Pneumocystis jirovecii pneumonia in patients with autoimmune disease on high-dose glucocorticoid.

Abstract

OBJECTIVE:

Indications for Pneumocystis jirovecii pneumonia (PCP) prophylaxis in patients with autoimmune disease remain unclear. We aimed to determine (1) the incidence of PCP in patients with autoimmune disease in general, in a clinical setting where prophylaxis is not routine, and (2) whether high-dose glucocorticoid (≥30 mg oral prednisolone or equivalent per day) is a risk factor for PCP infection.

METHODS:

A retrospective review of the medical records of patients with autoimmune diseases hospitalized to a tertiary center over a 5-year study period was carried out. Patient demographics, mean glucocorticoid dose (in the last 1 month), and the outcomes of patients who developed PCP were analyzed.

RESULTS:

The incidence rate of PCP infection was 75 per 100,000 patients per year. The in-hospital mortality was 50%, and all those who died were on high-dose glucocorticoid at the time of PCP diagnosis. There was a significant difference between the occurrence of PCP in patients who were on high-dose vs non-high-dose glucocorticoid (df = 1, P = 0.009), with a relative risk of 19 (P = 0.010; 95% confidence interval, 2.0-182.8). The mean oral prednisolone dose of patients who developed PCP and those who did not were 55.5 versus 10.7 mg, respectively, P = 0.002.

CONCLUSION:

High-dose glucocorticoid may be associated with an increased risk of PCP infection in patients with autoimmune diseases.

• Authors: Li-Ching Chew, Liza Marie Maceda-Galang, York Kiat Tan, Bibhas Chakraborty, Julian Thumboo
• Journal: Journal of clinical rheumatology : practical reports on rheumatic & musculoskeletal diseases (J Clin Rheumatol) Vol. 21 Issue 2 Pg. 72-5 (Mar 2015) ISSN: 1536-7355 [Electronic] United States
• PMID: 25710857 (Publication Type: Journal Article)

Chemical References

• Anti-Infective Agents
• Glucocorticoids
• Trimethoprim, Sulfamethoxazole Drug Combination
• Prednisolone

Topics

• Adult
• Aged
• Anti-Infective Agents
• Autoimmune Diseases (complications, drug therapy)
• Female
• Glucocorticoids (administration & dosage, adverse effects)
• Humans
• Incidence
• Male
• Middle Aged
• Pneumocystis carinii
• Pneumonia, Pneumocystis (diagnosis, drug therapy, epidemiology)
• Prednisolone (administration & dosage, adverse effects)
• Retrospective Studies
• Risk Factors
• Trimethoprim, Sulfamethoxazole Drug Combination