Combined Trimethoprim and Caspofungin Treatment for Severe Pneumocystis Jiroveci Pneumonia in a Five Year Old Boy with Acute Lymphoblastic Leukemia

Abstract

Caspofungin was used for the first time with trimethoprim/sulfamethoxazole (TMP/SMX) for treatment of high risk Pneumocystis jiroveci pneumonia (PCP) in a pediatric immunocompromised patient. Despite the need for mechanical ventilation, the pediatric patient with relapsed acute lymphoblastic leukemia improved within nine days of treatment and showed no major side effects. The apparent relative lack of toxicity and of pharmacokinetic drug interactions makes caspofungin an attractive agent.

Zusammenfassung

Caspofungin wurde zum ersten Mal in Kombination mit Trimethoprim/Sulfamethoxazol (TMP/SMX) für die Behandlung einer Pneumocystis-jiroveci-Pneumonie (PCP) bei einem pädiatrischen immunsupprimierten Patienten eingesetzt. Trotz Beatmungspflichtigkeit kam es bei dem Patienten mit dem Rezidiv einer akuten lymphatischen Leukämie nach neuntägiger Behandlung zu einer deutlichen Besserung der klinischen Situation ohne größere Nebenwirkungen. Die gute Verträglichkeit und das Fehlen von pharmakokinetischen Interaktionen machen Caspofungin zu einem attraktiven Wirkstoff.

pneumocystis jiroveci pneumonia - acute respiratory failure - immunosuppression

Pneumocystis-jiroveci-Pneumonie - akute Ateminsuffizienz - Immunsuppression

References

• 1 Annaloro C, Della Volpe A, Usardi P, Lambertenghi Deliliers G. Caspofungin treatment of Pneumocystis pneumonia during conditioning for bone marrow transplantation.  Eur J Clin Microbiol Infect Dis. 2005;  20 1-3
• 2 Eckert C, Biondi A, Seeger K. et al . Prognostic value of minimal residual disease in relapsed childhood acute lymphblastic leukaemia.  Lancet. 2001;  358 1239-1241
• 3 Ewig S, Bauer T, Schneider C. et al . Clinical characteristics and outcome of Pneumocystis jiroveci pneumonia in HIV-infected and otherwise immunosuppressed patients.  Eur Respir J. 1995;  8 1548-1553
• 4 Groll A H, Lehrnbecher T. New antifungal drugs and the pediatric cancer patient: current status of clinical development.  Klin Padiatr. 2005;  217 158-168
• 5 Groll A H, Ritter J. Diagnosis and management of fungal infections and pneumocystis pneumonitis in pediatric cancer patients.  Klin Padiatr. 2005;  217 (Suppl 1) S 37-S 66
• 6 Groll A H, Walsh T J. Caspofungin: pharmacology, safety and therapeutic potential in superficial and invasive fungal infections.  Expert Opin Investig Drugs. 2001;  10 1545-1558
• 7 Harms D O, Janka-Schaub G E. Co-operative study group for childhood acute lymphblastic leukemia (COALL): long-term follow-up of trials 82, 85, 89 and 92.  Leukemia. 2000;  14 2234-2239
• 8 Pagano L, Fianchi L, Mele L. et al . Pneumocystis jiroveci pneumonia in patients with malignant haematological diseases: 10 years' experience of infection in GIMEMA centres.  Br J Haematol. 2002;  117 379-386
• 9 Powles M A, Liberator P, Anderson J. et al . Efficacy of MK-991 (L-743, 872), a semisynthetic pneumocandin, in murine models of Pneumocystis jiroveci.  Antimicrob Agents Chemother. 1998;  42 1985-1989
• 10 Roblot F, Godet C, Le Moal G. et al . Analysis of underlying diseases and prognosis factors associated with Pneumocystis jiroveci pneumonia in immunocompromised HIV-negative patients.  Eur J Clin Microbiol Infect Dis. 2002;  21 523-531
• 11 Yang C H, Yang L J, Jaing T H, Chan H L. Toxic epidermal necrolysis following combination of methotrexate and trimethoprim-sulfamethoxazole.  Int J Dermatol. 2000;  39 621-623
• 12 Zahar J R, Robin M, Azoulay E. et al . Pneumocystis jiroveci pneumonia in critically ill patients with malignancy: a descriptive study.  Clin Infect Dis. 2002;  35 929-934