|Co-factors||Glucocorticoids||Treatment of AIDS risk groups||Treatment of cancer|
|Pneumocystis carinii pneumonia in patients without AIDS.|| ||Sepkowitz KA
| ||"Overshadowed by this epidemic was the continued occurrence of PCP in persons not infected with the human immunodeficiency virus, most notably those receiving immunosuppressive therapy for neoplastic disease or other indications. A review from Memorial Sloan-Kettering Cancer Center has demonstrated that, in addition to those patients previously defined as at risk--those with acute lymphocytic leukemia or allogeneic bone marrow transplantation--patients receiving corticosteroid therapy for a primary or metastatic brain neoplasm are at risk for PCP..."|
| ||Clin Infect Dis 1993 Nov;17 Suppl 2:S416-22||1993|
|Pneumocystis carinii pneumonia among patients without AIDS at a cancer hospital.|| ||Sepkowitz KA, Brown AE, Telzak EE, Gottlieb S, Armstrong D
| ||"To determine the predisposing factors, attack rate by underlying disease, and outcome of Pneumocystis carinii pneumonia among patients without the acquired immunodeficiency syndrome (AIDS) at a cancer center. Twelve-year retrospective review from a tertiary-care cancer center. One hundred forty patients, constituting 142 cases, with morphologically proved P carinii pneumonia. All but seven patients had previously established predisposing factors for P carinii pneumonia, including corticosteroid use in 87%... In addition to patients with certain hematologic neoplasms, those with primary or metastatic brain neoplasm who receive corticosteroids are at risk for the development of P carinii pneumonia..."|
| ||JAMA 1992 Feb 12;267(6):832-7||1992|
|Pneumocystis pneumonia in patients with cancer: clinical setting|| ||DeVita VT Jr, Goodell B, Hubbard S, Geelhoed GW, Young RC.
| ||"The most common clinical setting for the development of pneumocystis pneumonia in the United States is in a patient successfully treated with combination chemotherapy, usually including steroids, for a hematologic malignancy..."|
| ||Natl Cancer Inst Monogr 1976 Oct;43:41-7||1976|
|Pneumocystis carinii pneumonia in cancer patients.|| ||Varthalitis I, Meunier F.
| ||"Concern has been arisen about the recently reported increasing incidence of PCP in patients with cancer... Intensity of immunosuppression plays a crucial role, especially long-term (> 2 months) corticosteroid treatment. PCP is usually manifested clinically during augmentation or during tapering of corticosteroid dose..."|
| ||Cancer Treat Rev 1993 Oct;19(4):387-413||1993|
|Peripheral blood CD4 + T-lymphocyte counts during Pneumocystis carinii pneumonia in immunocompromised patients without HIV infection.|| ||Mansharamani NG, Balachandran D, Vernovsky I, Garland R, Koziel H.
| ||"To assess the potential use of peripheral blood CD4 + T-lymphocyte counts (CD4 + counts) as a clinically useful biological marker to identify specific immunocompromised patients (without HIV infection) at high risk for Pneumocystis carinii pneumonia (PCP)... One hundred seventy-one consecutive confirmed HIV-seronegative hospitalized and ambulatory adults, including 22 patients with active PCP, 8 patients with bacterial pneumonia, 24 persons in two groups considered at high clinical risk, 38 persons in two groups considered at low or undefined risk, and 79 persons in four groups considered not at risk for PCP (including healthy individuals)... Compared to counts in healthy individuals, median CD4 + counts were significantly decreased in patients with active PCP (61 cells/microL vs 832 cells/microL; p = 0.001) where 91% of patients had a CD4 + count < 300 cells/microL at the time of PCP diagnosis... high clinical risk groups of recent organ transplant recipients... and patients receiving chemotherapy... For the low or undefined clinical risk groups... individuals receiving long-term corticosteroid therapy (alone or in combination with other agents) had CD4 + counts < 300 cells/microL... These data suggest that for immunosuppressed persons without HIV infection (especially in low or undefined PCP risk groups), CD4 + counts may be a useful clinical marker to identify specific individuals at particularly high clinical risk for PCP and may help to guide chemoprophylaxis."|
| ||Chest 2000 Sep;118(3):712-20||2000|
|Pneumocystis carinii pneumonia in patients without AIDS, 1980 through 1993. An analysis of 78 cases.|| ||Arend SM, Kroon FP, van't Wout JW.
| ||"Pneumocystis carinii pneumonia (PCP) occurs in immunocompromised patients without the acquired immunodeficiency syndrome (AIDS). There has been an increasing yearly number of cases of PCP in our patients without AIDS. To determine the nature of the underlying disorder and previous immunosuppressive treatment in patients with PCP without AIDS. A study of the charts of 78 such patients admitted to our hospital from 1980 through 1993. The number of PCP cases per year increased during the period studied. All patients had an underlying disorder, either hematologic malignancy (49%), solid organ tumor (4%), vasculitis or other immunologic disorder (22%), or they had undergone renal transplantation (17%) or bone marrow transplantation (9%). Previous immunosuppressive medication consisted of prednisone or other corticosteroids in 72 (92%) of 78 patients, cytotoxic drugs in 55 (71%) of 78 patients, both in 50 (64%) of 78 patients, and none in one patient. Quantification of previous corticosteroid treatment showed a large variability among patients... A trend toward a higher mortality in patients with previous corticosteroid use was detected (P = .06)... Pneumocystis carinii pneumonia may complicate a variety of immunocompromised states, with considerable mortality. Pneumocystis carinii pneumonia occurred at all levels of immunosuppression; no threshold level could be defined."|
| ||Arch Intern Med 1995 Dec 11-25;155(22):2436-41 Related Articles, Books ||1995|
|PNEUMOCYSTIS CARINII PNEUMONIA IN HIV-NEGATIVE PATIENTS WITH HAEMATOLOGIC DISEASE.|| ||Van der Lelie J, Venema D, Kuijper E.J, Van Steenwijk R.P, Van Oers Thomas M.H.J. and Von dem Borne A.E.G.Kr.
| ||"Since 1990 Pneumocystis carinii pneumonia (PCP) was diagnosed in 15 adult HIV-negative haematologic patients in our hospital. None of them had received PCP prophylaxis. All except one had been treated with prednisone. Symptoms usually started after stopping or tapering... The others recovered completely. There were no relapses."|
| ||Infection 1997;25:78-81||1997|
|Pneumocystis carinii pneumonia in patients without HIV infection.|| ||Russian DA, Levine SJ.
| ||Pneumocystis carinii is an important, but sporadic, opportunistic pulmonary pathogen in immunosuppressed HIV seronegative persons... Recently, solid tumor patients, in particular those receiving high-dose corticosteroids for brain neoplasms, and patients with inflammatory or collagen-vascular disorders, especially patients with Wegener granulomatosis receiving immunosuppressive therapy, have been identified as subgroups at increased risk for P. carinii pneumonia. Other factors associated with P. carinii pneumonia include the intensity of the immunosuppressive regimen and tapering doses of corticosteroids.|
| ||Am J Med Sci 2001 Jan;321(1):56-65||2001|