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🌱來自: Pneumocystis pneumonia, PJP, Adult

Clinical Setting of Pneumocystis pneumonia, PJP, Adult

• Pneumocystis pneumonia (PJP) is a potentially life-threatening fungal pneumonia in immunocompromised patients, especially HIV/AIDS.

Patients at risk PJP, Adult

Indications for primary prophylaxis-chronic suppression:

• HIV/AIDS patients with CD4 count < 200 cells/μL
• Any patient taking equivalent of ≥ 20 mg Prednisone/day for more than 1 month
• Patients receiving Alemtuzumab (monoclonal antibody for CLL), Temozolomide (alkylating agent for astrocytoma therapy)
• Hematopoietic and solid organ transplant recipients during immunosuppression
• Patients given Fludarabine (purine analog used to treat hematologic malignancy)
• Patients with Wegener’s granulomatosis treated with Prednisone + cyclophosphamide

Diagnosis: Sputum PCR. If not available, DFA on sputum.

Beta D-Glucan

• Cell wall polysaccharide of Pneumocystis and other fungi

• Can detect in serum with chromogenic quantitative immunoassay

• Pooled sensitivity/specificity of 95%/86%. Negative predictive value of over 95%: Clin Micro Infect 19:39, 2013

• Need appropriate clinical syndrome; many false positives: J Clin  Micro 51:3478, 2013.

• Concomitant antiretroviral therapy (ART) for HIV:

  • NIH HIV/AIDS Guidelines recommend initiation of ART within two weeks of starting treatment for PJP (see clinicalinfo.HIV.gov)
  • Early therapy reduced risk of progression of AIDS and death by nearly half without associated increased risk of adverse events or immune reconstitution inflammatory syndrome (IRIS)