Pneumocystis jirovecii: a review with a focus on prevention and treatment

医学 耶氏肺孢子虫 重症监护医学 氨苯砜 戊脒 肺炎 甲氧苄啶 肺孢子虫肺炎 阿托瓦库恩 克林霉素 免疫学 内科学 抗生素 疟疾 微生物学 恶性疟原虫 生物
作者
R. Benson Weyant,Dima Kabbani,Karen Doucette,Cecilia Lau,Carlos Cervera
出处
期刊:Expert Opinion on Pharmacotherapy [Taylor & Francis]
卷期号:22 (12): 1579-1592 被引量:68
标识
DOI:10.1080/14656566.2021.1915989
摘要

Introduction: Pneumocystis jirovecii (PJ) is an opportunistic fungal pathogen that can cause severe pneumonia in immunocompromised hosts. Risk factors for Pneumocystis jirovecii pneumonia (PJP) include HIV, organ transplant, malignancy, certain inflammatory or rheumatologic conditions, and associated therapies and conditions that result in cell-mediated immune deficiency. Clinical signs of PJP are nonspecific and definitive diagnosis requires direct detection of the organism in lower respiratory secretions or tissue. First-line therapy for prophylaxis and treatment remains trimethoprim-sulfamethoxazole (TMP-SMX), though intolerance or allergy, and rarely treatment failure, may necessitate alternate therapeutics, such as dapsone, pentamidine, atovaquone, clindamycin, primaquine and most recently, echinocandins as adjunctive therapy. In people living with HIV (PLWH), adjunctive corticosteroid use in treatment has shown a mortality benefit.Areas covered: This review article covers the epidemiology, pathophysiology, diagnosis, microbiology, prophylaxis indications, prophylactic therapies, and treatments.Expert opinion: TMP-SMX has been first-line therapy for treating and preventing pneumocystis for decades. However, its adverse effects are not uncommon, particularly during treatment. Second-line therapies may be better tolerated, but often sacrifice efficacy. Echinocandins show some promise for new combination therapies; however, further studies are needed to define optimal antimicrobial therapy for PJP as well as the role of corticosteroids in those without HIV.
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