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Potapenko et al. (Abstract)

Cellular Therapy and Transplantation (CTT), Vol. 3, No. 9
doi: 10.3205/ctt-2010-No9-abstract77
© The Authors. This abstract is provided under the following license: Creative Commons Attribution 3.0 Unported

Abstract accepted for "4th Raisa Gorbacheva Memorial Meeting on Hematopoietic Stem Cell Transplantation",
Saint Petersburg, Russia, September 18–20, 2010

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

Vsevolod G. Potapenko, Anna V. Klimovich, Irina А. Samorodova, Natalia А. Kotova, Irina V. Ishmatova, Vladimir J. Kubit, Igor А. Lisukov, Nadezda V. Medvedeva

City Clinical Hospital No 31, Hematology and Oncology Department with Chemotherapy Services for Adult Patients, Saint-Petersburg, Russia

Correspondence: Vsevolod G. Potapenko, City Clinical Hospital No 31, chemotherapy department for oncological and hematological patients, pr. Dinamo 3, Saint-Petersburg, 197110, Russia. E-mail: clest@spam is badinbox.ru

Abstract

Background: The inclusion of trimethoprim/sulfamethoxazole (TMP/SMX) in the standard empirical treatment of neutropenic fever is a potential option to decrease mortality from infection caused by Pneumocystis jiroveci in patients receiving conventional chemotherapy for hematological malignancies.

Purpose: To demonstrate the importance of TMP/SMX inclusion in the empirical treatment of patients with typical PCP features, despite negative Pneumocystis carinii (PC) antigens.

Materials and methods: Four pts (3 pts with NHL and 1 with ALL) with a median age of 29 (22–47) years were included in this study. All of them were in a period of immunosuppression due to chemotherapy. The diagnosis of pneumocystic infection was based on clinical signs and compared with antigen detection in bronchoalveolar lavage (BAL) or sputum.

Results: In all 4 pts clinical and laboratory PCP-like features were observed: prolonged dry cough, prolonged subfebrile hyperthermia, slow shortness of breathing increasing, respiratory alkalosis, hypoxemia and hypocapnia, LDH increase, and X-ray manifestation prior to physical signs. Empirical antibacterial and antifungal treatment was ineffective. The PC-antigen was negative in all cases. The appearance of clinical and laboratory symptoms previously described was estimated as suspicious for P.jiroveci infection and all patients were treated with TMP/SMX (15 mg/kg of trimethoprim) alone or in combination with voriconazole. All four subjects experienced transient worsening of pulmonary insufficiency and stabilization of the roentgenological changes. After three days of the TMP/SMX course a tendency to both ventilation function and X-ray improvement was observed. After 20 days complete clinical, laboratory and X-ray recovery was demonstrated.

Discussion: The detection of the PC-antigen in bronchoalveolar lavage or induced sputum is a sensitive method of P.jiroveci infection diagnostics. Nevertheless, typical clinical and laboratory features insist on the use of TMP/SMX in the empirical therapy despite PC-antigen test negativity.

Keywords: pneumocystis pneumonia, empirical treatment

 

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