Role of primary prophylaxis for pneumocystis pneumonia in patients treated with systemic corticosteroids or other immunosuppressive agents for immune-mediated dermatologic conditions

Lehman, Julia S.; Kalaaji, Amer N.

doi:10.1016/j.jaad.2009.11.588

Cited by 32 publications

(23 citation statements)

References 44 publications

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“…7 Providers should monitor patients on immunosuppressive medications closely, educate them about early or subtle signs of infection, and have a high index of suspicion for PJP in patients with respiratory symptoms or febrile illness. 49 Additional studies are warranted to better define subgroups of IBD patients who are at increased risk of PJP, and who therefore would be most appropriate to receive primary prophylaxis.…”

Section: Discussionmentioning

confidence: 99%

Low Risk of Pneumonia From Pneumocystis jirovecii Infection in Patients With Inflammatory Bowel Disease Receiving Immune Suppression

Cotter

Gathaiya

Catania

et al. 2017

Clinical Gastroenterology and Hepatology

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Background & Aims Use of immunosuppressants and inflammatory bowel disease (IBD) may increase the risk of pneumonia caused by Pneumocystis jirovecii (PJP). We assessed the risk of PJP in a population-based cohort of patients with IBD treated with corticosteroids, immune-suppressive medications, and biologics. Methods We performed a population-based cohort study of residents of Olmsted County, Minnesota, diagnosed with Crohn’s disease (n=427) or ulcerative colitis (n=510) from 1970 through 2011. Records of patients were reviewed to identify all episodes of immunosuppressive therapies and concomitant PJP prophylaxis through February 2016. We reviewed charts to identify cases of PJP, cross-referenced with the Rochester Epidemiology Project database (using diagnostic codes for PJP) and the Mayo Clinic and Olmsted Medical Center databases. The primary outcome was risk of PJP and associated with use corticosteroids, immune-suppressive medications, and biologics by patients with IBD. Results Our analysis included 937 patients and 6066 patient-yrs (p-y) of follow up (median, 14.8 yrs per patient). Medications used included corticosteroids (520 patients; 55.5%; 555.4 p-y of exposure), immunosuppressants (304 patients; 32.4%; 1555.7 p-y of exposure), and biologics (193 patients; 20.5%; 670 p-y of exposure). Double therapy (corticosteroids and either immunosuppressants and biologics) was used by 236 patients (25.2%), with 173 p-y of exposure. Triple therapy (corticosteroids, immunosuppressants, and biologics) was used by 70 patients (7.5%) with 18.9 p-y of exposure. There were 3 cases of PJP, conferring a risk of 0.2 (95% CI, 0.01–1.0) to corticosteroids, 0.1 (95% CI, 0.02–0.5) cases per 100 p-y of exposure to immunosuppressants, 0.3 (95% CI, 0.04–1.1) cases per 100 p-y of exposure to biologics, 0.6 (95% CI, 0.01–3.2) cases per 100 p-y of exposure to double therapy, and 0 (95% CI, 0.0–19.5) cases per 100 p-y of exposure to triple therapy. Primary prophylaxis for PJP was prescribed to 37 patients, for a total of 24.9 p-y of exposure. Conclusion In a population-based cohort of patients with IBD patients treated with corticosteroids, immunosuppressants, and biologics, there were only 3 cases of PJP, despite the uncommon use of PJP prophylaxis. Routine administration of PJP prophylaxis in these patients may not be warranted, although it should be considered for high-risk groups, such patients receiving triple therapy.

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Section: Discussionmentioning

confidence: 99%

Low Risk of Pneumonia From Pneumocystis jirovecii Infection in Patients With Inflammatory Bowel Disease Receiving Immune Suppression

Cotter

Gathaiya

Catania

et al. 2017

Clinical Gastroenterology and Hepatology

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“…27,28 Particular risk factors for PCP include immunosuppression, advanced age, hypoalbuminemia, underlying pulmonary dysfunction, treatment with prednisone in doses greater than 15 mg per day for greater than 8 weeks, or treatment with cyclophosphamide. 28 Uncommonly reported systemic fungal infections occurring in patients with immunobullous disease include necrotizing fasciitis, cellulitis, or disseminated disease caused by Cryptococcus neoformans 29,30 and pulmonary aspergillosis (Fig. 6).…”

Section: Distant or Systemicmentioning

confidence: 99%

“…28 Given this low incidence, and that medications used for PCP prophylaxis have risks, prophylaxis may be reserved for patients with additional risk factors (discussed earlier). 28,50 First-line prophylaxis regimens include trimethoprim-sulfamethoxazole double strength by mouth daily or once 3 times weekly. Alternate regimens include dapsone 50 mg by mouth twice daily or 100 mg by mouth daily, atovaquone 1500 mg by mouth daily, or pentamidine 300 mg aerosol inhaled monthly via nebulizer.…”

Section: Seek Medical Interventions Early If Infection Is Suspectedmentioning

confidence: 99%

Infection and Infection Prevention in Patients Treated with Immunosuppressive Medications for Autoimmune Bullous Disorders

Lehman¹,

Murrell²,

Camilleri³

et al. 2011

Dermatologic Clinics

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“…Es importante considerar que en pacientes que reciban una dosis de prednisona mayor a 16 mg/ día por más de 8 sem se debe agregar cotrimoxazol forte trisemanal o cotrimoxazol simple en dosis diaria, para la profilaxis de neumonía por Pneumocystis jiroveci 25 . Otros autores prefieren realizar conteos de linfocitos T CD4 al cabo de un mes de inmunosupresión sólo si 1 : el conteo total de linfocitos es menor a 600/mm 3 , 2 si se planea someter al paciente a más de 3 meses de terapia esteroidal o 3 si se usan más de 15 mg/día de prednisona o su equivalente; en estos casos y si el conteo de linfocitos T CD4 es menor a 200/mm 3 , los autores recomiendan iniciar profilaxis con cotrimoxazol en el esquema antes comentado 26 .…”

Section: Discussionunclassified

Pénfigo vulgar tipo cutáneo: Caso clínico

et al. 2013

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Cutaneous pemphigus vulgaris.A case report , el pénfigo paraneoplásico, el pénfigo inducido por drogas 1 y el pénfigo por IgA. El PV se puede desarrollar a cualquier edad pero es más frecuente entra la cuarta y sexta década de vida. No tiene diferencias por sexo 4 y se encontraría con mayor prevalencia en las personas con ascendencia mediterránea 1 o judía 5. La enfermedad se inicia habitualmente con úlceras orales dolorosas que no curan 6 , a diferencia de las virales o de la estomatitis aftosa, que curan en días o semanas 1 . Rara vez se encuentran ampollas en las mucosas debido a que se rompen precozmente. Las úlceras son múltiples, superficiales e irregulares y se originan en mucosas sanas. Las mucosas más comúnmente comprometidas son la labial, palatina y de la lengua. Por esta razón, el diagnóstico de pénfigo debe considerarse en toda úlcera que no cure en un período mayor a un mes 1 . Luego de semanas a meses, comienza el compromiso cutáneo, inicialmente en cuero cabelludo, cara y tórax superior pudiendo acompañarse de síntomas de compromiso nasal y esofágico. La enfermedad puede también comprometer la región periungueal 1 . Las lesiones cutáneas se originan en piel sana, inicialmente como ampollas flácidas, que se rompen durante los primeros días transformándose en erosiones superficiales con un collarete de epidermis laxa alrededor 1 . El PV activo -y en sus formas más severas-, presenta signo de Nikolsky positivo en piel sana y perilesional.

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Role of primary prophylaxis for pneumocystis pneumonia in patients treated with systemic corticosteroids or other immunosuppressive agents for immune-mediated dermatologic conditions

Cited by 32 publications

References 44 publications

Low Risk of Pneumonia From Pneumocystis jirovecii Infection in Patients With Inflammatory Bowel Disease Receiving Immune Suppression

Low Risk of Pneumonia From Pneumocystis jirovecii Infection in Patients With Inflammatory Bowel Disease Receiving Immune Suppression

Infection and Infection Prevention in Patients Treated with Immunosuppressive Medications for Autoimmune Bullous Disorders

Pénfigo vulgar tipo cutáneo: Caso clínico

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