Die Rolle von Pneumocystis jirovecii Infektionen bei Rheuma-Patienten

Zusammenfassung

Bei immunsuppremierten Patienten, Patienten mit einer fortgeschrittenen HIV-Infektion, onkologische Patienten mit und ohne Therapie sowie Patienten mit rheumatologischen Grunderkrankungen kann es zu Infektionen mit Pneumocystis jirovecii kommen. In diesem Artikel wird die in veröffentlichen Analysen / Registerdaten beschriebene Häufigkeit bei Patienten mit verschiedenen rheumatologischen Grunderkrankungen, an einer Pneumocystis jirovecii Infektion zu erkranken und eine Pneumonie zu entwickeln, untersucht. Ferner wird die Frage nach auslösenden antirheumatischen Therapien sowie nach der Notwendigkeit der Gabe einer Prophylaxe gestellt. Insgesamt ist jedoch das Risiko, an einer Infektion mit Pneumocystis jirovecii zu erkranken, für Patienten mit rheumatologischen Grunderkrankungen gering.

Abstract

Infections with Pneumocystis jirovecii can occur in immunocompromised patients, patients with an advanced HIV infection, oncology patients with or without treatment, and in patients with underlying rheumatologic diseases. This article examines the frequency of Pneumocystis infection and pneumonia in patients with various underlying rheumatologic diseases as described in published analyses/registry data. Furthermore, the question of triggering antirheumatic therapies and the need for prophylaxis is raised. Overall, however, the risk of developing Pneumocystis jirovecii infection in patients with underlying rheumatologic diseases is low.

Schlüsselwörter

Pneumocystis Pneumonie - Rheumatoide Arthritis - Cotrimoxazol - Granulomatose mit Polyangiitis

Key words

Pneumocystis pneumonia - Cotrimoxazol - pneumatoid arthritis - granulomatosis with polyangiitis

Publication History

Article published online:
28 November 2023

• Literatur

• 1 Stringer JR, Beard CB, Miller R. et al. A new name (Pneumocystis jiroveci) for Pneumocystis from humans. In: Emerg Infect Dis. 8. Jahrgang, Nr. 9 2002. S 891-898 PMID 12194762
• 2 Index Fungorum
• 3 Rüchel R. Pneumocystis jiroveci. In: Birgid Neumeister, Heinrich K. Geiss, Rüdiger W. Braun, Peter Kimmig (Hrsg.): Mikrobiologische Diagnostik. 2. Auflage. Thieme; Stuttgart – New York: 2009. ISBN 978-3-13-743602-7. S 668-672
• 4 Thomas CF, Limper AH. Pneumocystis pneumonia. N Engl J Med 2004; 350: 2487-2498
• 5 Charpentier E, Menard S, Marques C. et al. Immunantwort bei Pneumocystis-Infektionen entsprechend dem Status des Immunsystems des Wirts. J Pilze (Basel) 2021; 7: 625
• 6 Asai N, Motojima S, Ohkuni Y. et al. Pathophysiologischer Mechanismus der Nicht-HIV-Pneumocystis-jirovecii-Pneumonie. Respir Investig 2022; 60: 522-530
• 7 Roux A, Gonzalez F, Roux M. et al. Groupe de recherche respiratoire en reanimation en onco-hématologie (Grrr-OH). Update on pulmonary Pneumocystis jirovecii infection in non-HIV patients. Médecine et Maladies Infectieuses 2014; 44: 185-198
• 8 Stamp LK, Hurst M. Is there a role for consensus guidelines for P. jiroveci pneumonia prophylaxis in immunosuppressed patients with rheumatic diseases?. JRheumatol 2010; 37: 686-688
• 9 Falagas ME, Manta KG, Betsi GI. et al. Infection-related morbidity and mortality in patients with connective tissue diseases: a systematic review. Clin Rheumatol 2007; 26: 663-670
• 10 Kadoya A, Okada J, Iikuni Y. et al. Risk factors for Pneumocystis carinii pneumonia in patients with polymyositis/dermatomyositis or systemic lupus erythematosus. J Rheumatol 1996; 23: 1186-1188
• 11 Sepkowitz KA. Opportunistic infections in patients with and patients without Acquired Immunodeficiency Syndrome. Clin Infect Dis 2002; 34: 1098-1107
• 12 Suryaprasad A, Stone JH. When is it safe to stop Pneumocystis jiroveci pneumonia prophylaxis? Insights from three cases complicating autoimmune diseases. Arthritis Rheum 2008; 59: 1034-1039
• 13 Mecoli CA, Saylor D, Gelber AC. et al. Pneumocystis jiroveci pneumonia in rheumatic disease: a 20-year single-centre experience. Clin Exp Rheumatol 2017; 35: 671-673
• 14 Singer NG, McCune WJ. Prevention of infectious complications in rheumatic disease patients: immunization, Pneumocystis carinii prophylaxis, and screening for latent infections. Current Opinion in Rheumatology 1999; 11: 173-178
• 15 Mori S, Ueki Y, Miyamura T. et al. Outcomes and Risk Factors for Mortality in Pneumocystis Pneumonia Patients with Rheumatoid Arthritis: A Multicenter Retrospective Cohort Study. Mod Rheumatol 2022; roac 088
• 16 Fragoulis GE, Nikiphorou E, Dey M. et al EULAR recommendations for screening and prophylaxis of chronic and opportunistic infections in adults with autoimmune inflammatory rheumatic diseases. Ann Rheum Dis 2022; ard-2022-223335 DOI: 10.1136/ard-2022-223335.. Epub ahead of print PMID: 36328476
• 17 Stern A, Green H, Paul M. et al. Prophylaxis for Pneumocystis pneumonia (PCP) in non HIV immunocompromised patients. Cochrane Database Syst Rev 2014; CD005590
• 18 Schmajuk G, Jafri K, Evans M. et al. Pneumocystis jirovecii pneumonia (PJP) prophylaxis patterns among patients with rheumatic diseases receiving high-risk immunosuppressant drugs. Semin Arthritis Rheum 2019; 48: 1087-1092
• 19 Boone B, Lazaroff SM, Wheless L. et al. Rates of Pneumocystis jirovecii pneumonia an prophylaxis prescribing patterns in a large electronic health record cohort of patients with systemic lupus erythematosus. Semin. Arthritis Rheum. 2022; 57: 152106