trimethoprim--sulfamethoxazole-drug-combination and Leukemia-Lymphoma--Adult-T-Cell

Topics: Anti-Bacterial Agents; Antibodies, Monoclonal, Humanized; Antineoplastic Agents, Immunological; Diuretics; Drug Eruptions; Esomeprazole; Factor Xa Inhibitors; Fatal Outcome; Female; Furosemide; Humans; Immunologic Factors; Lenalidomide; Leukemia-Lymphoma, Adult T-Cell; Middle Aged; Proton Pump Inhibitors; Pyridines; Thiazoles; Trimethoprim, Sulfamethoxazole Drug Combination

Adult T-cell leukemia/lymphoma (ATLL) is usually preceded by infection with human T-cell lymphotropic virus I (HTLV-I). Patients with ATLL frequently get opportunistic infections of the lungs, intestines, and central nervous system. Pneumocystis pneumonia is commonly known as an AIDS defining illness. Grocott's methenamine silver stain of bronchoalveolar lavage (BAL) samples obtained via bronchoscopy remain the gold standard for diagnosis. Pulmonary cryptococcosis is seen in patients with T-cell deficiencies and a diagnosis is made by culture of sputum, BAL, or occasionally of pleural fluid. We present the second case of coinfection with these two organisms in a patient with ATLL who was successfully treated with trimethoprim-sulfamethoxazole, corticosteroids, and fluconazole. We illustrate the need for high clinical vigilance for seeking out an additional diagnosis, especially in immunocompromised patients if they are not improving despite receiving appropriate treatment.

Topics: Adrenal Cortex Hormones; Anti-Infective Agents; Antifungal Agents; Cryptococcosis; Cryptococcus neoformans; Drug Therapy, Combination; Fluconazole; Humans; Immunocompromised Host; Leukemia-Lymphoma, Adult T-Cell; Male; Middle Aged; Opportunistic Infections; Pneumocystis carinii; Pneumonia, Pneumocystis; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

This study aimed to quantify the risks of Pneumocystis pneumonia (PCP) among adult T-cell leukaemia (ATL) patients without prophylaxis. We used hospital administrative data collected nationwide in Japan over 4 years. The research design was a retrospective cohort study. Subjects were 4369 patients diagnosed with ATL aged 18 years or older. The subjects were categorized into four treatment groups: no agent, chemotherapy, chemotherapy + steroids and steroids. We described the risks of PCP among ATL patients without prophylaxis. Risks of PCP were 3·2% for the no agent group, 9·7% for the chemotherapy group, 10·0% for the chemotherapy + steroids group and 16·6% for the steroids group. Logistic regression analyses showed that the chemotherapy, chemotherapy + steroids and steroids groups had significantly higher risk of PCP than did the no agent group [adjusted odds ratio (AOR) 3·30 (1·55-7·02), P = 0·002 for the chemotherapy group; AOR 3·35 (2·18-5·17), P < 0·001 for the chemotherapy + steroids group; AOR 6·12 (3·99-9·38), P < 0·001 for the steroids group]. In conclusion, the chemotherapy, chemotherapy + steroids and steroids groups had significantly higher risks of PCP. Prophylaxis for PCP among ATL patients being treated with chemotherapy, chemotherapy + steroids and steroids is highly recommended.

Topics: Adrenal Cortex Hormones; Aged; Antifungal Agents; Antineoplastic Combined Chemotherapy Protocols; Chemotherapy-Induced Febrile Neutropenia; Comorbidity; Cross Infection; Drug Synergism; Female; Humans; Japan; Leukemia-Lymphoma, Adult T-Cell; Male; Middle Aged; Pentamidine; Pneumocystis carinii; Pneumonia, Pneumocystis; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Adult; Antibodies, Monoclonal, Humanized; Antifungal Agents; Antineoplastic Combined Chemotherapy Protocols; Cohort Studies; Female; Humans; Leukemia-Lymphoma, Adult T-Cell; Male; Pneumocystis carinii; Pneumonia, Pneumocystis; Receptors, CCR4; Retrospective Studies; Trimethoprim, Sulfamethoxazole Drug Combination