trimethoprim--sulfamethoxazole-drug-combination and Pulmonary-Aspergillosis

Pneumocystis jirovecii is the causative agent of Pneumocystis pneumonia (PcP), a common and often life-threatening opportunistic infection in HIV-infected patients. However, non-HIV, immunocompromised patients are at risk of PcP as well, whereas the mortality appears to be higher among these patients. Pneumocystis co-infections with other microorganisms are less frequent and only sparse reports of combined PcP and invasive pulmonary fungal infections exist in the literature, especially in the non-HIV patients. Two cases of pulmonary co-infections by P. jirovecii and Aspergillus fumigatus are presented. Both patients were non-HIV infected, the first one was suffering from crescentic IgA nephropathy under immunosuppressive treatment and the second from resistant non-Hodgkin lymphoma under chemotherapy. Both patients were treated with intravenous trimethoprim/sulphamethoxazole (TMP/SMX) combined with voriconazole. The first patient showed gradual clinical improvement while the outcome for the second patient was unfavourable. In addition, a literature review of the previous published cases of co-infection by P. jirovecii and other fungi in non-HIV patients was performed. Our target was to provide comprehensive information on this kind of infections, highlighting the importance of clinical suspicion.

Topics: Adult; Aged, 80 and over; AIDS-Related Opportunistic Infections; Aspergillus fumigatus; Coinfection; Female; Humans; Immunocompromised Host; Immunosuppressive Agents; Invasive Fungal Infections; Lung; Male; Middle Aged; Pneumocystis carinii; Pneumonia, Pneumocystis; Pulmonary Aspergillosis; Retrospective Studies; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Anti-Infective Agents; Antifungal Agents; Biopsy; Diagnosis, Differential; Fever; Granulomatous Disease, Chronic; Humans; Infant, Newborn; Itraconazole; Lung; Male; Pulmonary Aspergillosis; Radiography, Interventional; Tomography, X-Ray Computed; Trimethoprim, Sulfamethoxazole Drug Combination; Voriconazole

Pulmonary nocardiosis is a rare but severe infection caused by Nocardia species. This study aimed at describing the clinical characteristics and prognosis of pulmonary nocardiosis.. An observational, retrospective study was undertaken of patients diagnosed with pulmonary nocardiosis over a 13-year period at the Kinki-Chuo Chest Medical Center, Osaka, Japan.. Seven patients with airway nocardial colonization and 59 patients with pulmonary nocardiosis were identified, one of whom had disseminated nocardiosis. Patients with pulmonary nocardiosis were predominantly male patients (73%), with a mean age of 66 (range, 15-88) years. New-onset cough and dyspnea were the most common manifestations (76%). Although 52 (88%) patients had at least one underlying pulmonary disease, most patients did not appear to be systemically immunocompromised. The predominant abnormality on chest computed tomography in pulmonary nocardiosis was airspace consolidation (52%), sometimes associated with cavitation. Multivariate Cox proportional-hazards analysis revealed the following significant and independent risk factors for overall mortality: age >68 years (hazard ratio [HR], 4.7; 95% confidence interval [CI], 1.6-14; p=0.05), pulmonary aspergillosis (HR, 8.8; 95% CI, 2.4-33; p=0.01), and trimethoprim/sulfamethoxazole (TMP-SMZ) resistance (HR, 4.3; 95% CI, 1.6-11; p=0.04).. Clinicians should be aware that pulmonary nocardiosis can occur even in immunocompetent patients, especially those with an underlying pulmonary disease. In pulmonary nocardiosis, older age, pulmonary aspergillosis, and TMP-SMZ resistance are associated with increased risk of mortality.

Topics: Age Factors; Aged; Aged, 80 and over; Drug Resistance, Bacterial; Female; Humans; Immunocompetence; Male; Middle Aged; Nocardia Infections; Pulmonary Aspergillosis; Retrospective Studies; Risk; Risk Factors; Sex Factors; Time Factors; Trimethoprim, Sulfamethoxazole Drug Combination