Pneumocystis Pneumonia and the Rheumatologist: Which Patients Are At Risk and How Can PCP Be Prevented?

Purpose of Review Immunosuppressive therapy for connective tissue diseases (CTDs) is steadily becoming more intense. The resultant impairment in cell-mediated immunity has been accompanied by an increasing risk for opportunistic infection (OI). Pneumocystis pneumonia (PCP) has been recognized as an...

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Bibliographic Details
Published in:Current rheumatology reports 2017-06, Vol.19 (6), p.35-35, Article 35
Main Authors: Wolfe, Rachel M., Peacock, James E.
Format: Article
Language:English
Subjects:
Antirheumatic Agents - adverse effects
Antirheumatic Agents - therapeutic use
Female
Humans
Immunosuppressive Agents - adverse effects
Immunosuppressive Agents - therapeutic use
Infection and Arthritis (K Winthrop
Male
Medicine
Medicine & Public Health
Opportunistic Infections - etiology
Pneumonia, Pneumocystis - etiology
Rheumatic Diseases - drug therapy
Rheumatology
Risk Factors
Section Editor
Topical Collection on Infections and Arthritis
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Summary:Purpose of Review Immunosuppressive therapy for connective tissue diseases (CTDs) is steadily becoming more intense. The resultant impairment in cell-mediated immunity has been accompanied by an increasing risk for opportunistic infection (OI). Pneumocystis pneumonia (PCP) has been recognized as an OI in patients with CTDs, but specific risk factors and precise indications for PCP prophylaxis remain poorly defined. This review was undertaken to update information on the risk of PCP in patients with CTDs and to examine current guidelines for PCP prophylaxis in this population. Recent Findings Data on the occurrence of PCP and indications for prophylaxis in patients with CTDs is sparse. Large systematic reviews did not incorporate patients with CTD secondary to the lack of randomized control trials. Upon reviewing guidelines published since 2015, prophylaxis for PCP is recommended only for patients with ANCA-positive vasculitis, specifically granulomatosis with polyangiitis (GPA), who are undergoing intense induction therapy. Summary Evidence-based recommendations for the prophylaxis of PCP in patients with CTDs cannot be provided. There is expert consensus that PCP prophylaxis is warranted in patients with GPA undergoing induction therapy. Prophylaxis should perhaps also be considered for other CTD patients who are receiving similar intense immunosuppressive therapy especially if they are lymphopenic or have a low CD4 count.
ISSN:1523-3774
1534-6307
DOI:10.1007/s11926-017-0664-6