Autoimmune inflammatory disorders, systemic corticosteroids and pneumocystis pneumonia: A strategy for preventionReport as inadecuate




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BMC Infectious Diseases

, 4:42

First Online: 16 October 2004Received: 02 June 2004Accepted: 16 October 2004

Abstract

BackgroundPneumocystis pneumonia PCP is an increasing problem amongst patients on immunosuppression with autoimmune inflammatory disorders AID. The disease presents acutely and its diagnosis requires bronchoalveolar lavage in most cases. Despite treatment with intravenous antibiotics, PCP carries a worse prognosis in AID patients than HIV positive patients. The overall incidence of PCP in patients with AID remains low, although patients with Wegener-s granulomatosis are at particular risk.

DiscussionIn adults with AID, the risk of PCP is related to treatment with systemic steroid, ill-defined individual variation in steroid sensitivity and CD4+ lymphocyte count. Rather than opting for PCP prophylaxis on the basis of disease or treatment with cyclophosphamide, we argue the case for carrying out CD4+ lymphocyte counts on selected patients as a means of identifying individuals who are most likely to benefit from PCP prophylaxis.

SummaryCorticosteroids, lymphopenia and a low CD4+ count in particular, have been identified as risk factors for the development of PCP in adults with AID. Trimethoprim-sulfamethoxazole co-trimoxazole is an effective prophylactic agent, but indications for its use remain ill-defined. Further prospective trials are required to validate our proposed prevention strategy.

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Author: Evin Sowden - Andrew J Carmichael

Source: https://link.springer.com/







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