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Article: The unmasking of Pneumocystis jiroveci pneumonia during reversal of immunosuppression: Case reports and literature review

TitleThe unmasking of Pneumocystis jiroveci pneumonia during reversal of immunosuppression: Case reports and literature review
Authors
Issue Date2004
PublisherBioMed Central Ltd. The Journal's web site is located at http://www.biomedcentral.com/bmcinfectdis/
Citation
Bmc Infectious Diseases, 2004, v. 4 How to Cite?
AbstractBackground: Pneumocystis jiroveci pneumonia (PCP) is an important opportunistic infection among immunosuppressed patients, especially in those infected with human immunodeficiency virus (HIV). The clinical presentation of PCP in immunosuppressed patients have been well-reported in the literature. However, the clinical importance of PCP manifesting in the setting of an immunorestitution disease (IRD), defined as an acute symptomatic or paradoxical deterioration of a (presumably) preexisting infection, which is temporally related to the recovery of the immune system and is due to immunopathological damage associated with the reversal of immunosuppressive processes, has received relatively little attention until recently. Case presentation: We aim to better define this unique clinical syndrome by reporting two cases of PCP manifesting acutely with respiratory failure during reversal of immunosuppression in non-HIV infected patients, and reviewed the relevant literature. We searched our databases for PCP cases manifesting in the context of IRD according to our predefined case definition, and reviewed the case notes retrospectively. A comprehensive search was performed using the Medline database of the National Library of Medicine for similar cases reported previously in the English literature in October 2003. A total of 28 non-HIV (excluding our present case) and 13 HIV-positive patients with PCP manifesting as immunorestitution disease (IRD) have been reported previously in the literature. During immunorestitution, a consistent rise in the median CD4 lymphocyte count (28/μL to 125/μL), with a concomitant fall in the median HIV viral load (5.5 log10 copies/ml to 3.1 log10 copies/ml) was observed in HIV-positive patients who developed PCP. A similar upsurge in peripheral lymphocyte count was observed in our patients preceding the development of PCP, as well as in other non-HIV immunosuppressed patients reported in the literature. Conclusions: PCP manifesting as IRD may be more common than is generally appreciated. Serial monitoring of total lymphocyte or CD4 count could serve as a useful adjunct to facilitate the early diagnosis and pre-emptive treatment of this condition in a wide range of immunosuppressed hosts, especially in the presence of new pulmonary symptoms and/or radiographic abnormalities compatible with the diagnosis. © 2004 Wu et al; licensee BioMed Central Ltd.
Persistent Identifierhttp://hdl.handle.net/10722/53441
ISSN
2015 Impact Factor: 2.69
2015 SCImago Journal Rankings: 1.510
PubMed Central ID
ISI Accession Number ID
References

 

DC FieldValueLanguage
dc.contributor.authorWu, AKLen_HK
dc.contributor.authorCheng, VCCen_HK
dc.contributor.authorTang, BSFen_HK
dc.contributor.authorHung, IFNen_HK
dc.contributor.authorLee, RAen_HK
dc.contributor.authorHui, DSen_HK
dc.contributor.authorYuen, KYen_HK
dc.date.accessioned2009-04-03T07:19:50Z-
dc.date.available2009-04-03T07:19:50Z-
dc.date.issued2004en_HK
dc.identifier.citationBmc Infectious Diseases, 2004, v. 4en_HK
dc.identifier.issn1471-2334en_HK
dc.identifier.urihttp://hdl.handle.net/10722/53441-
dc.description.abstractBackground: Pneumocystis jiroveci pneumonia (PCP) is an important opportunistic infection among immunosuppressed patients, especially in those infected with human immunodeficiency virus (HIV). The clinical presentation of PCP in immunosuppressed patients have been well-reported in the literature. However, the clinical importance of PCP manifesting in the setting of an immunorestitution disease (IRD), defined as an acute symptomatic or paradoxical deterioration of a (presumably) preexisting infection, which is temporally related to the recovery of the immune system and is due to immunopathological damage associated with the reversal of immunosuppressive processes, has received relatively little attention until recently. Case presentation: We aim to better define this unique clinical syndrome by reporting two cases of PCP manifesting acutely with respiratory failure during reversal of immunosuppression in non-HIV infected patients, and reviewed the relevant literature. We searched our databases for PCP cases manifesting in the context of IRD according to our predefined case definition, and reviewed the case notes retrospectively. A comprehensive search was performed using the Medline database of the National Library of Medicine for similar cases reported previously in the English literature in October 2003. A total of 28 non-HIV (excluding our present case) and 13 HIV-positive patients with PCP manifesting as immunorestitution disease (IRD) have been reported previously in the literature. During immunorestitution, a consistent rise in the median CD4 lymphocyte count (28/μL to 125/μL), with a concomitant fall in the median HIV viral load (5.5 log10 copies/ml to 3.1 log10 copies/ml) was observed in HIV-positive patients who developed PCP. A similar upsurge in peripheral lymphocyte count was observed in our patients preceding the development of PCP, as well as in other non-HIV immunosuppressed patients reported in the literature. Conclusions: PCP manifesting as IRD may be more common than is generally appreciated. Serial monitoring of total lymphocyte or CD4 count could serve as a useful adjunct to facilitate the early diagnosis and pre-emptive treatment of this condition in a wide range of immunosuppressed hosts, especially in the presence of new pulmonary symptoms and/or radiographic abnormalities compatible with the diagnosis. © 2004 Wu et al; licensee BioMed Central Ltd.en_HK
dc.languageengen_HK
dc.publisherBioMed Central Ltd. The Journal's web site is located at http://www.biomedcentral.com/bmcinfectdis/en_HK
dc.relation.ispartofBMC Infectious Diseasesen_HK
dc.rightsCreative Commons: Attribution 3.0 Hong Kong License-
dc.rightsB M C Infectious Diseases. Copyright © BioMed Central Ltd.en_HK
dc.subject.meshImmunosuppression - adverse effectsen_HK
dc.subject.meshPneumocystis jiroveci - isolation & purificationen_HK
dc.subject.meshPneumonia, Pneumocystis - diagnosis - drug therapyen_HK
dc.subject.meshAntifungal Agents - therapeutic useen_HK
dc.subject.meshImmunosuppressive Agents - adverse effectsen_HK
dc.titleThe unmasking of Pneumocystis jiroveci pneumonia during reversal of immunosuppression: Case reports and literature reviewen_HK
dc.typeArticleen_HK
dc.identifier.openurlhttp://library.hku.hk:4550/resserv?sid=HKU:IR&issn=1471-2334&volume=4&issue=1&spage=57&epage=&date=2004&atitle=The+unmasking+of+Pneumocystis+jiroveci+pneumonia+during+reversal+of+immunosuppression:+case+reports+and+literature+reviewen_HK
dc.identifier.emailHung, IFN:ivanhung@hkucc.hku.hken_HK
dc.identifier.emailYuen, KY:kyyuen@hkucc.hku.hken_HK
dc.identifier.authorityHung, IFN=rp00508en_HK
dc.identifier.authorityYuen, KY=rp00366en_HK
dc.description.naturepublished_or_final_versionen_HK
dc.identifier.doi10.1186/1471-2334-4-57en_HK
dc.identifier.pmid15588295en_HK
dc.identifier.pmcidPMC539247-
dc.identifier.scopuseid_2-s2.0-25444480034en_HK
dc.identifier.hkuros100217-
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-25444480034&selection=ref&src=s&origin=recordpageen_HK
dc.identifier.volume4en_HK
dc.identifier.isiWOS:000225993600001-
dc.publisher.placeUnited Kingdomen_HK
dc.identifier.scopusauthoridWu, AKL=7402998681en_HK
dc.identifier.scopusauthoridCheng, VCC=23670479400en_HK
dc.identifier.scopusauthoridTang, BSF=8908243000en_HK
dc.identifier.scopusauthoridHung, IFN=7006103457en_HK
dc.identifier.scopusauthoridLee, RA=7408203830en_HK
dc.identifier.scopusauthoridHui, DS=7101862411en_HK
dc.identifier.scopusauthoridYuen, KY=36078079100en_HK

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