Abstract

BACKGROUND: Opportunistic infection has been documented in systemic lupus erythematosus with special attention paid to Pneumocystis jirovecii because of the significant morbidity and high mortality. OBJECTIVES: The limited large-scale investigations covering P. jirovecii pneumonia (PCP) in systemic lupus erythematosus following biologics or immunosuppressants therapy prompted us to perform this study in southern Taiwan. METHODS: A retrospective study was completed in 858 hospitalized lupus patients from January 2000 to December 2011. The definite diagnosis of PCP was made by the laboratory detection of Pneumocystis organisms together with consistent clinical and radiological manifestations of PCP. Positive polymerase chain reaction results of sputum samples were not regarded as infection in this study, unless P. jirovecii was the sole pathogen found and pulmonary manifestations resolved following antibiotics for PCP treatment alone. RESULTS: The laboratory identification of Pneumocystis organisms depended on lung biopsy in 2 cases and bronchoalveolar lavage in 3 patients. Five cases, 2 women and 3 men aged 30 to 50 years (41.8 ± 8.8 years), were identified with a 0.6% incidence. None received chemoprophylactics against P. jirovecii infection. All had lupus nephritis and lymphopenia with low CD4 T-cell counts. Prior usages of higher daily prednisolone dosages and concomitant biologics or immunosuppressants were observed in all patients. Pneumocystis jirovecii pneumonia contributed to a high mortality rate (60%). CONCLUSIONS: We report the rare occurrence but high mortality of PCP infection in this study. A consensus guideline addressing prophylactic antibiotics against Pneumocystis organisms in highest-risk lupus patients on biologics or immunosuppressants could be helpful in guiding their management.

Original languageEnglish
Pages (from-to)252-258
Number of pages7
JournalJournal of Clinical Rheumatology
Volume19
Issue number5
DOIs
Publication statusPublished - 2013 Aug 1

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Pneumocystis carinii
Pneumocystis Pneumonia
Taiwan
Systemic Lupus Erythematosus
Pneumocystis
Immunosuppressive Agents
Biological Products
Mortality
Pneumocystis Infections
Anti-Bacterial Agents
Lung
Lymphopenia
Lupus Nephritis
Opportunistic Infections
Bronchoalveolar Lavage
CD4 Lymphocyte Count
Prednisolone
Infection
Sputum
Retrospective Studies

All Science Journal Classification (ASJC) codes

  • Rheumatology

Cite this

@article{f50ac4965c594c1a86994856cc22e98c,
title = "Pneumocystis jirovecii pneumonia in systemic lupus erythematosus from Southern Taiwan",
abstract = "BACKGROUND: Opportunistic infection has been documented in systemic lupus erythematosus with special attention paid to Pneumocystis jirovecii because of the significant morbidity and high mortality. OBJECTIVES: The limited large-scale investigations covering P. jirovecii pneumonia (PCP) in systemic lupus erythematosus following biologics or immunosuppressants therapy prompted us to perform this study in southern Taiwan. METHODS: A retrospective study was completed in 858 hospitalized lupus patients from January 2000 to December 2011. The definite diagnosis of PCP was made by the laboratory detection of Pneumocystis organisms together with consistent clinical and radiological manifestations of PCP. Positive polymerase chain reaction results of sputum samples were not regarded as infection in this study, unless P. jirovecii was the sole pathogen found and pulmonary manifestations resolved following antibiotics for PCP treatment alone. RESULTS: The laboratory identification of Pneumocystis organisms depended on lung biopsy in 2 cases and bronchoalveolar lavage in 3 patients. Five cases, 2 women and 3 men aged 30 to 50 years (41.8 ± 8.8 years), were identified with a 0.6{\%} incidence. None received chemoprophylactics against P. jirovecii infection. All had lupus nephritis and lymphopenia with low CD4 T-cell counts. Prior usages of higher daily prednisolone dosages and concomitant biologics or immunosuppressants were observed in all patients. Pneumocystis jirovecii pneumonia contributed to a high mortality rate (60{\%}). CONCLUSIONS: We report the rare occurrence but high mortality of PCP infection in this study. A consensus guideline addressing prophylactic antibiotics against Pneumocystis organisms in highest-risk lupus patients on biologics or immunosuppressants could be helpful in guiding their management.",
author = "Weng, {Chia Tse} and Liu, {Ming Fei} and Weng, {Meng Yu} and Lee, {Nan Yao} and Wang, {Ming Chang} and Lin, {Wei Chieh} and Ou, {Chih Ying} and Lai, {Wu Wei} and Hsu, {Shiang Chin} and Chao, {Sheau Chiou} and Chung, {Ta Jung} and Lee, {Chung Ta} and Shieh, {Chi Chang} and Wang, {Jiu Yao} and Wang, {Chrong Reen}",
year = "2013",
month = "8",
day = "1",
doi = "10.1097/RHU.0b013e31829d5017",
language = "English",
volume = "19",
pages = "252--258",
journal = "Journal of Clinical Rheumatology",
issn = "1076-1608",
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}

TY - JOUR

T1 - Pneumocystis jirovecii pneumonia in systemic lupus erythematosus from Southern Taiwan

AU - Weng, Chia Tse

AU - Liu, Ming Fei

AU - Weng, Meng Yu

AU - Lee, Nan Yao

AU - Wang, Ming Chang

AU - Lin, Wei Chieh

AU - Ou, Chih Ying

AU - Lai, Wu Wei

AU - Hsu, Shiang Chin

AU - Chao, Sheau Chiou

AU - Chung, Ta Jung

AU - Lee, Chung Ta

AU - Shieh, Chi Chang

AU - Wang, Jiu Yao

AU - Wang, Chrong Reen

PY - 2013/8/1

Y1 - 2013/8/1

N2 - BACKGROUND: Opportunistic infection has been documented in systemic lupus erythematosus with special attention paid to Pneumocystis jirovecii because of the significant morbidity and high mortality. OBJECTIVES: The limited large-scale investigations covering P. jirovecii pneumonia (PCP) in systemic lupus erythematosus following biologics or immunosuppressants therapy prompted us to perform this study in southern Taiwan. METHODS: A retrospective study was completed in 858 hospitalized lupus patients from January 2000 to December 2011. The definite diagnosis of PCP was made by the laboratory detection of Pneumocystis organisms together with consistent clinical and radiological manifestations of PCP. Positive polymerase chain reaction results of sputum samples were not regarded as infection in this study, unless P. jirovecii was the sole pathogen found and pulmonary manifestations resolved following antibiotics for PCP treatment alone. RESULTS: The laboratory identification of Pneumocystis organisms depended on lung biopsy in 2 cases and bronchoalveolar lavage in 3 patients. Five cases, 2 women and 3 men aged 30 to 50 years (41.8 ± 8.8 years), were identified with a 0.6% incidence. None received chemoprophylactics against P. jirovecii infection. All had lupus nephritis and lymphopenia with low CD4 T-cell counts. Prior usages of higher daily prednisolone dosages and concomitant biologics or immunosuppressants were observed in all patients. Pneumocystis jirovecii pneumonia contributed to a high mortality rate (60%). CONCLUSIONS: We report the rare occurrence but high mortality of PCP infection in this study. A consensus guideline addressing prophylactic antibiotics against Pneumocystis organisms in highest-risk lupus patients on biologics or immunosuppressants could be helpful in guiding their management.

AB - BACKGROUND: Opportunistic infection has been documented in systemic lupus erythematosus with special attention paid to Pneumocystis jirovecii because of the significant morbidity and high mortality. OBJECTIVES: The limited large-scale investigations covering P. jirovecii pneumonia (PCP) in systemic lupus erythematosus following biologics or immunosuppressants therapy prompted us to perform this study in southern Taiwan. METHODS: A retrospective study was completed in 858 hospitalized lupus patients from January 2000 to December 2011. The definite diagnosis of PCP was made by the laboratory detection of Pneumocystis organisms together with consistent clinical and radiological manifestations of PCP. Positive polymerase chain reaction results of sputum samples were not regarded as infection in this study, unless P. jirovecii was the sole pathogen found and pulmonary manifestations resolved following antibiotics for PCP treatment alone. RESULTS: The laboratory identification of Pneumocystis organisms depended on lung biopsy in 2 cases and bronchoalveolar lavage in 3 patients. Five cases, 2 women and 3 men aged 30 to 50 years (41.8 ± 8.8 years), were identified with a 0.6% incidence. None received chemoprophylactics against P. jirovecii infection. All had lupus nephritis and lymphopenia with low CD4 T-cell counts. Prior usages of higher daily prednisolone dosages and concomitant biologics or immunosuppressants were observed in all patients. Pneumocystis jirovecii pneumonia contributed to a high mortality rate (60%). CONCLUSIONS: We report the rare occurrence but high mortality of PCP infection in this study. A consensus guideline addressing prophylactic antibiotics against Pneumocystis organisms in highest-risk lupus patients on biologics or immunosuppressants could be helpful in guiding their management.

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U2 - 10.1097/RHU.0b013e31829d5017

DO - 10.1097/RHU.0b013e31829d5017

M3 - Article

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AN - SCOPUS:84881477483

VL - 19

SP - 252

EP - 258

JO - Journal of Clinical Rheumatology

JF - Journal of Clinical Rheumatology

SN - 1076-1608

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