Late onset Pneumocystis jirovecii pneumonia (PJP) in patients with ANCA associated vasculitis

El Hakem Matraiah, Nkiruka Olisaka, Mariana Philipos, David Walbaum, Paula Dospinescu, Nicholas Fluck, Neil Basu, Dana Kidder

Research output: Contribution to journalArticle

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Abstract

Immunosuppression in anti-neutrophil cytoplasmic antibody (ANCA) associated vasculitis (AAV) is complicated by increasing risk of infections including opportunistic infections like, Pneumocystis jirovecii pneumonia (PJP). Available evidence on risk factors and indications for prophylaxis in AAV is derived from PJP occurring early in the course of AAV. In this retrospective study, we characterized the profile of PJP in patients with AAV. PJP cases were identified retrospectively based on positive polymerase chain reaction test from electronic record followed by confirmation from medical records over 10 year period. AAV patients without PJP over the same period were used as control group. Sixteen PJP+AAV+ were identified, in fourteen of them we were able to confirm they received PJP prophylaxis during induction therapy, While in two cases data were missing. The onset of the infection was after 6 months from AAV diagnosis in 80% of cases. Escalations in immunosuppression prior to PJP were observed in six cases within 3 months prior to PJP onset. Overall mortality was 12.5%. By univariate analysis, renal involvement at AAV diagnosis was associated with PJP. These results indicate that PJP is not limited to the first six months following AAV diagnosis. Late onset infection can occur in context of augmented immunotherapy, particularly with concurrent lymphopenia. Other risk factors that can independently predict late onset PJP remains to be identified.
Original languageEnglish
Pages (from-to)1991-1996
Number of pages6
JournalClinical Rheumatology
Volume37
Issue number7
Early online date28 May 2018
DOIs
Publication statusPublished - Jul 2018

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Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis
Pneumocystis carinii
Pneumocystis Pneumonia
Immunosuppression
Infection
Lymphopenia
Opportunistic Infections
Immunotherapy
Medical Records

Keywords

  • Penumocystis jiroveci pneumonia
  • Anti-neutrophil cytoplasmic antibody
  • Vasculitis
  • Prophylaxis
  • Co-trimoxazole

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Late onset Pneumocystis jirovecii pneumonia (PJP) in patients with ANCA associated vasculitis. / Matraiah, El Hakem; Olisaka, Nkiruka; Philipos, Mariana; Walbaum, David; Dospinescu, Paula; Fluck, Nicholas; Basu, Neil; Kidder, Dana.

In: Clinical Rheumatology, Vol. 37, No. 7, 07.2018, p. 1991-1996.

Research output: Contribution to journalArticle

Matraiah, EH, Olisaka, N, Philipos, M, Walbaum, D, Dospinescu, P, Fluck, N, Basu, N & Kidder, D 2018, 'Late onset Pneumocystis jirovecii pneumonia (PJP) in patients with ANCA associated vasculitis', Clinical Rheumatology, vol. 37, no. 7, pp. 1991-1996. https://doi.org/10.1007/s10067-018-4155-6
Matraiah EH, Olisaka N, Philipos M, Walbaum D, Dospinescu P, Fluck N et al. Late onset Pneumocystis jirovecii pneumonia (PJP) in patients with ANCA associated vasculitis. Clinical Rheumatology. 2018 Jul;37(7):1991-1996. https://doi.org/10.1007/s10067-018-4155-6
Matraiah, El Hakem ; Olisaka, Nkiruka ; Philipos, Mariana ; Walbaum, David ; Dospinescu, Paula ; Fluck, Nicholas ; Basu, Neil ; Kidder, Dana. / Late onset Pneumocystis jirovecii pneumonia (PJP) in patients with ANCA associated vasculitis. In: Clinical Rheumatology. 2018 ; Vol. 37, No. 7. pp. 1991-1996.
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