The medication for pneumocystis pneumonia with glucose-6-phosphate dehydrogenase deficiency patients

Abstract

Pneumocystis pneumonia (PCP) is an opportunity acquired infection, which is usually easy to occur in patients with AIDS, organ transplantation, and immunosuppressive drugs. The prevention and treatment must be necessary for PCP patients with immunocompromise. And the oxidants are currently a typical regimen, including sulfanilamide, dapsone, primaquine, etc. Glucose-6-phosphate dehydrogenase (G6PD) deficiency is an X-linked gene-disease that affects about 400 million people worldwide. The lack of G6PD in this population results in a decrease in intracellular glutathione synthesis and a weakening of the detoxification ability of the oxidants. As a result, oxidants can directly damage haemoglobin in red blood cells, inducing methemoglobin and hemolysis. When patients with G6PD deficiency have low immunity, they are prone to PCP infection, so choosing drugs that do not induce hemolysis is essential. There are no clear guidelines to recommend the drug choice of this kind of population at home and abroad. This paper aims to demonstrate the drug choice for PCP patients with G6PD deficiency through theoretical research combined with clinical cases.

Re-estimation of the burden of serious fungal diseases in Uganda

“… 87 , 88 The anti-malarial agent, primaquine is an alternative medication for the treatment of PCP, when combined with clindamycin; however, its usage is challenged by the high burden of glucose-6-phosphate dehydrogenase (G6PD) deficiency in many African countries. 89 , 90 The WHO has guided the use of rapid diagnostic tests for G6PD deficiency in the context of Plasmodium vivax malaria treatment with primaquine. 91 However, data on the utilization of rapid diagnostic tests for G6PD deficiency in the larger context of patients with PCP who would need primaquine for second-line treatment are scarce and are a subject for critical review and further research.…”

Screening and the analysis of genotypic and phenotypic characterization of glucose-6-phosphate dehydrogenase (G6PD) deficiency in Fujian province, China

“…Thus, the use of antimalarial drugs cause severe haemolysis in G6PD-defcient individuals. However, the ingestion of fava beans, some oxidizing drugs (e.g., aspirin, sulfadiazine) and traditional Chinese medicines (e.g., berberine, honeysuckle) cancause a risk of haemolysis in G6PD defcient individuals in China ( Lin et al, 1998 ; Chen et al, 2021 ; Zhang et al, 2022 ). Terefore, it is also essential to test for G6PD deficiency.…”

Diagnostic performance of metagenomic next-generation sequencing for Pneumocystis jirovecii pneumonia

“…Pneumocystis jirovecii is an important fungal microorganism in immunocompromised patients [ 14 ]. PJP risk was usually related to individuals with HIV, bone marrow or solid organ transplant, malignancies including Hodgkin’s lymphoma and acute lymphoblastic leukemia, long-term usage of glucocorticoids, and severe malnutrition [ 41 , 42 ]. Clinically significant PJP is found merely in hosts with acquired or congenital immunodeficiencies.…”

“…HIV patients often present with a longer course of PJP. Patients with immune dysfunction without HIV appear to have more severe manifestations and a higher risk of respiratory failure and death [ 42 ]. In the current meta-analysis, the pooled sensitivity of mNGS in the diagnosis of PJP in non-HIV patients was 0.992, and the summary specificity was 0.910.…”