Artikel
Pneumocystis Jirovicii Pneumonia in Pediatric Patients: An Analysis of 16 Confirmed Consecutive Cases During 14 Years
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Veröffentlicht: | 3. Juni 2014 |
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Background: Pneumocystis jirovicii pneumonia (PCP) occurs in various immunocompromised patients. Despite the prophylaxis strategies commonly performed in clinical practice, certain patients develop PCP. This study was performed to investigate pediatric cases with PCP in our center.
Method: We identified pediatric patients with microbiologically confirmed PCP from January 2000 to February 2014. A retrospective chart review was performed.
Result: Sixteen patients were identified with median age of 8.05 years (range, 0.4-18.6 years). Among these 16 patients, 12 patients had hematology-oncology diseases, two had primary immunodeficiency (1 with severe combined immunodeficiency and 1 with Wiskott Aldrich syndrome), one had systemic lupus erythematosus (SLE) and one received kidney transplant (KT). Five patients were transplant recipients; 2 allogeneic and 2 autologous hematopoietic stem cell transplant (HCT) and 1 with KT. The median absolute lymphocyte (ALC) at diagnosis was 515 cells/mm3 (range, 20-5111 cells/mm3). Thirteen patients (13/16, 81.2%) were not receiving prophylaxis at the time of PCP development. Two autologous HCT recipients (neuroblastoma and endodermal sinus tumor) and one KT recipient while not on prophylaxis developed PCP. Each autologous recipient received HCT twice and three times of HCT, respectively, before the development of PCP. KT recipient developed PCP 485 days after the cessation of routine one-year prophylaxis. TMP/SMX was given as main therapeutic agent; TMP/SMX only in 6 patients (37.5%) and steroid was given in 8 patients (50%). Median treatment duration was 15 days (range, 4-33 days). Overall mortality was 31.2% (5/16).
Conclusion: Majority of our patients developed PCP while not on prophylaxis. Continuous efforts and more data are needed to identify additional high risk patients who may get benefit from PCP prophylaxis.
Key words: Pneumocystis carinii, Pneumocystis jirovecii, PCP prophylaxis, TMP/SMX, immunocompromised recipient, transplantation