Pjp prophylaxis steroids

Pneumonia caused by P. jirovecii (formerly called P. carinii ) is an opportunistic infection most commonly associated with the human immunodeficiency virus (HIV). However, individuals who are immunosuppressed for other reasons, such as those undergoing treatment for organ transplantation or connective tissue diseases with steroids and other immunosuppressants also are at risk of PJP. Wicks and colleagues recently reported that % of patients with PJP seen at the Royal Melbourne Hospital had an underlying connective tissue disease.

Since the start of the AIDS epidemic, PCP has been closely associated with AIDS. Because it only occurs in an immunocompromised host, it may be the first clue to a new AIDS diagnosis if the patient has no other reason to be immunocompromised (. taking immunosuppressive drugs for organ transplant ). An unusual rise in the number of PCP cases in North America, noticed when physicians began requesting large quantities of the rarely used antibiotic pentamidine , was the first clue to the existence of AIDS in the early 1980s. [14] [15]

TMP-SMX is the treatment of choice for PCP (AI) . 68,69 The dose must be adjusted for abnormal renal function. Multiple randomized clinical trials indicate that TMP-SMX is as effective as parenteral pentamidine and more effective than other regimens. Adding leucovorin to prevent myelosuppression during acute treatment is not recommended because efficacy is questionable and some evidence exists for a higher failure rate (AII) . 70 Oral outpatient therapy with TMP-SMX is highly effective in patients with mild-to-moderate disease (AI) . 69

In 2009, Kovacs and Masur summarized the first 100 years since identification of Pneumocystis. They concluded that in HIV-negative patients there is no reliable laboratory marker for risk of this infection, but that in these patients PCP is more likely to be an acute illness causing severe respiratory distress of rapid onset when compared with HIV-positive patients. That makes routine prophylaxis more reasonable. Their recommended approach is to use PCP prophylaxis in patients receiving at least 20 mg of prednisone per day for at least 1 month. They also note that steroid therapy can accelerate symptomatic and physiologic improvement and improve survival in patients with moderate or severe PCP. Since steroids are in themselves immunosupressive, management of corticosteroids in PCP-infected patients is quite complex.

The use of HAART has made significant changes to the prognosis of HIV-related pulmonary infections. Currently, the most common HIV-related pulmonary infection diagnosed in developed countries is bacterial pneumonia, and in developing countries, tuberculosis. [ 14 ] An American study of hospitalised patients reported a mortality rate of %. Mortality is about 10-20% in mild-to-moderate cases, rising to 65% in patients who require artificial ventilation. [ 14 ] Due to restricted access to optimal medical care, PCP remains a common AIDS-defining illness in developed nations and is associated with significant morbidity and mortality. [ 27 ]

Pjp prophylaxis steroids

pjp prophylaxis steroids

In 2009, Kovacs and Masur summarized the first 100 years since identification of Pneumocystis. They concluded that in HIV-negative patients there is no reliable laboratory marker for risk of this infection, but that in these patients PCP is more likely to be an acute illness causing severe respiratory distress of rapid onset when compared with HIV-positive patients. That makes routine prophylaxis more reasonable. Their recommended approach is to use PCP prophylaxis in patients receiving at least 20 mg of prednisone per day for at least 1 month. They also note that steroid therapy can accelerate symptomatic and physiologic improvement and improve survival in patients with moderate or severe PCP. Since steroids are in themselves immunosupressive, management of corticosteroids in PCP-infected patients is quite complex.

Media:

pjp prophylaxis steroids

http://buy-steroids.org