Preventive Effect of Sulfamethoxasole-trimethoprim on Pneumocystis jiroveci Pneumonia in Patients with Interstitial Pneumonia

Tatsuji Enomoto; Arata Azuma; Aki Matsumoto; Takahito Nei; Kazue Fujita; Kumiko Hattori; Yoshinobu Saito; Shinji Abe; Jiro Usuki; Shoji Kudoh

doi:10.2169/internalmedicine.47.0402

ORIGINAL ARTICLES

Preventive Effect of Sulfamethoxasole-trimethoprim on Pneumocystis jiroveci Pneumonia in Patients with Interstitial Pneumonia

Tatsuji Enomoto, Arata Azuma, Aki Matsumoto, Takahito Nei, Kazue Fujita, Kumiko Hattori, Yoshinobu Saito, Shinji Abe, Jiro Usuki, Shoji Kudoh

Author information

Tatsuji Enomoto
Department of Respiratory Medicine, Tokyo Metropolitan Hiroo General Hospital
Division of Pulmonary Diseases, Infection, and Oncology, Nippon Medical School
Arata Azuma
Division of Pulmonary Diseases, Infection, and Oncology, Nippon Medical School
Aki Matsumoto
Division of Pulmonary Diseases, Infection, and Oncology, Nippon Medical School
Takahito Nei
Division of Pulmonary Diseases, Infection, and Oncology, Nippon Medical School
Kazue Fujita
Division of Pulmonary Diseases, Infection, and Oncology, Nippon Medical School
Kumiko Hattori
Department of Respiratory Medicine, Tokyo Metropolitan Hiroo General Hospital
Division of Pulmonary Diseases, Infection, and Oncology, Nippon Medical School
Yoshinobu Saito
Division of Pulmonary Diseases, Infection, and Oncology, Nippon Medical School
Shinji Abe
Division of Pulmonary Diseases, Infection, and Oncology, Nippon Medical School
Jiro Usuki
Division of Pulmonary Diseases, Infection, and Oncology, Nippon Medical School
Shoji Kudoh
Division of Pulmonary Diseases, Infection, and Oncology, Nippon Medical School

Keywords: interstitial pneumonia, pneumocystis pneumonia, circulating CD4+ lymphocyte count, prophylaxis with trimethoprim-sulfamethoxazole, beta-glucan

JOURNAL OPEN ACCESS

2008 Volume 47 Issue 1 Pages 15-20

DOI https://doi.org/10.2169/internalmedicine.47.0402

Details

Abstract

Background Pneumocystis jiroveci pneumonia (PCP) is a potentially fatal complication in interstitial pneumonia patients receiving glucocorticoid therapy. Prophylaxis of PCP during glucocorticoid therapy is an important issue in the treatment of interstitial pneumonia.
Objective We evaluated the prophylactic effect of sulfamethoxasole-trimethoprim (TMP-SMX) in interstitial pneumonia patients receiving glucocorticoids.
Methods We retrospectively analyzed 74 interstitial pneumonia patients who received glucocorticoid therapy.
Results Seven of the 74 patients developed PCP. At the time of diagnosis of PCP, the mean duration of glucocorticoid therapy was 71 days and the mean daily dose of prednisolone was 37 mg. Among the 7 patients, the circulating CD4+ lymphocyte count was 370 /μl on average and it was over 200 /μl in 3 cases. The PCP patients showed a significant reduction of the lymphocyte count at 4 weeks after initiation of steroid therapy. None of the patients who received prophylactic TMP-SMX therapy developed PCP even if the CD4+ lymphocyte count was less than 200 /μl.
Conclusion Interstitial pneumonia patients receiving glucocorticoid therapy can benefit from TMP-SMX prophylaxis against PCP. Development of PCP cannot be ruled out in patients with a CD4+ lymphocyte count of greater than 200 /μl.

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