Pneumocystis jirovecii

The frequency of this yeast infection of the lung with Pneumocystis jirovecii (formerly called P. carinii)... 

Cysts and trophozoites of Pneumocystis jirovecii can be detected in bronchoalveolar lavage specimens using monoclonal antibodies that yield results that are slightly more sensitive than GMS, Giemsa, or Papanicolaou staining (Fig. 3.19).1 4,216,217 Antibodies are most helpful in cases of extrapulmonary pneumocystosis or... 

Pneumocystis jirovecii, the causal agent of Pneumocystis jirovecii pneumonia (PCP). been observed in S. pneumoniae and Plasmodium falciparum ... 

Hematologic A 10-year-old boy with acute leukemia developed an immune hemolytic anemia after taking co-trimoxazole for 3 days for Pneumocystis jirovecii prophylaxis [117 ]. A direct antiglobulin (Coombs ) test was strongly positive for IgG and C3, and an indirect antibody test was strongly positive in the presence of co-trimoxazole and trimethoprim, but not sulfamethoxazole alone trimethoprim-dependent erythrocyte antibodies were detected by flow cytometry. 

Musculoskeletal A 28-year-old woman with an allogeneic stem cell transplant developed rhabdomyolysis and renal failure after taking co-trimoxazole for 3 days for Pneumocystis jirovecii pneumonia [123 ]. The CK activity peaked at 13500 but normalized over 7-10 days after withdrawal. Previous reports of rhabdomyolysis associated... 

A 38-year-old HIV-positive man developed a severe septic-shock-like reaction after taking co-trimoxazole for 2 days for Pneumocystis jirovecii prophylaxis [125 ]. He became moribund and cyanosed, with fever, tachycardia, hypotension, and pulmonary infiltrates. Co-trimoxazole was withdrawn and he was treated for presumed bacterial sepsis. He improved over 3 days and was given co-trimoxazole again 1 hour later he again developed fever, hypotension, tachycardia, rash, and chest crackles. 

Infection risk The risk of infections and serious infections with rituximab may be similar to that with the TNT antagonists. To date, there have been no reports from trials of an increased risk of tuberculosis or opportunistic infections with rituximab [162 ]. Some investigators have reported an increase in Pneumocystis jirovecii pneumonia, and increased number of infections has been documented in patients treated with maintenance rituximab for low-grade lymphoma and in patients with concomitant severe immunodeficiency, whether caused by HIV or immunosuppressive agents [152 ]. In rheumatoid arthritis, the susceptibility factors for severe infections include chronic lung and/or cardiac disease, extra-articular involvement, and low IgG before rituximab treatment [163 ]. After kidney transplantation, the off-label use of rituximab is associated with a high risk of infectious disease and death related to infectious disease [164 ]. 

Infection risk Fatal Pneumocystis jirovecii pneumonia complicated immunosuppressive therapy in two patients with steroid-refractory ulcerative colitis taking steroids and tacrolimus [146" ]. Despite immediate therapy with high-dose co-trimoxazole and broad-spectrum antibiotics, both patients died with progressive respiratory failure. 

Escher M, Stange EF, Herrlinger KR. Two cases of fatal Pneumocystis jirovecii pneumonia as a complication of tacrolimus therapy in ulcerative colitis—a need for prophylaxis. J Crohns Colitis 2010 4(5) 606-9. 

DRUGS USED IN THE TREATMENT OF PNEUMOCYSTIS JIROVECII INFECTIONS... 

Dapsone-induced hemolytic anemia in lung transplant recipients who received dapsone for prophylaxis of Pneumocystis jirovecii pneumonia has been reported in a retrospective study of 43 patients, of whom 10 had hemolytic anemia without G6PD deficiency [55 ]. The mean fall in hemoglobin from baseline was 2.7 g/h (95% Cl = 1.9, 3.5). The odds ratio for hemolysis was 4.75 for each 1.0 mg/dl increase in serum creatinine (95% Cl = 1.07, 21). The authors concluded that the prevalence of dapsone-induced hemolytic anemia in lung transplant recipients is five times higher than the reported rates for other groups who routinely use dapsone prophylaxis for Pneumocystis pneumonia and that individuals with renal insufficiency or low body weight and for whom the dose exceeds 1.5 mg/kg may be at increased risk of dapsone-induced hemolytic anemia. 

The treatment of BO consists of corticosteroids and augmented immunosuppression, targeting chronic GVHD. However, a minority of patients shows clinical improvement (5). There is a report of eight BMT recipients with BO whose pulmonary function improved after treatment with azithromycin (6) and one BMT recipient treated with infliximab (7). In addition to immunosuppression and anti-inflammatory therapy, prophylaxis against Pneumocystis jirovecii pneumonia and Streptococcus pneumoniae should be provided to patients with BO. In selected patients with respiratory failure secondary to BO, lung transplantation may be an option (1). 

Lee KY, Huang CH, Tang HJ, Yang CJ, Ko WC, Chen YH, et al. Acute psychosis related to use of trimethoprim/sulfemethoxazole in the treatment of HIV-infected patients with Pneumocystis jirovecii pneumonia a multicentre, retrospective study. J Antimicrob Chemother... 

Acute generalised exanthematous pustulosis (AGEP) is a severe cutaneous adverse reaction, mostly drug related or associated with viral infections. It can also manifest as a reaction to dapsone therapy in the setting of HTV infection when used as prophylaxis for pneumocystis jirovecii pneumonia [75 ]. 

Hyperbilirubinaemia Symptomatic hyperbilirubinaemia due to haemolytic anaemia is a potential adverse event when using the combination of atazanavir and dapsone (for pneumocystis jirovecii pneumonia prophylaxis) in the treatment of patients with HIV [78 ]. Symptoms and laboratory evidence of haemolysis resolved upon discontinuation of dapsone, enabling successful antiretroviral therapy. 

Design, synthesis and evaluation of 6-6 fused bicyclic nonclassical Pneumocystis jirovecii(pj) and Toxoplasma gondiiftg) dihydrofolate reductase(DHFR) selective inhibitors... 

---