Pneumocystis jirovecii Pneumonia in Patients Receiving Tumor-Necrosis-Factor-Inhibitor Therapy: Implications for Chemoprophylaxis

Grubbs, James; Baddley, John W.

doi:10.1007/s11926-014-0445-4

Cited by 30 publications

(26 citation statements)

References 78 publications

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“…Three years after, the first reported cases of PCP in patients on infliximab were reported in the literature [8]. Subsequent reports were reported over the following years.…”

Section: Tumor Necrosis Factor and Host Response To Pcpmentioning

confidence: 98%

“…The treatment of choice is trimethoprim-sulfamethoxazole (TMP-SMX). In patients who are sulfa-allergic or intolerant, second line therapies include primaquine, pentamidine, and dapsone [8]. Although PCP is typically associated with human immunodeficiency virus (HIV)-infected populations, a range of patient populations and medications have been associated with increased risk of PCP [9].…”

Section: Introductionmentioning

confidence: 99%

“…In non-HIV populations, patients with PCP infection typically present with abrupt onset of respiratory insufficiency that may correlate with a tapered dosage of immunosuppressant agents [5]. One study found that patients with HIV had symptoms for 37.8 days on average before diagnosis compared to 7.6 days in non-HIV patients [8]. The non-HIV patients have more neutrophils and fewer pneumocystis organisms in their lungs as well as higher C-reactive protein and lower beta-D glucan levels [8].…”

Section: Introductionmentioning

confidence: 99%

“…One study found that patients with HIV had symptoms for 37.8 days on average before diagnosis compared to 7.6 days in non-HIV patients [8]. The non-HIV patients have more neutrophils and fewer pneumocystis organisms in their lungs as well as higher C-reactive protein and lower beta-D glucan levels [8]. Mortality in patients without AIDS may be 30 to 60 percent [5].…”

Section: Introductionmentioning

confidence: 99%

“…Therefore, if the initial specimen is negative, bronchoscopy with bronchoalveolar lavage should be performed [5]. The use of simultaneous serum beta-D glucan and respiratory sample polymerase chain reaction (PCR) testing for PJP may help with diagnosis [8].…”

Section: Introductionmentioning

confidence: 99%

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Pneumocystis Pneumonia in Inflammatory Bowel Disease: The Costs of Immunosuppression

DeFilippis¹,

Scherl²

2015

J Gastrointest Dig Syst

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Patients with inflammatory bowel disease (IBD) are subject to a spectrum of immunosuppressive agents including corticosteroids, immunomodulators, and biological therapies. Despite the benefits of these therapies and their ability to induce remission, they increase the risk of infectious complications with various organisms including Pneumocystis jiroveci pneumonia (PCP), which is associated with significant morbidity and mortality. Although PCP infection is typically associated with HIV-infected populations, the risk is increased in patients with IBD. Inflammatory autoimmune diseases like IBD account for as high as 20% of PCP infection in HIV-negative patients with greater than 50% mortality. Despite this, there are no clear guidelines for PCP prophylaxis in IBD. PCP should be considered in the differential when an IBD patient on immunosuppression presents with fever and respiratory symptoms. Here we review the existing literature regarding PCP risk in inflammatory bowel disease, the role of tumor necrosis alpha-inhibitors, and considerations for prophylaxis.

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“…Three years after, the first reported cases of PCP in patients on infliximab were reported in the literature [8]. Subsequent reports were reported over the following years.…”

Section: Tumor Necrosis Factor and Host Response To Pcpmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Pneumocystis Pneumonia in Inflammatory Bowel Disease: The Costs of Immunosuppression

DeFilippis¹,

Scherl²

2015

J Gastrointest Dig Syst

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Prophylaxis for Pneumocystis jirovecii pneumonia in patients with inflammatory bowel disease: A systematic review

Sierra

Daiya

2022

Pharmacotherapy

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Pneumocystis jirovecii pneumonia (PJP) is an opportunistic, airborne infection that can lead to life-threatening pneumonia and respiratory failure by targeting T lymphocytes. 1,2 Historically, PJP risk was often associated with patients with human immunodeficiency virus (HIV), malignancies including acute lymphoblastic leukemia (ALL) and Hodgkin's lymphoma, and solid organ or bone marrow transplant. 3 However, inflammatory bowel disease (IBD), including Crohn's disease (CD) or ulcerative colitis (UC), can also increase the risk of PJP. 4 Before the routine use of prophylaxis and antiretroviral therapy, there was a higher prevalence of opportunistic infections (OI) especially among patients with acquired immunodeficiency syndrome. 5 Patients with CD4 T lymphocyte (CD4) counts of less than 200 cells/m 3 or CD4 cell percentage <14% were at higher risks of OI due to significant immunosuppression. 5,6 Studies suggest that mortality from PJP in patients receiving immunomodulators may be higher than in patients with HIV. [7][8][9] A retrospective review evaluated 475 patients who developed PJP (442 HIV patients, 33 non-HIV patients) from 1985 to 1995 at

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Position statement on infection screening, prophylaxis, and vaccination in pediatric patients with rheumatic diseases and immunosuppressive therapies, part 2: infection prophylaxis

et al. 2023

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This study aims to provide practical recommendations on prophylaxis for infection in pediatric patients with immune-mediated rheumatic diseases receiving/scheduled to receive immunosuppressive therapy. A qualitative approach was applied. A narrative literature review was performed via Medline. Primary searches were conducted using MeSH terms and free text to identify articles that analyzed data on infections and vaccinations in pediatric patients with immune-mediated rheumatic diseases receiving immunosuppressive therapy. The results were presented and discussed in a nominal group meeting comprising a committee of 12 pediatric rheumatologists from the Prevention and Treatment of Infections Working Group of the Spanish Society of Pediatric Rheumatology. Several recommendations were generated. A consensus procedure was implemented via a Delphi process that was extended to members of the Spanish Society of Pediatric Rheumatology and the Vaccine Advisory Committee of the Spanish Association of Pediatrics. Participants produced a score ranging from 0 (completely disagree) to 10 (completely agree). Agreement was considered to have been reached if at least 70% of participants voted ≥ 7. The literature review included more than 400 articles. Overall, 63 recommendations were generated (23 on infection prophylaxis) and voted by 59 pediatric rheumatologists and other pediatric specialists, all of whom achieved the pre-established level of agreement. The recommendations on prophylaxis of infection cover vaccination and prophylaxis against varicella zoster virus, tuberculosis, Pneumocystis jiroveccii, and invasive fungal infections in pediatric patients with immune-mediated rheumatic diseases receiving/scheduled to receive immunosuppressive therapy. Conclusion: Based on current evidence and a Delphi process, we provided consensus and updated recommendations on prophylaxis and treatment of infections to guide those caring for pediatric rheumatology patients. What is Known: •Data largely derived from adults find that infectious diseases and related complications are a major cause of morbidity and mortality in patients with immune-mediated rheumatic diseases. •It is crucial to be aware of the preventive measures that should be implemented to prevent these infections in children, although most guidelines are often extrapolated from adult cases. What is New: •In the absence of evidence, a literature review and a Delphi survey were conducted to establish a series of expert recommendations that could prove useful in clinical practice, providing a practical and simple day-to-day approach to be used by pediatric rheumatologists. •The recommendations focus on tuberculosis, herpes zoster virus, fungal infections, and Pneumocystis jirovecii.

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Pneumocystis jirovecii Pneumonia in Patients Receiving Tumor-Necrosis-Factor-Inhibitor Therapy: Implications for Chemoprophylaxis

Cited by 30 publications

References 78 publications

Pneumocystis Pneumonia in Inflammatory Bowel Disease: The Costs of Immunosuppression

Pneumocystis Pneumonia in Inflammatory Bowel Disease: The Costs of Immunosuppression

Prophylaxis for Pneumocystis jirovecii pneumonia in patients with inflammatory bowel disease: A systematic review

Position statement on infection screening, prophylaxis, and vaccination in pediatric patients with rheumatic diseases and immunosuppressive therapies, part 2: infection prophylaxis

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