trimethoprim--sulfamethoxazole-drug-combination and Lymphoproliferative-Disorders

Thanks to a simplification of surgical techniques, single or double lung transplants have expanded significantly in latter years. Infection remains an important cause for morbidity and mortality, more so in early rather than late stages. Bacterial infections cause approximately fifty per cent of all infections. They can be prevented in part by prophylaxis. Infections to CMV have become less frequent thanks to adequate prophylaxis with ganciclovir. Herpetic infections are prevented by acyclovir or ganciclovir. A better control of immunosuppression seems to be associated with fewer lymphoproliferative disorders secondary to the Epstein-Barr virus. Respiratory viruses remain a serious threat for these patients, although infections due to respiratory syncitial virus may be attenuated by ribavirine. Fungal infections are dangerous but prophylactic prescription of azole derivatives have reduced the incidence and severity. Prophylaxis of infections to Pneumocystis carinii is essential, the use of sulfamethoxazole trimethoprim is efficacious against this as well as nocardiosis. Infections to Mycobacterium tuberculosis are often atypical and should be looked for and anticipated whenever possible.

Topics: Acyclovir; Antibiotic Prophylaxis; Antifungal Agents; Antiviral Agents; Bacterial Infections; Chemoprevention; Cytomegalovirus Infections; Ganciclovir; Graft Survival; Heart-Lung Transplantation; Herpesviridae Infections; Herpesvirus 4, Human; Humans; Immunosuppression Therapy; Lung Transplantation; Lymphoproliferative Disorders; Mycobacterium Infections, Nontuberculous; Nocardia Infections; Pneumonia, Pneumocystis; Respiratory Syncytial Virus Infections; Ribavirin; Survival Rate; Trimethoprim, Sulfamethoxazole Drug Combination; Tuberculosis, Pulmonary; Tumor Virus Infections; Virus Diseases

Guidelines for primary Pneumocystis jirovecii pneumonia (PCP) prophylaxis for patients with hematologic malignancy (HM) are still lacking. Our objective was to identify risk factors for PCP among patients with HM to help recognize patients who would benefit from primary PCP prophylaxis.. We performed a case-control study of adult patients with HM and negative for human immunodeficiency virus and with confirmed PCP by using cytology or histopathology from 2 medical centers over an 11-year period. Each case was matched with 4 patients without PCP by type of HM and year of treatment. We compared demographic, clinical, and laboratory data among cases and controls. Data were analyzed by using SPSS version 18.0.. Fourteen cases and 56 controls were included in the study period. No significant differences were seen in demographics between both groups. All identified patients had lymphoproliferative HM, the majority of patients (93%) had either non-Hodgkin lymphoma or chronic lymphocytic leukemia. Autoimmune diseases were more frequent in cases vs. controls (28.6% vs. 5.4% P = .01). The receipt and duration of chemotherapy were similar in both groups. Among chemotherapeutic agents, including steroids, only fludarabine was associated with increased risk for PCP (50% vs. 17.9%; P = .02). No difference was found in total or lymphocyte percentage in cases at the time of PCP diagnosis vs. nadir values in controls.. Patients with lymphoproliferative HM, specifically chronic lymphocytic leukemia and non-Hodgkin lymphoma, who are receiving fludarabine and with autoimmune disorders are at increased risk for PCP and should be considered for PCP primary prophylaxis.

Topics: Aged; Aged, 80 and over; Antineoplastic Agents; Case-Control Studies; Cladribine; Female; Humans; Leukemia, Lymphocytic, Chronic, B-Cell; Lymphoma, Non-Hodgkin; Lymphoproliferative Disorders; Male; Middle Aged; Pneumocystis carinii; Pneumonia, Pneumocystis; Retrospective Studies; Risk Factors; Time Factors; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Vidarabine

A 49-year-old man with advanced HIV/AIDS on anti-retroviral therapy (HAART) and trimethoprim-sulfamethoxazole (TMP-SMX) presented with a several-month history of pruritic, erythematous, lichenified papules that coalesced into hyperkeratotic plaques on the trunk and extremities in a sun-exposed distribution. He shortly thereafter developed a progressive depigmentation over more than 80 percent of his body surface area. A biopsy specimen of an erythematous plaque on the trunk showed a superficial and mid-dermal infiltrate of lymphocytes with eosinophils, most consistent with either chronic lichenoid drug eruption or atypical lymphoproliferative disorder (ACLD) of HIV. The patient's lichenoid skin disease has persisted despite discontinuation of TMP-SMX, although it has improved partially with administration of topical glucocorticoids and acitretin. His depigmentation has continued to progress. We discuss the overlapping diagnostic entities which may be comprised by this patient's clinical disease, and highlight a unique presentation of the complex interaction between HIV infection and the skin.

Topics: Acitretin; Acquired Immunodeficiency Syndrome; Anti-HIV Agents; Antiretroviral Therapy, Highly Active; Bacteremia; Diagnosis, Differential; Disease Progression; Eczema; Erythema; Glucocorticoids; Herpes Simplex; Humans; Lichenoid Eruptions; Lymphoma, T-Cell, Cutaneous; Lymphoproliferative Disorders; Male; Middle Aged; Photosensitivity Disorders; Pseudolymphoma; Trimethoprim, Sulfamethoxazole Drug Combination; Ultraviolet Therapy; Vitiligo

Posttransplant lymphoproliferative disorder (PTLD) is a serious complication after solid organ transplantation. An elevated serum lactate dehydrogenase (LDH) is a marker of PTLD activity. We report the case of a 58-year-old female renal transplant patient with a prior history of extranodal PTLD, which developed 19 years after a second transplant. She was successfully treated with rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone (R-CHOP) and maintained subsequently on sirolimus and prednisone. She presented 3 years later with fever, dyspnea, cough, lung infiltrates and elevated serum LDH concerning for recurrence of PTLD. Bronchoscopy revealed Pneumocystis carinii (jiroveci) pneumonia. The patient was treated with trimethoprim-sulfamethoxazole, but developed nausea and was converted to dapsone. The patient was readmitted 4 weeks later with increasing dyspnea and hypoxemia and found to have a methemoglobin level of 16%. Dapsone was discontinued with resolution of all symptoms. We discuss the diagnostic and clinical challenges in this complex case.

Topics: Anti-Infective Agents; Biomarkers; Dapsone; Female; Humans; Kidney Transplantation; L-Lactate Dehydrogenase; Lymphoproliferative Disorders; Middle Aged; Pneumocystis Infections; Postoperative Complications; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: 2-Aminopurine; Alemtuzumab; Antibiotic Prophylaxis; Antibodies, Monoclonal; Antibodies, Monoclonal, Humanized; Antibodies, Monoclonal, Murine-Derived; Antibodies, Neoplasm; Antigens, CD; Antigens, Neoplasm; Antineoplastic Agents; Bone Marrow Transplantation; CD52 Antigen; Clinical Trials as Topic; Cytomegalovirus Infections; Disease Susceptibility; Famciclovir; Ganciclovir; Glycoproteins; Graft vs Host Disease; Humans; Immunologic Deficiency Syndromes; Immunosuppressive Agents; Incidence; Infections; Lymphoproliferative Disorders; Opportunistic Infections; Pneumonia, Pneumocystis; Rituximab; Transplantation Conditioning; Trimethoprim, Sulfamethoxazole Drug Combination; Viremia; Virus Activation

To characterize clinical, diagnostic and course features of pneumonia caused by Pneumocystis carinii (PC) in hematologic inpatients.. 27 patients with blood diseases were studied. 22 of them had acute respiratory insufficiency and 5 had unclear lung affection. The data from bronchoalveolar lavage (BAL), lung biopsy, serum tests for IgG, IgM anti-PC-antibodies were used for diagnosis of PC-pneumonia.. PC-pneumonia was diagnosed in 8 of 27 patients. Clinical manifestations characteristic for PC-pneumonia were not found. In 5 patients the diagnosis was made on the evidence provided by BAL. Lymphocyte count in BAL was elevated to 27.7 +/- 8.7%. Open biopsy of the lung and transbronchial biopsy diagnosed PC-pneumonia in 2 and 1 patients, respectively. Previous BAL examinations failed to detect PC-pneumonia in 2 of them. In all the patients PC-pneumonia was associated with another infection (bacterial, cytomegaloviral). Histologically, the picture of the disease was determined by the severity of the lung affection or its complications. 5 of 8 patients failed treatment with trimethoprim-sulphamethoxazole and died. Marked respiratory insufficiency was registered at PC-pneumonia diagnosis in all the lethal cases.. Clinical and x-ray pictures of PC-pneumonia in hemoblastosis patients are not specific. All such patients with symptoms of lung infection resistant to antibacterial and antifungal therapy should be examined for PC-pneumonia.

Topics: Acute Disease; Adolescent; Adult; Aged; Anemia, Aplastic; Anemia, Refractory, with Excess of Blasts; Anti-Infective Agents; Biopsy; Bronchoalveolar Lavage Fluid; Female; Hematologic Diseases; Humans; Leukemia, Myelogenous, Chronic, BCR-ABL Positive; Leukemia, Myeloid; Lung; Lymphoproliferative Disorders; Male; Middle Aged; Multiple Myeloma; Pneumonia, Pneumocystis; Radiography, Thoracic; Respiratory Insufficiency; Tomography, X-Ray Computed; Trimethoprim, Sulfamethoxazole Drug Combination

In order to reveal the activity of polymorphonuclear neutrophil leukocytes (PMNL) representing the first step of defence against infections, measurements of chemiluminescence (CL) were performed in patients suffering from acquired immune deficiency syndrome (AIDS), lymphadenopathy, or hemophilia. In comparison with healthy controls, AIDS patients revealed significant reduction (about 50 per cent) of phagocytic, i.e. CL activity of neutrophils, which had been induced by Zymosan. Only part of the patients suffering from lymphadenopathy answered with decreased granulocyte activity on the application of Zymosan. If concanavalin A was used as stimulant of metabolic activity of PMNL-independently of phagocytosis-again AIDS and some of the lymphadenopathy patients showed a markedly reduced neutrophil response. In conclusion it should be stated that there is some evidence for at least two defects of cellular immunity associated with AIDS and to some extent, with AIDS-endangered homosexuals suffering from lymphadenopathy: first the defect of PMNL to answer to concanavalin A with increased metabolic activity, and secondly the defect of PMNL to start phagocytosis induced by Zymosan with a subsequent release of oxygen radicals which are measurable as chemiluminescence. The appraisal of granulocyte activity by means of measurements of chemiluminescence might become an additional criterion for AIDS diagnostics.

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Anti-Infective Agents, Urinary; Concanavalin A; Drug Combinations; Hemophilia A; Humans; Immunoglobulins; Luminescent Measurements; Luminol; Lymphoproliferative Disorders; Male; Neutrophils; Phagocytosis; Sulfamethoxazole; T-Lymphocytes, Helper-Inducer; T-Lymphocytes, Regulatory; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Zymosan