P114 Risk factors and clinical characteristics for Pneumocystis jirovecii pneumonia in Japanese patients with ulcerative colitis. (25th January 2019)

• Record Type: Journal Article
• Authors: Sato, T; Koshiba, R; Kojima, K; Fujimoto, K; Kawai, M; Kamikoduru, K; Yokoyama, Y; Takagawa, T; Uchino, M; Hida, N; Watanabe, K; Miwa, H; Ikeuchi, H; Nakamura, S
• Is Part Of: Journal of Crohn's and colitis. Volume 13(2019)Supplement 1
• Page Start: S144
• Page End: S145
• Publication Date: 2019-01-25
• Subjects: Inflammatory bowel diseases -- Periodicals; 616.344005
• DOI: 10.1093/ecco-jcc/jjy222.238
• Languages: English
• ISSNs: 1873-9946

Abstract

Abstract: Background: Pneumocystis jirovecii pneumonia (PJP) is usually classified into two types: PJP with HIV (HIV-PJP) and PJP without HIV (non-HIV-PJP: NH-PJP). Respiratory failures progress more rapidly and require more artificial respiratory control, falling in poor prognosis in NH-PJP than in HIV-PJP. 1–3 There is no consensus in the approach to prophylaxis against NH-PJP in patients with ulcerative colitis (UC) despite prophylaxis with sulfamethoxazole/trimethoprim (TPM-SMX) reduces NH-PJP infections. 4 The purpose of this study was to determine the clinical characteristics and risk factors for NH-PJP in patients with UC treated with immunosuppressants. Methods: Of the 3927 patients with UC between April 2007 and March 2017 received immunosuppressive drugs. Seventy patients experienced pneumonia, including nine patients with NH-PJP. A retrospective case–control study was conducted in these patients, with an NH-PJP group ( n = 9) and a non-NH-PJP group ( n = 36). The Lichtiger clinical activity index (LCI) was compared between the initiation of treatment and the onset of NH-PJP. The day of NH-PJP onset after immunosuppressant therapy was calculated with the Kaplan–Meier estimator. Results: Two patients in the NH-PJP group died. The median LCI (range) at the initiation of treatment was 13 (8–17), whereas that at NH-PJP onset was 2 (1–8) ( p = 0.016) Comparison of Lichtiger clinical activity index before treatment and at the onset of PJP. Median score 13 (range 8–17) before treatment decreased significantly to 2 (1–8) at the onset of PCP. *Wilcoxon's signed-rank test. The median period to NH-PJP onset was 83 days from the beginning of immunosuppressive treatment. Age and the dose of prednisolone (PSL; mg/day) were significantly greater ( p = 0.02 and p = 0.002, respectively), three immunosuppressants were used significantly more frequently ( p = 0.004), and the lymphocyte counts during treatment were significantly lower ( p < 0.01) in the NH-PJP group than in the non-NH-PJP group. The cut-off value, sensitivity, and specificity for the lowest lymphocyte count to predict NH-PCP during treatment were 570/μl, 0.81, and 0.89, respectively, according to a receiver-operating characteristic curve. Conclusions: NH-PJP occurred when the symptoms of UC were stabilising, when the immunosuppressive drugs were reduced. Senior age, a higher dose of PSL (mg/day), and lower lymphocyte counts during treatment are risk factors for NH-PJP. Prophylactic treatment with TPM-SMX should be used for UC patients with these risk factors. References 1. Thomas CF Jr, Limper AH. Pneumocystis pneumonia: clinical presentation and diagnosis in patients with and without acquired immune deficiency syndrome. Semin Respir Infect 1998;13:289–95. 2. Sato T, Inokuma S, Maezawa R. Clinical characteristics of Pneumocystis carinii pneumonia in patients with connective tissue diseases. Mod Rheumatol 2005;15:191–7. 3. Iikuni N, Kitahama M, Ohta S, et al . Evaluation of Pneumocystis pneumonia infection risk factors in patients with connective tissue disease. Mod Rheumatol 2006;16:282–8. 4. Rahier JF, Magro F, Abreu C, et al . Second European evidence-based consensus on the prevention, diagnosis and managementof opportunistic infections in inflammatory bowel disease. J Crohns Colitis 2014;8:443–68.