Pneumocystis and rheumatic disease 3.5/5 (2)

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Pneumocystis

Pneumocystis in lungs before (AB) and after antibiotics, Yoon SY, 2012. CC BY-NC 3.0

Definition

Pneumocystis carinii / jiroveci is a fungus that can cause a life-threatening infection of the lungs, especially in the lower lungs.

History

  • 1908 Carlos Chagas discovers the disease
  • 1912 The disease is called pneumocystis carinii
  • 1940 Otto Jiroveci describes disease caused by pneumocystis in humans
  • 1988 rRNA sequencing (genetic investigation) shows that pneumocystis is a fungus
  • 2003 The disease is called pneumocystis jirovecii

Symptoms

Healthy people may be pneumocystis carriers without having symptoms (or needing treatment)

  • Night sweats
  • Weight Loss
  • Lungs
    • Dry cough
    • Shortness of breath
  • Debut after treatment with Prednisone more than 15-20mg / d, rituximab (Rixathon, MabThera) or Sendoxan

Diagnosis

  • Signs of oxygen deficiency (Hypoxemia, low pO2) and elevated lactate dehydrogenase (LD) in blood sample
  • Unexpected drop in lung function at lung function tests and 6 minutes walking test
  • CT examination of lungs shows diffuse infiltrates
  • Bronchoscopy with BAL examinations
    • If bronchoscopy is not possible, cleansing fluid from the throat can be used
    • PCR analyze
    • Grocott / Giesma / Immunfluoresens -stainings are less current alternatives

Differential diagnoses (similar diseases)

Treatment

  • Bactrim 15-20mg / kg / day divided into four doses in adults with normal renal function. Renal impairment: GFR 10-50: lower dose, eg 1 / 4 of the usual dose. Alterantiv is Atovaquon, clindamycin + primaquin, dapson + trimethoprim
  • Add Prednisolon 40mg x 2 for the first 5 days

Pneumocystis prophylaxis / prevention

  1. Prophylactic (preventive) treatment against Pneumocystis jiroveci in
    • Immunosuppressive treatment with, for example

More options, of which alternative 1 is mostly used:

  1. Bactrim / Trimethoprim Sulfa (cotromoxasol) (either 2 tablets three days a week or 1 tablets daily)
  2. By sulfa allergy is dapsone 50mg x 1 an option (outside approved indication)
    • Dapson also contains a sulphate component and allergy is possible
  3. An alternative is pentamidine inhalations for example 300mg each 4. week. However, there is an adverse reaction risk that indicates careful follow-up
  4. Atovaquone 1500mg / day has the indication in the US but is very expensive
  5. Pentamidine Inhalations 300mg Each 4. week

Prognosis

  • Serious infection
  • Mortality
    • 30-60% (not HIV)
    • 10-20% (for HIV infection)

Literature

Opportunistic infections, BINDEVEVSSYKDOMMER.no


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