Abstract
Objectives. A retrospective multicentric study was conducted over a five-year period to evaluate
the clinical and laboratory characteristics and outcome of patients with proven Pneumocystis carinii pneumonia (PCP) complicating hematologic malignancies.
Results. The study included 60 HIV-negative patients with 18 non-Hodgkin's malignant lymphoma
(30%), 13 chronic lymphocytic leukaemia (21.7%), 10 acute leukemia (16.6%), 5 multiple
myeloma (8.3%), 4 Waldenström's diseases (6.6%), 4 chronic myeloid leukemia (6.6%),
3 myelodysplasia (5%), 2 Hodgkin's diseases (3.3%) and 1 thrombopenia. Bronchoalveolar
lavage was diagnostic in all patients. Forty-nine patients received cytotoxic drugs
(81.7%), 25 (41.7%) a long-term corticotherapy and 15 (25%) underwent bone marrow
transplantation. Twenty-seven patients (45%) required admission in the intensive care
unit, 35 (58.3%) received an adjunctive corticotherapy and 18 mechanical ventilation
(30%). Twenty patients (33.3%) died of PCP. A previous long-term corticotherapy (p=0.04), high respiratory (p=0.05) and pulse rates (p=0.02), elevated C reactive protein (p=0.01) and mechanical ventilation (OR=13.37; IC: 1.9–50) were associated with a poor
prognosis. Adjunctive corticotherapy did not modify the prognosis.
Conclusions. These results suggest that PCP can occur during the course of various hematologic
malignancies, not only lymphoproliferative disorders. Prognosis remains poor. The
diagnosis should be advocated more frequently and earlier to improve the prognosis.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of InfectionAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Intensity of immunosuppressive therapy and the incidence of Pneumocystis carinii pneumonitis.Cancer. 1975; 36: 2004-2009
- Pneumocystis carinii pneumonia among patients with neoplastic disease.Sem Resp infections. 1992; 7: 114-121
- Pneumocystis carinii pneumonia without acquired immunodeficiency syndrome.Arch Intern Med. 1995; 155: 1125-1128
- Opportunistic infections in patients with and patients without acquired immunodeficiency syndrome.Clin Infect Dis. 2002; 34: 98-107
- Analysis of underlying diseases and prognosis factors associated with Pneumocystis carinii pneumonia in immunocompromised HIV-negative patients.Eur J Clin Microbiol Infect Dis. 2002; 21: 523-531
- Pneumocystis carinii pneumonia in patients with cancer.Cancer. 1993; 71: 481-485
- Prognostic markers of short-term mortality in AIDS-associated Pneumocystis carinii pneumonia.Chest. 2001; 119: 844-851
- New insights into transmission, diagnosis and drug treatment of Pneumocystis carinii pneumonia.JAMA. 2001; 286: 2450-2460
- Update on the epidemiology and transmission of Pneumocystis carinii.Microbes Infect. 2002; 4: 95-103
- Molecular epidemiology of human pneumocystosis.Med Mal Inf. 1999; 29: 733-738
- The role of person-to-person transmission in an epidemiologic study of Pneumocystis carinii pneumonia.AIDS. 2002; 16: 1821-1825
- Current issues in the epidemiology, transmission and reactivation of Pneumocystis carinii.Sem Resp Infections. 1998; 13: 283-288
- Pneumocystis carinii pneumonia in patients with malignant haematological diseases: 10 years’ experience of infection in GIGEMA centres.Br J Haematol. 2002; 117: 379-386
- Excess prevalence of Pneumocystis carinii pneumonia in patients treated for lymphoma with combination chemotherapy.Ann Intern Med. 1986; 104: 338-344
- Fludarabine and mitoxantrone: effective and well-tolerated salvage therapy in relapsed indolent lymphoproliferative disorders.Ann Oncol. 2001; 12: 1455-1460
- Infectious complications in chronic lymphocytic leukaemia.Hematol Cell Ther. 1999; 41: 145-151
- Infections in patients with chronic lymphocytic leukemia treated with fludarabine.Ann Intern Med. 1998; 129: 559-566
- Summary of the guidelines for preventing opportunistic infections among hematopoietic stem cell transplant recipients.Clin Infect Dis. 2001; 33: 139-144
- Pneumocystis carinii pneumonia in human immunodeficiency virus (HIV)-positive and HIV-negative immunocompromised patients.Clin Infect Dis. 1999; 29: 1519-1523
- High rates of Pneumocystis carinii pneumonia in allogenic blood and marrow transplant recipients receiving dapsone prophylaxis.Clin Infect Dis. 1999; 29: 1467-1471
- Pneumocystis carinii pneumonia developing within one month of intensive chemotherapy for treatment of acute lymphoblastic leukemia.N Engl J Med. 1991; 325: 661-662
- When to initiate anti Pneumocystis carinii prophylaxis in acute lymphoblastic leukemia treatment?.Leukemia. 1994; 1: 216
- Antibacterial prophylaxis with trimethoprim-sulfamethoxazole during induction treatment for acute lymphoblastic leukemia.Dan Med Bull. 2001; 48: 275-277
- Pneumocystis carinii pneumonia in patients receiving chemotherapy for breast cancer.Clin Infect Dis. 1997; 25: 215-218
- Pneumocystis carinii pneumonia in HIV-negative immunocompromised adults.Med J Austral. 1995; 162: 233-235
- Pneumocystis carinii pneumonia in cancer patients.Canc Treat Reviews. 1993; 19: 387-413
- Pneumocystis carinii pneumonia in critically ill patients with malignancy: a descriptive study.Clin Infect Dis. 2002; 35: 929-934
- Pneumocystis carinii pneumonia in the course of connective tissue disease: report of 34 cases.J Rheumatol. 1994; 21: 246-251
- Pneumocystis carinii pneumonia in heart transplant recipients.Infection. 1993; 21: 75-79
- Pulmonary colonization with Pneumocystis carinii in human immunodeficiency virus-negative patients: assessing risk with blood CD4+ T cell counts.Clin Infect Dis. 1999; 29: 1331-1332
- Early diagnosis and treatment of pulmonary opportunistic infection by using polymerase chain reaction and beta-glucan in patients with hematological neoplasms.Kurume Med J. 2000; 48: 117-127
- Genotypes of clustered cases of Pneumocystis carinii pneumonia.Scand J Infect Dis. 2001; 33: 285-289
- Development and evaluation of a quantitative, touch-down, real-time PCR assay for diagnosing Pneumocystis carinii pneumonia.J Clin Microbiol. 2002; 40: 490-494
- Independent risk of mechanical ventilation for AIDS-related Pneumocystis carinii pneumonia associated with bronchoalveolar lavage neutrophilia.Respir Med. 2001; 95: 661-665
- A meta-analysis of salvage therapy for Pneumocystis carinii pneumonia.Arch Intern Med. 2001; 161: 1529-1533
- Corticosteroids as adjunctive therapy for severe Pneumocystis carinii pneumonia in non-human immunodeficiency virus-infected patients: retrospective study of 31 patients.Clin Infect Dis. 1999; 29: 670-672
- Use of adjunctive corticosteroids in severe adults non-HIV Pneumocystis carinii pneumonia.Chest. 1998; 113: 1215-1224
- Prophylaxis for Pneumocystis carinii pneumonia in solid organ transplant recipients—as long as the pros outweigh the cons.Clin Infect Dis. 1999; 28: 247-249
- Mutations in dihydropteroate synthase gene of Pneumocystis carinii in HIV patients with Pneumocystis carinii pneumonia.Intern J Antimicrob Ag. 2001; 6: 547-551
- Effects of mutations in Pneumocystis carinii dihydropteroate synthase gene on outcome of AIDS-associated P. carinii pneumonia.Lancet. 1999; 354: 1347-1351
- Effect of mutations in Pneumocystis carinii dihydropteroate synthase gene on outcome of P. carinii pneumonia in patients HIV-1: a prospective study.Lancet. 2001; 358: 545-549
- A meta-analysis of the relative efficacy and toxicity of Pneumocystis carinii prophylaxis regimens.Arch Intern Med. 1996; 156: 177-188
- Aerosolized pentamidine as Pneumocystis prophylaxis after bone marrow transplantation is inferior to other regimens and is associated with decreased survival and an increased risk of other infections.Biol Blood Marrow Transplant. 2000; 6: 35-43
- Aerosolized pentamidine prophylaxis for Pneumocystis carinii pneumonia after allogenic marrow transplantation.Transpl Infect Dis. 2002; 4: 66-74
Article info
Identification
Copyright
© 2003 The British Infection Society. Published by Elsevier Inc. All rights reserved.
