Pneumocystis pneumonia in children

Pyrgos, Vasilios; Shoham, Shmuel; Roilides, Emmanuel; Walsh, Thomas J.

doi:10.1016/j.prrv.2009.06.010

Cited by 52 publications

(50 citation statements)

References 101 publications

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“…As documented in our case, lymphopenia (especially CD4 count <300 cells/mm 3 ) has been associated with increased risk of PCP in 60–95% of cases (5, 24, 50, 65). Notably, not all immunosuppressed patients will present with lymphopenia (24, 65).…”

Section: Literature Review and Discussionsupporting

confidence: 74%

“…PCP continues to be an acquired immune deficiency syndrome-defining illness although the advent of antiretroviral therapy has resulted in incidence reduction (4). PCP has been recognized as a disease in children with primary cell-mediated immunodeficiency, patients receiving chemotherapy for hematological malignancies, solid organ, and bone marrow transplant recipients and in patients requiring immunosuppressants (5). Notably, the incidence in the immunosuppressed non-HIV population is increasing with the escalating use of immunosuppressive agents (4, 6, 7).…”

Section: Literature Review and Discussionmentioning

confidence: 99%

“…Adverse reactions include leukopenia, thrombocytopenia, and rashes including Stevens–Johnson syndrome (5). However, reactions appear less common in children (20).…”

Section: Literature Review and Discussionmentioning

confidence: 99%

“…Lymphoid malignancies have the highest risk with rates of 22–45% (68). The overall risk of PCP post solid organ transplant has been estimated to be 5–15% in the absence of PCP prophylaxis (5). Risk factors include malnutrition, previous cytomegalovirus infection, and underlying lung disease.…”

Section: Literature Review and Discussionmentioning

confidence: 99%

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Pneumocystis jirovecii Pneumonia in Pediatric Inflammatory Bowel Disease: A Case Report and Literature Review

2017

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Immunosuppressive therapy is a known risk factor for opportunistic infections. We report the first case of severe Pneumocystis jirovecii infection requiring intensive care in a pediatric patient with inflammatory bowel disease (IBD). The literature was reviewed and there were 92 reported cases of Pneumocystis pneumonia (PCP) in patients with IBD. Most sources were case reports and there was likely reporting bias toward patients receiving immunomodulators, anti-tumor necrosis factor (anti-TNF) therapy, and those who died. Overall, 56% of patients were males and 58% had Crohn’s disease. The median age was 45 years (interquartile range 30–68, range 8–78) and 86% of patients were lymphopenic. The case-fatality rate was 23%. Corticosteroids were used as IBD treatment in 88% of patients who subsequently developed PCP, 42% received thiopurines, 44% used anti-TNF therapy, and 15% received either cyclosporine or tacrolimus. Rates of mono, dual, triple, and quadruple immunosuppression therapy were 35, 35, 29, and 2%, respectively. This report highlights the importance of considering PCP in immunosuppressed lymphopenic pediatric IBD patients who present with unusual symptoms. Moreover, it should give gastroenterologists the impetus to limit immunosuppressive therapy to its minimal effective dose and consider options such as exclusive enteral nutrition wherever possible. Although there is no place for global PCP prophylaxis in IBD given the low incidence, in an era when there is increasing use of biologic agents with combination immunosuppressive therapy, the risk-benefit profile of PCP chemoprophylaxis should be revisited in selected cohorts such as patients on triple immunosuppression with corticosteroids, thiopurines, and a biological agent or calcineurin inhibitor, especially in lymphopenic individuals.

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Section: Literature Review and Discussionsupporting

confidence: 74%

Section: Literature Review and Discussionmentioning

confidence: 99%

“…Adverse reactions include leukopenia, thrombocytopenia, and rashes including Stevens–Johnson syndrome (5). However, reactions appear less common in children (20).…”

Section: Literature Review and Discussionmentioning

confidence: 99%

Section: Literature Review and Discussionmentioning

confidence: 99%

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Pneumocystis jirovecii Pneumonia in Pediatric Inflammatory Bowel Disease: A Case Report and Literature Review

2017

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“…7,8 Because of the lack of high-quality data, national recommendations conflict regarding second-line prophylaxis in pediatric patients, and consequently, practice varies according to institutional preference. [7][8][9][10][11][12][13][14] In patients undergoing HCT, second-line prophylaxis is frequently used because TMP-SMZ is thought to contribute to bone marrow suppression in patients with ongoing cytopenias. 12 Pentamidine is often thought preferable to dapsone and atovaquone as second-line in the HCT population because both require patients to tolerate oral intake; in addition, dapsone has been implicated in hematologic toxicities in HCT patients, and atovaquone may potentiate liver dysfunction.…”

mentioning

confidence: 99%

Safe and Effective Prophylaxis with Bimonthly Intravenous Pentamidine in the Pediatric Hematopoietic Stem Cell Transplant Population

Levy

Musick

Zinter

et al. 2016

Pediatric Infectious Disease Journal

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Background: Without prophylaxis, Pneumocystis jiroveci pneumonia (PCP) develops in 5%-15% of pediatric hematopoietic stem cell transplant (HCT) patients with mortality above 50%. Trimethoprim-sulfamethoxazole is a standard PCP prophylaxis; pentamidine is frequently used as second-line prophylaxis because of trimethoprim-sulfamethoxazole's potential for cytopenias. Monthly intravenous (IV) pentamidine has variable efficacy with PCP infection rates of 0%-10% in pediatric patients, and higher breakthrough rates in those younger than 2 years. We hypothesized that bimonthly (twice monthly) pentamidine might have equivalent safety and improved efficacy; therefore, we conducted a retrospective analysis of bimonthly pentamidine PCP prophylaxis. Methods: We retrospectively reviewed records of all pediatric HCT patients who received bimonthly IV pentamidine between December 2006 and June 2013, and collected data regarding demographics, clinical course, prophylaxis rationale, laboratory values and adverse events. Results: Between December 2006 and June 2013, 111 pediatric HCT patients received bimonthly IV pentamidine (574 doses, 8758 patient-days); 31 patients were younger than 2 years at initiation. In the majority (53% of courses), pentamidine was initiated because of cytopenias. Fourteen patients (12.6% of patients, 2.4% of doses) experienced a side-effect prompting discontinuation, including 3 patients with infusion-related hypotension/anaphylaxis and 3 with acute pancreatic dysfunction. No patients [0% (95% confidence interval: 0-3.2)] developed PCP during or after bimonthly IV pentamidine prophylaxis. Conclusions: Bimonthly IV pentamidine for PCP prophylaxis in the HCT pediatric population has comparable safety to monthly IV pentamidine and was highly effective, including in the very young. Bimonthly IV pentamidine should be considered in pediatric patients as second-line PCP prophylaxis.Key Words: pediatric, stem cell transplant, PCP prophylaxis, intravenous pentamidine (Pediatr Infect Dis J 2016;35:135-141) I n the absence of prophylaxis, Pneumocystis jiroveci pneumonia (PCP) develops in 5%-15% of pediatric hematopoietic stem cell transplant (HCT) patients and has a mortality rate higher than 50%.1-3 Trimethoprim-sulfamethoxazole (TMP-SMZ) is standard and validated prophylaxis in the vast majority of adult and pediatric oncologic patients. [4][5][6][7][8] Recent meta-analyses have demonstrated high efficacy of TMP-SMZ prophylaxis in pediatric HCT populations with disease risk reduction of 0.09 and very low PCP breakthrough (0%-0.2%).7 However, some pediatric patients cannot tolerate TMP-SMZ because of bone marrow suppression, allergy, side effects or inability to use oral medications; in these patients, atovaquone, dapsone or pentamidine are considered acceptable second-line prophylaxis. 7,8 Because of the lack of high-quality data, national recommendations conflict regarding second-line prophylaxis in pediatric patients, and consequently, practice varies according to institutional preference. [7][8][9][10][11]...

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Pediatric Imaging in Global Health Radiology

Haberle

Maxfield

2014

Radiology in Global Health

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Pneumocystis pneumonia in children

Cited by 52 publications

References 101 publications

Pneumocystis jirovecii Pneumonia in Pediatric Inflammatory Bowel Disease: A Case Report and Literature Review

Pneumocystis jirovecii Pneumonia in Pediatric Inflammatory Bowel Disease: A Case Report and Literature Review

Safe and Effective Prophylaxis with Bimonthly Intravenous Pentamidine in the Pediatric Hematopoietic Stem Cell Transplant Population

Pediatric Imaging in Global Health Radiology

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