Empiric trimethoprim/sulfamethoxazole treatment of suspected Pneumocystis jiroveci pneumonia in patients with hematological malignancies

Cellular Therapy and Transplantation

Anna V. Klimovich¹  Vladimir J. Kubit¹  Igor А. Lisukov¹  Nadezda V. Medvedeva¹  Irina V. Ishmatova¹  Irina А. Samorodova¹  Natalia А. Kotova¹  Vsevolod G. Potapenko¹ 

关键词: pneumocystis pneumonia;    empirical treatment;   

DOI  :  10.3205/ctt-2010-No9-abstract77

学科分类：肿瘤学

来源: Universitaetsklinikum Hamburg - Eppendorf / University Medical Center Hamburg - Eppendorf

【 摘 要 】

Background:Theinclusionoftrimethoprim/sulfamethoxazole(TMP/SMX)inthestandardempiricaltreatmentofneutropenicfeverisapotentialoptiontodecreasemortalityfrominfectioncausedbyPneumocystisjiroveciinpatientsreceivingconventionalchemotherapyforhematologicalmalignancies.Purpose:TodemonstratetheimportanceofTMP/SMXinclusionintheempiricaltreatmentofpatientswithtypicalPCPfeatures,despitenegativePneumocystiscarinii(PC)antigens.Materialsandmethods:Fourpts(3ptswithNHLand1withALL)withamedianageof29(22–47)yearswereincludedinthisstudy.Allofthemwereinaperiodofimmunosuppressionduetochemotherapy.Thediagnosisofpneumocysticinfectionwasbasedonclinicalsignsandcomparedwithantigendetectioninbronchoalveolarlavage(BAL)orsputum.Results:Inall4ptsclinicalandlaboratoryPCP-likefeatureswereobserved:prolongeddrycough,prolongedsubfebrilehyperthermia,slowshortnessofbreathingincreasing,respiratoryalkalosis,hypoxemiaandhypocapnia,LDHincrease,andX-raymanifestationpriortophysicalsigns.Empiricalantibacterialandantifungaltreatmentwasineffective.ThePC-antigenwasnegativeinallcases.TheappearanceofclinicalandlaboratorysymptomspreviouslydescribedwasestimatedassuspiciousforP.jiroveciinfectionandallpatientsweretreatedwithTMP/SMX(15mg/kgoftrimethoprim)aloneorincombinationwithvoriconazole.Allfoursubjectsexperiencedtransientworseningofpulmonaryinsufficiencyandstabilizationoftheroentgenologicalchanges.AfterthreedaysoftheTMP/SMXcourseatendencytobothventilationfunctionandX-rayimprovementwasobserved.After20dayscompleteclinical,laboratoryandX-rayrecoverywasdemonstrated.Discussion:ThedetectionofthePC-antigeninbronchoalveolarlavageorinducedsputumisasensitivemethodofP.jiroveciinfectiondiagnostics.Nevertheless,typicalclinicalandlaboratoryfeaturesinsistontheuseofTMP/SMXintheempiricaltherapydespitePC-antigentestnegativity.

【 授权许可】

Unknown