embolisms and infarction) and prescription of thrombolytic agents after the start of observation. After propensity-score matching, the incidence rate of thrombosis at Month 1, 2, 3, 4 was calculated using Kaplan–Meier methods. Univariate analysis were conducted by chi-squared test for categorical data and Mann-Whitney U-test for continuous data. Adjusted odds ratio (OR) was calculated using a multivariate logistic regression model.ResultsThe mean age was 47 years old and the proportion of female was 76%. There were no statistically significant differences in baseline variables between the two groups after propensity-score matching (both groups: n=434). The percentage of cases with thrombosis in both groups at each month were similar (SPT vs non-SPT at Month 1, 2, 3, and 4; 3.0% vs 4.4% (p=0.28), 3.5% vs 5.1% (p=0.24), 3.9% vs 5.3% (p=0.331), and 4.6% vs 5.5% (p=0.536), respectively). There were no significant differences in cumulative incidence rates of thrombosis between the two groups (P=0.265 by log-rank test). Univariate analysis revealed five risk factors of thrombosis; activity of daily living (p=0.004), hepatic failure (p<0.0001), malignancy (p=0.02), and use of methotrexate (p=0.038) and oral contraceptive (p=0.037). After adjusting for covariates, OR of SPT was 0.82 [95%Cl 0.44-1.52], which was not significantly ...

show abstract

Section: Referencesmentioning

confidence: 99%

Fri0238 risk of Thrombosis in Patients Receiving Steroid Pulse Therapy in Lupus Nephritisusing Japanese Health Insurance Database

Honda

Sakai

Suzuki

et al. 2019

Poster Presentations

View full text Add to dashboard Cite

show abstract

“…В некоторых работах обращается внимание на сниже-ние абсолютного числа лимфоцитов у больных системны-ми РЗ, у которых в дальнейшем развилась ППн [3,9,[10][11][12][13]. Однако контрольная «точка отсечения» уровня лимфоцитов, при которой следует начинать профилакти-ку, до сих пор дебатируется.…”

Section: факторы риска инфекцииunclassified

“…Частота ее составляет 6%, или 20 случаев на 10 000 пациенто-лет [14,18]. Летальность от ППн в дан-ной группе больных колеблется от 33 до 56% [9,10,12,13,18]. Подобно другим системным РЗ факторы риска летальности от пневмоцистоза при ДМ/ПМ не определе-ны.…”

Section: воспалительные миопатииunclassified

Pneumocystic Pneumonia in Rheumatic Diseases: Current Issues in Prophylaxis

Белов¹,

Тарасова²,

Буханова³

2017

Med. sov.

View full text Add to dashboard Cite

“…Several case series and comparison studies between patients with PCP and those without showed that low lymphocyte counts are a risk factor for the development of PCP in patients with systemic lupus erythematosus (SLE) or polymyositis/dermatomyositis (PM/DM), 41 those with WG or SLE, 42 and those with inflammatory rheumatic diseases including RA. 34 , 35 , 37 , 38 , 43 Means of lymphocyte counts in PCP patients varied among studies, ranging from 88 to 1,053/μL.…”

Section: Risk Factors Of Pcp In Ra and Other Inflammatory Rheumatic Dmentioning

confidence: 99%

Pneumocystis JiroveciiPneumonia in Rheumatoid Arthritis Patients: Risks and Prophylaxis Recommendations

Mori¹,

Sugimoto

2015

Clin Med Insights Circ Respir Pulm Med

View full text Add to dashboard Cite

Pneumocystis jirovecii infection causes fulminant interstitial pneumonia (Pneumocystis pneumonia, PCP) in patients with rheumatoid arthritis (RA) who are receiving biological and/or nonbiological antirheumatic drugs. Recently, we encountered a PCP outbreak among RA outpatients at our institution. Hospital-acquired, person-to-person transmission appears to be the most likely mode of this cluster of P. jirovecii infection. Carriage of P. jirovecii seems a time-limited phenomenon in immunocompetent hosts, but in RA patients receiving antirheumatic therapy, clearance of this organism from the lungs is delayed. Carriers among RA patients can serve as sources and reservoirs of P. jirovecii infection for other susceptible patients in outpatient facilities. Development of PCP is a matter of time in such carriers. Considering the poor survival rates of PCP cases, prophylactic antibiotics should be considered for RA patients who are scheduled to receive antirheumatic therapy. Once a new case of PCP occurs, we should take prompt action not only to treat the PCP patient but also to prevent other patients from becoming new carriers of P. jirovecii. Short-term prophylaxis with trimethoprim-sulfamethoxazole is effective in controlling P. jirovecii infection and preventing future outbreaks of PCP among RA patients.

show abstract

Pneumocystis jirovecci pneumonia in connective tissue diseases: Comparison with other immunocompromised patients

Cited by 20 publications

References 16 publications

Fri0238 risk of Thrombosis in Patients Receiving Steroid Pulse Therapy in Lupus Nephritisusing Japanese Health Insurance Database

Fri0238 risk of Thrombosis in Patients Receiving Steroid Pulse Therapy in Lupus Nephritisusing Japanese Health Insurance Database

Pneumocystic Pneumonia in Rheumatic Diseases: Current Issues in Prophylaxis

Pneumocystis JiroveciiPneumonia in Rheumatoid Arthritis Patients: Risks and Prophylaxis Recommendations

Contact Info

Product

Resources

About