Pneumocystis jiroveci infections

Human immunodeficiency virus, AIDS Mycobacterial, cytomegaloviral, and Pneumocystis carinii (P. jiroveci) infection... 

PCa cancCT of the prostate PCI pCTCutaneous coronary intCTvention PCN penicillin PCP phencyclidine PCP Pneumocystis jiroveci (fonuCTly carinii) pneumonia (a t5 pe of infection common in HIV infected or immunocompromised patients)... 

Prevention of infection caused by the acquisition of specific microorganisms which can lead to overt infection, e.g. meningococci, malaria parasites, mycobacteria, Pneumocystis jiroveci. 

Briel M, Bucher HC, Boscacci R, Furrer H. Adjunctive corticosteroids for Pneumocystis jiroveci pneumonia in patients with HlV-infection. Cochrane Database Syst Rev 2006. 

Clindamycin is indicated for the treatment of skin and soft-tissue infections caused by streptococci and staphylococci. It is often active against community-acquired strains of methicillin-resistant S aureus, an increasingly common cause of skin and soft tissue infections. Clindamycin is also indicated for treatment of anaerobic infection caused by bacteroides and other anaerobes that often participate in mixed infections. Clindamycin, sometimes in combination with an aminoglycoside or cephalosporin, is used to treat penetrating wounds of the abdomen and the gut infections originating in the female genital tract, eg, septic abortion and pelvic abscesses and aspiration pneumonia. Clindamycin is now recommended rather than erythromycin for prophylaxis of endocarditis in patients with valvular heart disease who are undergoing certain dental procedures. Clindamycin plus primaquine is an effective alternative to trimethoprim-sulfamethoxazole for moderate to moderately severe Pneumocystis jiroveci pneumonia in AIDS patients. It is also used in combination with pyrimethamine for AIDS-related toxoplasmosis of the brain. 

Sulfonamides are infrequently used as single agents. Many strains of formerly susceptible species, including meningococci, pneumococci, streptococci, staphylococci, and gonococci, are now resistant. The fixed-drug combination of trimethoprim-sulfamethoxazole is the drug of choice for infections such as Pneumocystis jiroveci (formerly P carinii) pneumonia, toxoplasmosis, nocardiosis, and occasionally other bacterial infections. 

Trimethoprim- sulfamethoxazole Synergistic combination of folate antagonists blocks purine production and nucleic acid synthesis Bactericidal activity against susceptible bacteria Urinary tract infections Pneumocystis jiroveci pneumonia toxoplasmosis nocardiosis Oral, IV renal clearance (half-life 8 h) dosed every 8-12 h t formulated in a 5 1 ratio of sulfamethoxazole to trimethoprim Toxicity Rash, fever, bone marrow suppression, hyperkalemia... 

Other synergistic antimicrobial combinations have been shown to be more effective than monotherapy with individual components. Trimethoprim-sulfamethoxazole has been successfully used for the treatment of bacterial infections and Pneumocystis jiroveci (carinii) pneumonia. 3-Lactamase inhibitors restore the activity of intrinsically active but hydrolyzable 3-lactams against organisms such as S aureus and Bacteroides fragilis. Three major mechanisms of antimicrobial synergism have been established ... 

Pneumocystis jiroveci is a fungal organism found in humans (P carinii infects animals) that responds to antiprotzoal drugs. See Chapter 52. 

Pneumocystis jiroveci pneumonia has been precipitated or aggravated by glucocorticoids (SEDA-20, 377 SEDA-22, 450 272,350,351). There is some concern about the use of glucocorticoids as adjunctive therapy in patients with AIDS who develop Pneumocystis jiroveci pneumonia. The immunosuppressant properties of glucocorticoids have been reported to enhance the risk of tuberculosis and other AIDS-related diseases (for example Kaposi s sarcoma or cytomegalovirus infection). 

AZATHIOPRINE LEFLUNOMIDE T risk of serious infections (sepsis) and of opportunistic infections (Pneumocystis jiroveci pneumonia, tuberculosis, aspergillosis) Additive immunosuppression Monitor platelets, white bloods cell, haemoglobin and haematocrit at baseline and regularly - weekly, during concomitant therapy. With evidence of bone marrow suppression, discontinue leflunomide and administer colestyramine or charcoal to T elimination of leflunomide - For signs and symptoms of immunosuppression, see Qinical Features of Some Adverse Drug Interactions, Immunosuppression and blood dyscrasias... 

In a retrospective study, the use of glucocorticoids during Pneumocystis jiroveci pneumonia (mean total dose methylprednisolone 420 mg, mean treatment duration 12 days) did not increase the risk of development or relapse of tuberculosis or other AIDS-related diseases (SEDA-20, 377) (276). The study included 129 patients (72 who took glucocorticoids and 57 who did not) who were followed up at 6,12,18, and 24 months of glucocorticoid therapy. The rates of infections were similar in both groups, and the cumulative rate of tuberculosis at 2 years was 12-13%. 

An accumulating series of case reports has focused on the possible more frequent occurrence of opportunistic infections despite normal leukocyte counts in patients treated for rheumatoid arthritis or, less often, psoriasis (97,100,101). Various bacterial, fungal, and viral opportunistic infections have been described, with Pneumocystis jiroveci pneumonia as the most frequently reported (SEDA-21, 389) (SEDA-22, 417). Although the most severe, sometimes fatal, infectious diseases were usually observed in patients also taking glucocorticoids (SEDA-22, 417) (102,103), severe infections can also occur in occasional patients not taking concomitant glucocorticoids (SEDA-21, 389) (101,104-107). 

Fishman JA. Prevention of infection caused by Pneumocystis jiroveci in transplant recipients. Clin Infect Dis 2001 33 1397-1405. 

T risk of serious infections (sepsis) and of opportunistic infections Pneumocystis jiroveci pneumonia, tuberculosis, aspergillosis)... 

In clinical practice, potential immunosuppression limits the use of alemtuzumab. Up to 50% of patients who would otherwise be candidates for alemtuzumab have infections precluding its use, including Pneumocystis jiroveci pneumonia, herpes... 

Fig. 27.11a-c. Bilateral pneimionia caused by Pneumocystis jiroveci (PcP) at different stages of immunosuppression. The subpleural space is typically left out. Diffuse ground glass opacification appears typically in the early phase of infection... 

Stringer JR, Beard CB, Miller RF, Wakefield AE (2002) A new name (Pneumocystis jiroveci) for Pneumocystis from humans. Emerg Infect Dis Sep 8 http //www.cdc.gov/ncidod/ EID/vol8no9/02-0096.htm [26.03.03]... 

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