Advertisement

Influence of type of cancer and hematopoietic stem cell transplantation on clinical presentation of Pneumocystis jiroveci pneumonia in cancer patients

  • H. A. Torres
  • R. F. Chemaly
  • R. Storey
  • E. A. Aguilera
  • G. M. Nogueras
  • A. Safdar
  • K. V. I. Rolston
  • I. I. Raad
  • D. P. KontoyiannisEmail author
Article

Abstract

Pneumocystis jiroveci pneumonia is a common infection in patients with AIDS but an infrequent cause of pneumonia in cancer patients. Little is known about the impact of cancer type and hematopoietic stem cell transplantation on the presentation and outcome of P. jiroveci pneumonia in cancer patients. A retrospective cohort study of all patients with cancer and P. jiroveci pneumonia cared for at The M.D. Anderson Cancer Center during 1990–2003 was conducted. Eighty episodes of P. jiroveci pneumonia in 79 patients were identified. In most (67%) episodes, patients had a hematologic malignancy. In 23 (29%) episodes, patients had undergone hematopoietic stem cell transplantation. Twenty-seven percent of patients with histopathologically confirmed P. jiroveci pneumonia had nodular infiltrates on the radiographic study. Pleural effusion and pneumothorax were more common in patients with hematopoietic stem cell transplantation than in those with solid tumors. Clinical suspicion of P. jiroveci pneumonia was less common in patients with nodular infiltrates than in those without such a radiographic finding (7 vs. 39%; p=0.002). Twenty-six of 76 (34%) patients with data available died of P. jiroveci pneumonia. Predictors of death by univariate analysis included older age, tachypnea, high APACHE II score, use of mechanical ventilation or vasopressors, lower arterial pH level, absence of interstitial component, pneumothorax, and comorbid conditions (all p<0.05). Multivariate analysis identified the use of mechanical ventilation as an independent predictor of death. Death attributable to P. jiroveci pneumonia appeared to be higher in patients with hematopoietic stem cell transplantation. The clinical presentation of P. jiroveci pneumonia in cancer patients may be affected by the category of cancer and the history of hematopoietic stem cell transplantation. P. jiroveci pneumonia remains a rare yet severe infection in cancer patients.

Keywords

Hematopoietic Stem Cell Transplantation Invasive Aspergillosis Caspofungin Allogeneic Hematopoietic Stem Cell Transplantation Pentamidine 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgements

We wish to thank Stephanie Deming for editorial assistance. This work was supported in part by The University of Texas M.D. Anderson Faculty E. N. Cobb Scholar Award Research Endowment to D.P.K and a grant from the Puerto Rico Cancer Center (grant no. U54 CA96297) to G.N.

References

  1. 1.
    Sepkowitz KA, Brown AE, Telzak EE, Gottlieb S, Armstrong D (1992) Pneumocystis carinii pneumonia among patients without AIDS at a cancer hospital. JAMA 267:832–837PubMedCrossRefGoogle Scholar
  2. 2.
    Morris A, Lundgren JD, Masur H, Walzer PD, Hanson DL, Frederick T et al (2004) Current epidemiology of Pneumocystis pneumonia. Emerg Infect Dis 10:1713–1720PubMedGoogle Scholar
  3. 3.
    Sepkowitz KA (1993) Pneumocystis carinii pneumonia in patients without AIDS. Clin Infect Dis 17(Suppl 2):S416–S422PubMedGoogle Scholar
  4. 4.
    Schliep TC, Yarrish RL (1999) Pneumocystis carinii pneumonia. Semin Respir Infect 14:333–343PubMedGoogle Scholar
  5. 5.
    Walzer PD, Perl DP, Krogstad DJ, Rawson PG, Schultz MG (1974) Pneumocystis carinii pnenumonia in the United States. Epidemiologic, diagnostic, and clinical features. Ann Intern Med 80:83–93PubMedGoogle Scholar
  6. 6.
    Thomas CF Jr, Limper AH (2004) Pneumocystis pneumonia. N Engl J Med 350:2487–2498PubMedCrossRefGoogle Scholar
  7. 7.
    Lionakis MS, Kontoyiannis DP (2003) Glucocorticoids and invasive fungal infections. Lancet 362:1828–1838PubMedCrossRefGoogle Scholar
  8. 8.
    Sepkowitz KA (2002) Opportunistic infections in patients with and patients without acquired immunodeficiency syndrome. Clin Infect Dis 34:1098–1107PubMedCrossRefGoogle Scholar
  9. 9.
    Sepkowitz KA (1992) Pneumocystis carinii pneumonia among patients with neoplastic disease. Semin Respir Infect 7:114–121PubMedGoogle Scholar
  10. 10.
    Meyers JD, Pifer LL, Sale GE, Thomas ED (1979) The value of Pneumocystis carinii antibody and antigen detection for diagnosis of Pneumocystis carinii pneumonia after marrow transplantation. Am Rev Respir Dis 120:1283–1287PubMedGoogle Scholar
  11. 11.
    Kovacs JA, Hiemenz JW, Macher AM et al (1984) Pneumocystis carinii pneumonia: a comparison between patients with the acquired immunodeficiency syndrome and patients with other immunodeficiencies. Ann Intern Med 100:663–671PubMedGoogle Scholar
  12. 12.
    Russian DA, Levine SJ (2001) Pneumocystis carinii pneumonia in patients without HIV infection. Am J Med Sci 321:56–65PubMedCrossRefGoogle Scholar
  13. 13.
    Limper AH, Offord KP, Smith TF, Martin WJ 2nd (1989) Pneumocystis carinii pneumonia. Differences in lung parasite number and inflammation in patients with and without AIDS. Am Rev Respir Dis 140:1204–1209PubMedGoogle Scholar
  14. 14.
    Roblot F, Godet C, Le Moal G et al (2002) Analysis of underlying diseases and prognosis factors associated with Pneumocystis carinii pneumonia in immunocompromised HIV-negative patients. Eur J Clin Microbiol Infect Dis 21:523–531PubMedCrossRefGoogle Scholar
  15. 15.
    Centers for Disease Control (1993) Revised classification system for HIV infection and expanded surveillance case definition for AIDS among adolescents and adults. MMWR Morbid Mortal Wkly Rep 41:no. RR-17Google Scholar
  16. 16.
    Vasconcelles MJ, Bernardo MV, King C, Weller EA, Antin JH (2000) Aerosolized pentamidine as pneumocystis prophylaxis after bone marrow transplantation is inferior to other regimens and is associated with decreased survival and an increased risk of other infections. Biol Blood Marrow Transplant 6:35–43PubMedCrossRefGoogle Scholar
  17. 17.
    Yale SH, Limper AH (1996) Pneumocystis carinii pneumonia in patients without acquired immunodeficiency syndrome: associated illness and prior corticosteroid therapy. Mayo Clin Proc 71:5–13PubMedCrossRefGoogle Scholar
  18. 18.
    Pagano L, Fianchi L, Mele L et al (2002) Pneumocystis carinii pneumonia in patients with malignant haematological diseases: 10 years’ experience of infection in GIMEMA centres. Br J Haematol 117:379–386PubMedCrossRefGoogle Scholar
  19. 19.
    Worth LJ, Dooley MJ, Seymour JF, Mileshkin L, Slavin MA, Thursky KA (2005) An analysis of the utilisation of chemoprophylaxis against Pneumocystis jiroveci pneumonia in patients with malignancy receiving corticosteroid therapy at a cancer hospital. Br J Cancer 92:867–872PubMedCrossRefGoogle Scholar
  20. 20.
    Cheng VC, Hung IF, Wu AK, Tang BS, Chu CM, Yuen KY (2004) Lymphocyte surge as a marker for immunorestitution disease due to Pneumocystis jiroveci pneumonia in HIV-negative immunosuppressed hosts. Eur J Clin Microbiol Infect Dis 23:512–514PubMedCrossRefGoogle Scholar
  21. 21.
    McGuinness G, Gruden JF (1999) Viral and Pneumocystis carinii infections of the lung in the immunocompromised host. J Thorac Imaging 14:25–36PubMedCrossRefGoogle Scholar
  22. 22.
    Glatt AE, Chirgwin K (1990) Pneumocystis carinii pneumonia in human immunodeficiency virus-infected patients. Arch Intern Med 150:271–279PubMedCrossRefGoogle Scholar
  23. 23.
    Pareja JG, Garland R, Koziel H (1998) Use of adjunctive corticosteroids in severe adult non-HIV Pneumocystis carinii pneumonia. Chest 113:1215–1224PubMedCrossRefGoogle Scholar
  24. 24.
    Bigby TD (1994) Diagnosis of Pneumocystis carinii pneumonia. How invasive? Chest 105:650–652PubMedCrossRefGoogle Scholar
  25. 25.
    Mansharamani NG, Balachandran D, Vernovsky I, Garland R, Koziel H (2000) Peripheral blood CD4+ T-lymphocyte counts during Pneumocystis carinii pneumonia in immunocompromised patients without HIV infection. Chest 118:712–720PubMedCrossRefGoogle Scholar
  26. 26.
    Barbounis V, Aperis G, Gambletsas E et al (2005) Pneumocystis carinii pneumonia in patients with solid tumors and lymphomas: predisposing factors and outcome. Anticancer Res 25:651–655PubMedGoogle Scholar
  27. 27.
    Varthalitis I, Aoun M, Daneau D, Meunier F (1993) Pneumocystis carinii pneumonia in patients with cancer. An increasing incidence. Cancer 71:481–485PubMedCrossRefGoogle Scholar
  28. 28.
    Zahar JR, Robin M, Azoulay E, Fieux F, Nitenberg G, Schlemmer B (2002) Pneumocystis carinii pneumonia in critically ill patients with malignancy: a descriptive study. Clin Infect Dis 35:929–934PubMedCrossRefGoogle Scholar
  29. 29.
    Denning DW (2003) Echinocandin antifungal drugs. Lancet 362:1142–1151PubMedCrossRefGoogle Scholar
  30. 30.
    Powles MA, Liberator P, Anderson J et al (1998) Efficacy of MK-991 (L-743,872), a semisynthetic pneumocandin, in murine models of Pneumocystis carinii. Antimicrob Agents Chemother 42:1985–1989PubMedGoogle Scholar
  31. 31.
    Schmatz DM, Romancheck MA, Pittarelli LA et al (1990) Treatment of Pneumocystis carinii pneumonia with 1,3-beta-glucan synthesis inhibitors. Proc Natl Acad Sci USA 87:5950–5954PubMedCrossRefGoogle Scholar
  32. 32.
    Ito M, Nozu R, Kuramochi T et al (2000) Prophylactic effect of FK463, a novel antifungal lipopeptide, against Pneumocystis carinii infection in mice. Antimicrob Agents Chemother 44:2259–2262PubMedCrossRefGoogle Scholar
  33. 33.
    McNeil MM, Nash SL, Hajjeh RA et al (2001) Trends in mortality due to invasive mycotic diseases in the United States, 1980–1997. Clin Infect Dis 33:641–647PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  • H. A. Torres
    • 1
  • R. F. Chemaly
    • 1
  • R. Storey
    • 1
  • E. A. Aguilera
    • 1
  • G. M. Nogueras
    • 2
  • A. Safdar
    • 1
  • K. V. I. Rolston
    • 1
  • I. I. Raad
    • 1
  • D. P. Kontoyiannis
    • 1
    Email author
  1. 1.Department of Infectious Diseases, Infection Control and Employee HealthThe University of Texas M.D. Anderson Cancer CenterHoustonUSA
  2. 2.Department of BiostatisticsU54 Puerto Rico Cancer CenterSan JuanPuerto Rico

Personalised recommendations