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Inicio Medicina Clínica (English Edition) Pneumocystis jirovecii pneumonia prophylaxis in immunocompromised patients with ...
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Vol. 152. Issue 12.
Pages 502-507 (June 2019)
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Vol. 152. Issue 12.
Pages 502-507 (June 2019)
Review
DOI: 10.1016/j.medcle.2019.01.018
Pneumocystis jirovecii pneumonia prophylaxis in immunocompromised patients with systemic autoimmune diseases
Profilaxis de la neumonía por Pneumocystis jirovecii en pacientes inmunodeprimidos con enfermedades autoinmunes sistémicas
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Beatriz P. Bragaa, Sergio Prieto-Gonzálezb, José Hernández-Rodríguezb,
Corresponding author
jhernan@clinic.ub.es

Corresponding author.
a Department of Internal Medicine, Hospital do Divino Espírito Santo de Ponta Delgada, São Miguel, Portugal
b Vasculitis Research Unit, Department of Autoimmune Diseases, Hospital Clínic, University of Barcelona, Institut d’Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
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Table 1. Antibiotic therapy for prophylaxis of Pneumocystis pneumonia.
Abstract

Pneumocystis jirovecii (P. jirovecii) causes a potentially fatal pneumonia in immunocompromised individuals (Pneumocystis pneumonia or PcP), particularly in HIV-infected patients and those treated with immunosuppressive drugs, such as transplant patients and those with systemic autoimmune diseases. P. jirovecii colonization can be found in almost a third of patients with systemic autoimmune diseases. Although the incidence of PcP in such patients is usually low, mortality is quite high, ranging between 30% and 50% in the majority of autoimmune diseases. PcP development is almost always observed in patients not receiving prophylaxis for the infection. Despite the above, there are no clinical guidelines established for PcP prophylaxis in patients with autoimmune diseases treated with glucocorticoids, cytotoxic drugs, or more recently, biological agents. The objective of this review is to analyze the available data on the incidence of PcP and the effect of PcP prophylaxis in patients with autoimmune diseases that may be useful in clinical practice.

Keywords:
Pneumocystis jirovecii
Pneumocystis pneumonia
Autoimmune diseases
PcP prophylaxis
Immunosuppressive drugs
Glucocorticoids
Cyclophosphamide
Biologic agents
Abbreviations:
ANCA
GCA
GC
GPA
PcP
PAN
RA
SLE
TMP–SMX
TNF
Resumen

El hongo Pneumocystis jirovecii (P. jirovecii) es la causa de una neumonía (Pneumocystis pneumonia o PcP) potencialmente mortal en individuos inmunodeprimidos, sobre todo en pacientes infectados por el VIH, y en aquellos tratados con fármacos inmunodepresores, como los sometidos a trasplantes y los afectos de enfermedades autoinmunes sistémicas. En estos últimos, alrededor de un tercio de los casos puede estar colonizado por P. jirovecii y, aunque la incidencia de la PcP suele ser baja, la mortalidad de la misma es considerablemente alta, y oscila entre el 30 y el 50% en la mayoría de las enfermedades autoinmunes. El desarrollo de la PcP se observa casi siempre en pacientes que no reciben profilaxis para la infección. Aun así, no existen guías clínicas establecidas para la profilaxis de la PcP en pacientes afectos de enfermedades autoinmunes que son tratados con glucocorticoides, fármacos citotóxicos o más recientemente, con agentes biológicos. El objetivo de esta revisión es analizar los datos disponibles sobre la incidencia de la PcP y el efecto de la profilaxis para infección por P. jirovecii en los pacientes afectos de enfermedades autoinmunes que puedan ser útiles en la práctica clínica.

Palabras clave:
Pneumocystis jirovecii
Pneumocystis pneumonia
Enfermedades autoinmunes
Profilaxis de PcP
Fármacos inmunodepresores
Glucocorticoides
Ciclofosfamida
Agentes biológicos

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