trimethoprim--sulfamethoxazole-drug-combination and Primary-Myelofibrosis

Nocardiosis is an infection caused by a soil-borne aerobic micro-organism. The pathogen is most commonly introduced in humans by inhalation into the respiratory tract. This infection may be transient and subclinical or may result in an acute or chronic bronchopulmonary process. Although an unusual cause of pulmonary infection in immunocompentent individuals, human nocardiosis is now documented more often in patients whose cell-mediated immunity is compromised by immunosuppression from comorbid disease or as a result of modern medical intervention. The diagnosis is often elusive unless a high index of suspicion is maintained. We present a patient with localized pulmonary nocardiosis who was immunosuppressed by virtue of a myeloproliferative disorder.

Topics: Aged; Anti-Infective Agents; Biopsy, Needle; Bronchoscopy; Follow-Up Studies; Humans; Immunocompromised Host; Lung; Lung Diseases; Male; Neural Tube Defects; Nocardia asteroides; Nocardia Infections; Primary Myelofibrosis; Radiography, Thoracic; Solitary Pulmonary Nodule; Time Factors; Tomography, X-Ray Computed; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

A retrospective survey was conducted over a 10-year period (1990-99) among 52 haematology divisions in order to evaluate the clinical and laboratory characteristics and outcome of patients with proven Pneumocystis carinii pneumonia (PCP) complicating haematological diseases. The study included 55 patients (18 with non-Hodgkin's lymphoma, 10 with acute lymphoblastic leukaemia, eight with acute myeloid leukaemia, five with chronic myeloid leukaemia, four with chronic lymphocytic leukaemia, four with multiple myeloma, three with myelodysplastic syndrome, two with myelofibrosis and one with thalassemia) who developed PCP. Among these, 18 (33%) underwent stem cell transplantation; only two received an oral prophylaxis with trimethroprim/sulphamethoxazole. Twelve patients (22%) developed PCP despite protective isolation in a laminar airflow room. The most frequent symptoms were: fever (86%), dyspnoea (78%), non-productive cough (71%), thoracic pain (14%) and chills (5%); a severe hypoxaemia was present in 39 patients (71%). Chest radiography or computerized tomography showed interstitial infiltrates in 34 patients (62%), alveolar infiltrates in 12 patients (22%), and alveolar-interstitial infiltrates in nine patients (16%). Bronchoalveolar lavage was diagnostic in 47/48 patients, induced sputum in 9/18 patients and lung biopsy in 3/8 patients. The diagnosis was made in two patients at autopsy. All patients except one started a specific treatment (52 patients trimethroprim/sulphamethoxazole, one pentamidine and one dapsone). Sixteen patients (29%) died of PCP within 30 d of diagnosis. Multivariate analysis showed that prolonged steroid treatment (P < 0.006) and a radiological picture of diffuse lung involvement (P < 0.003) were negative diagnostic factors.

Topics: Acute Disease; Adolescent; Adult; Aged; Anti-Infective Agents; Bronchoalveolar Lavage Fluid; Female; Hematologic Neoplasms; Humans; Immunocompromised Host; Leukemia, Lymphocytic, Chronic, B-Cell; Leukemia, Myelogenous, Chronic, BCR-ABL Positive; Leukemia, Myeloid; Lung; Lymphoma, Non-Hodgkin; Male; Middle Aged; Multiple Myeloma; Multivariate Analysis; Myelodysplastic Syndromes; Pneumonia, Pneumocystis; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Primary Myelofibrosis; Radiography; Retrospective Studies; Thalassemia; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination