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Pcp treatment in hiv

Satoshi Shibata, Toshiaki Kikuchi
Pneumocystis pneumonia (PCP) is an opportunistic disease that mainly affects patients with a deficiency of cell-mediated immunity, especially acquired immunodeficiency syndrome (AIDS). The incidence of PCP in these patients has declined substantially owing to the widespread use of antiretroviral therapy and PCP prophylaxis. However, PCP is still a major AIDS-related opportunistic infection, particularly in patients with advanced immunosuppression in whom human immunodeficiency virus type 1 (HIV-1) infection remains undiagnosed or untreated...
February 26, 2019: Respiratory Investigation
Agnes N Kiragga, Frank Mubiru, Andrew D Kambugu, Moses R Kamya, Barbara Castelnuovo
BACKGROUND: The roll out of antiretroviral therapy (ART) in Sub-Saharan Africa led to a decrease in mortality. Few studies have documented the causes of deaths among patients on long term antiretroviral therapy in Sub-Saharan Africa. Our objective was to describe the causes of death among patients on long term ART in Sub-Saharan Africa. METHODS: We used data from a prospective cohort of ART naïve patients receiving care and treatment at the Infectious Diseases Institute in Kampala, Uganda...
January 21, 2019: BMC Infectious Diseases
Wong Hoi She, Kenneth S H Chok, Iris W S Li, Ka Wing Ma, Sui Ling Sin, Wing Chiu Dai, James Y Y Fung, Chung Mau Lo
BACKGROUND: Pneumocystis pneumonia (PCP) is a common opportunistic infection caused by Pneumocystis jirovecii. Its incidence at 2 years or more after liver transplant (LT) is < 0.1%. PCP-related spontaneous pneumothorax and/or pneumomediastinum is rare in patients without the human immunodeficiency virus, with an incidence of 0.4-4%. CASE PRESENTATION: A 65-year-old woman who had split-graft deceased-donor LT for primary biliary cirrhosis developed fever, dyspnea and dry coughing at 25 months after transplant...
January 18, 2019: BMC Infectious Diseases
Yogita Singh, Bijay Ranjan Mirdha, Randeep Guleria, Sushil K Kabra, Anant Mohan, Rama Chaudhry, Lalit Kumar, Sada Nand Dwivedi, Sanjay K Agarwal
OBJECTIVES: Pneumocystis pneumonia (PCP) remains a debilitating cause of death among HIV-infected patients. Trimethoprim-sulfamethoxazole (TMP-SMX) combinations are the most effective anti-Pneumocystis treatment and prophylaxis. Long term usage of this combination has raised alarms about emergence of resistant organisms. Present study was carried out to investigate dihydropteroate synthase (DHPS) mutations and their clinical consequences in HIV-infected patients with PCP. METHODS: Seventy-six clinically suspected cases of pneumocystis pneumonia among HIV-seropositive adult patients from March 2014 to March 2017 were included...
January 15, 2019: Journal of Global Antimicrobial Resistance
Serges Tchatchouang, Ariane Nzouankeu, Valerie Donkeng, Sara Eyangoh, Laure Ngando, Veronique Penlap, Marie-Christine Fonkoua, Eric Walter Pefura Yone, Richard Njouom
Tuberculosis (TB) and pneumocystosis are opportunistic diseases associated with HIV/AIDS infection. In Cameroon, although TB HIV-associated diseases are known, limited one are available for pneumocystosis and bacteria. The study was done from January 2017 to January 2018 in Yaounde on HIV-positive and -negative subjects with respiratory tract infections (RTIs). The clinical samples were subjected to bacterial culture and multiplex RT-PCR targeting 10 bacteria and Pneumocystis jirovecii (PCP). Specimens from suspected TB patients were subjected to microscopy, culture and/or GeneXpert analysis...
January 8, 2019: AIDS Research and Human Retroviruses
Ronnye Rutledge, Olga Morozova, Britton A Gibson, Frederick L Altice, Adeeba Kamarulzaman, Jeffrey A Wickersham
PURPOSE: In Malaysia, an estimated 9.7%-12.4% of transgender women (TW) are HIV positive, with higher estimates among those engaged in sex work. According to the 90-90-90 Joint United Nations Programme on HIV/AIDS strategy, HIV testing is the first crucial step in curbing the HIV epidemic. This study examines correlates of recent HIV testing among TW in Greater Kuala Lumpur, Malaysia. METHODS: TW (N = 199) in Greater Kuala Lumpur completed a survey on healthcare access and utilization, including HIV testing history...
November 27, 2018: LGBT Health
P Lewis White, Jessica S Price, Matthijs Backx
The rates of Pneumocystis pneumonia (PcP) are increasing in the HIV-negative susceptible population. Guidance for the prophylaxis and treatment of PcP in HIV, haematology, and solid-organ transplant (SOT) recipients is available, although for many other populations (e.g., auto-immune disorders) there remains an urgent need for recommendations. The main drug for both prophylaxis and treatment of PcP is trimethoprim/sulfamethoxazole, but resistance to this therapy is emerging, placing further emphasis on the need to make a mycological diagnosis using molecular based methods...
November 22, 2018: Journal of Fungi (Basel, Switzerland)
Julius J Schmidt, Catherina Lueck, Stefan Ziesing, Matthias Stoll, Hermann Haller, Jens Gottlieb, Matthias Eder, Tobias Welte, Marius M Hoeper, André Scherag, Sascha David
BACKGROUND: Despite modern intensive care with standardized strategies against acute respiratory distress syndrome (ARDS), Pneumocystis pneumonia (PcP) remains a life-threatening disease with a high mortality rate. Here, we analyzed a large mixed cohort of immunocompromised patients with PcP, with regard to clinical course and treatment, and aimed at identifying predictors of outcome. METHODS: This was a single-center retrospective analysis in a tertiary care institution across 17 years...
November 19, 2018: Critical Care: the Official Journal of the Critical Care Forum
Ji Soo Choi, Sang Hoon Lee, Ah Young Leem, Joo Han Song, Song Yee Kim, Kyung Soo Chung, Ji Ye Jung, Young Ae Kang, Young Sam Kim, Joon Chang, Moo Suk Park
BACKGROUND: Pneumocystis jirovecii pneumonia (PCP) is often fatal in human immunodeficiency (HIV)-negative patients and typically presents with respiratory insufficiency. Predicting treatment failure is challenging. This study aimed to identify prognostic factors and examine PCP polymerase chain reaction (PCR)-negative conversion in non-HIV PCP patients with respiratory failure. METHOD: We retrospectively enrolled 81 non-HIV patients diagnosed with and treated for PCP with respiratory failure in the intensive care unit at a tertiary hospital over a 3-year period...
2018: PloS One
Divya Deodhar, Jency Maria Koshy, Mary John, Aroma Oberoi
Objectives: Pneumocystis jirovecii pneumonia (PCP) can differ in HIV and non HIV population due to degree of immunity. This study was undertaken with an aim to highlight the differences between the two groups. Methods: It was an observational study conducted in the department of Medicine of a tertiary care institution in North India. All cases tested positive for Pneumocystis jirovecii from January 2009 to December 2014 were included in the study. Demographic profile, clinical presentation, risk factors, treatment and course in hospital were noted and analyzed...
January 2018: Journal of the Association of Physicians of India
Sorabh Datta, Shanan Mahal, Virendrasinh Ravat, Bipin Saroha, Ehinor E Isidahome, Priya Patel
Objective To evaluate the difference in hospitalization outcomes, including morbidity and mortality among patients admitted for Pneumocystis pneumonia (PCP) with human immunodeficiency virus (HIV) and non-HIV condition. Methods A case-control study was done using the Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample (NIS) data. We identified PCP and HIV as the primary and secondary diagnosis using ICD-9--CM diagnosis codes. We used the multinomial logistic regression model to generate odds ratios (OR)...
August 1, 2018: Curēus
Hazim S Bukamur, Emhemmid Karem, Serag Fares, Mohammed Al-Ourani, Amro Al-Astal
Pneumomediastinum is a rare, potentially life-threatening complication of PCP that occurs in HIV-positive and HIV-negative patients. We are presenting a rare case pneumomediastinum caused by pneumocystis Jirovecii pneumonia in a HIV-negative patient with history of diffuse B-cell lymphoma on R CHOP chemotherapy. What is unique about our case is that the patient developed pneumomediastinum while in the hospital, on atovaquone that improved when switched to clindamycin and primaquine with improvement in her respiratory status...
2018: Respiratory Medicine Case Reports
Cristina Matesanz López, Andrés Felipe Cardona Arias, María Teresa Río Ramírez, Gonzalo Díaz Ibero, Sergio Julio Rodríguez Álvarez, María Antonia Juretschke Moragues
Pneumocystis in humans is caused by a unicellular and eukaryotic organism called P. jirovecii . The overall incidence of P. jirovecii pneumonia (PCP) has decreased with the use of highly active antiretroviral therapy and the use of chemoprophylaxis with trimethroprim sulfametoxazole (TMP/SMX) in cases of immunosuppressed patients. However, approximately 85% of patients with advanced HIV infections continue to experience this disease with inadequate management. Pneumocystis infection can present with spontaneous pneumothorax in 2-6% of cases [8] which can be a potentially fatal complication...
2018: Respiratory Medicine Case Reports
Wissam Sabbagh, Noor S Darwich
BACKGROUND Pneumocystis jiroveci pneumonia (PCP) - formerly known as Pneumocyctis carinii pneumonia - with newly diagnosed AIDS is an uncommon presentation in people over 50 years of age. A high level of suspicion is required for this diagnosis when an elderly patient with pneumonia is not responding to broad-spectrum antibiotic treatment. CASE REPORT We describe the case of a 63-year-old woman who presented with dyspnea, cough, and significant hypoxemia requiring high-flow oxygen supplement with bilateral lung infiltrates, treated with broad-spectrum antibiotics for a presumed diagnosis of pneumonia...
August 8, 2018: American Journal of Case Reports
Taiki Ando, Yoshiyuki Abe, Yukari Endo, Kurisu Tada, Ken Yamaji, Naoto Tamura
OBJECTIVE: Pneumocystis pneumonia (PCP) is a serious complication in patients with rheumatic diseases who are receiving immunosuppressive therapy. These patients have a higher mortality from PCP than those with human immunodeficiency virus. We examined factors associated with poor prognosis in patients with rheumatic diseases and evaluated PCP treatment in this population. METHODS: This retrospective, single-center, observational cohort study included 31 patients with rheumatic diseases who were admitted to Juntendo University Hospital for PCP treatment from June 2006 to December 2017...
August 13, 2018: Modern Rheumatology
Mouna Hanachi, Vanessa Bohem, Pauline Bemer, Nadja Kayser, Pierre de Truchis, Jean-Claude Melchior
It is generally acknowledged that malnutrition is a propensity factor for secondary infections in different clinical situations (malnutrition-associated infections in hospitalized patients and malnourished children in developing countries). However, it is not clear how malnutrition might facilitate the development of opportunistic infections in human immunodeficiency virus (HIV)-negative patients without a definite etiology (disease or treatment) of impaired cell-mediated immune response. We report here on a case of Pneumocystis jirovecii pneumonia in an HIV-negative patient suffering from anorexia nervosa with extreme malnutrition, which had a favorable outcome despite the severity of her respiratory failure...
June 2018: Clinical Nutrition ESPEN
Patrick M Wieruszewski, Jason N Barreto, Erin Frazee, Craig E Daniels, Pritish K Tosh, Ross A Dierkhising, Kristin C Mara, Andrew H Limper
BACKGROUND: Evidence supporting adjunctive corticosteroids during the treatment of Pneumocystis jirovecii pneumonia (PcP) in adults without HIV is minimal and controversial. METHODS: This retrospective cohort study included P jirovecii pneumonia-positive, hospitalized patients without HIV admitted to the Mayo Clinic from 2006 to 2016. Change from baseline in the respiratory component of the Sequential Organ Failure Assessment score (SOFAresp ) at day 5 was compared between early (within 48 h) steroid recipients and nonrecipients by using multivariable logistic regression and in a propensity-matched analysis...
September 2018: Chest
Rukumani Devi Velayuthan, Chandramathi Samudi, Harvinder Kaur Lakhbeer Singh, Kee Peng Ng, Esaki M Shankar, David W Denning
Fungal infections (mycoses) are likely to occur more frequently as ever-increasingly sophisticated healthcare systems create greater risk factors. There is a paucity of systematic data on the incidence and prevalence of human fungal infections in Malaysia. We conducted a comprehensive study to estimate the burden of serious fungal infections in Malaysia. Our study showed that recurrent vaginal candidiasis (>4 episodes/year) was the most common of all cases with a diagnosis of candidiasis ( n = 501,138). Oesophageal candidiasis ( n = 5850) was most predominant among individuals with HIV infection...
March 19, 2018: Journal of Fungi (Basel, Switzerland)
Rita O Oladele, Akaninyene A Otu, Malcolm D Richardson, David W Denning
Globally, Pneumocystis pneumonia (PCP) remains a common and lethal infection in both HIV-positive and HIV-negative patients, particularly in developing countries where rates of PCP increases with rising GDP. Pneumocystis jirovecii cannot be cultured in routine clinical laboratories; thus diagnosis relies on microscopy, histology, serology and/or polymerase chain reaction (PCR) of the Pneumocystis DNA. Most of these methods are expensive and require training. Accessing lower respiratory tract specimens in young children is often challenging and only PCR testing of nasopharyngeal aspirates is useful...
2018: Journal of Health Care for the Poor and Underserved
Gensheng Zhang, Miaomiao Chen, Shufang Zhang, Hongwei Zhou, Xiaozhen Ji, Jiachang Cai, Tianzheng Lou, Wei Cui, Ning Zhang
Combined treatment with caspofungin and trimethoprim/sulfamethoxazole (TMP/SMZ) as salvage therapy in non-HIV positive patients with severe pneumocystis pneumonia (PCP) yields poor outcomes. It remains unknown whether the use of this combination strategy as a first-line therapy would improve patient outcomes. The present study aimed to assess the efficacy of caspofungin combined with TMP/SMZ as a first-line therapy in non-HIV positive patients with severe PCP. A retrospective cohort study was conducted between March 2016 and February 2017...
February 2018: Experimental and Therapeutic Medicine
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