Pneumocystis jiroveci pneumonia in inflammatory bowel disease: when should prophylaxis be considered?

Abstract:

BACKGROUND:The incidence of inflammatory bowel disease (IBD) has increased over the past several decades with a corresponding increase in the number of patients on combination immunosuppressive therapy including corticosteroids, anti-metabolites and biologic agents. The exact incidence of pneumocystis jiroveci pneumonia (PJP) in IBD patients is unknown but there has been an increase in the number of reports of PJP in IBD patients on combination immunosuppressive therapy. METHODS:We evaluated the published literature describing PJP infections in IBD patients, as well as other non-HIV cohorts and identified risk factors for PJP infection in this group of patients. Prophylaxis and treatment regimens were reviewed. RESULTS:Corticosteroid therapy, lymphopenia (total lymphocyte count < 600 cells/mm), and age greater than 55 years appear to be risk factors for developing pneumocystis jiroveci pneumonia. In addition, PJP mortality is greater in the non-HIV cohort in contrast to the HIV population. No evidence-based guidelines for primary PJP prophylaxis exist to direct practice for gastroenterology providers. CONCLUSIONS:Better surveillance and reporting of opportunistic infections including PJP are needed to elucidate risk factors for acquisition of infection. Gastroenterology providers should continue to evaluate the need for PJP prophylaxis on a case-by-case basis to recognize patients who may benefit from primary PJP prophylaxis. In particular, older patients on corticosteroids, multiple immunosuppressive agents, and patients with lymphopenia should be considered for prophylaxis.

journal_name

Inflamm Bowel Dis

authors

Okafor PN,Nunes DP,Farraye FA

doi

10.1097/MIB.0b013e318281f562

subject

Has Abstract

pub_date

2013-07-01 00:00:00

pages

1764-71

issue

8

eissn

1078-0998

issn

1536-4844

journal_volume

19

pub_type

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