Pneumocystis carinii Pneumonia Following Stem Cell Transplantation

Ju, Ji Hyeon; Choi, Jung Hyun; Lee, Dong Gun; Baek, Ji Yeon; Koh, Yun Ho; Lee, Hae Jung; Kim, Se Hee; Shin, Ho Jin; Kim, Yoo Jin; Park, Yoon Hee; Park, Chi Young; Shin, Wan Shik; Kim, Chun Choo

Abstract

BACKGROUND: Pneumocytitis cainii pneumonia (PCP) can occur in immunocompromised hosts especially such as AIDS or cancer patients. Although recent research had focused on PCP in AIDS patients, few studies have described the clinical presentations of PCP in recipients of stem cell transplantation (SCT). We evaluated the clinical manifestations of PCP in SCT patients admitted at St. Mary's hospital, Seoul, Korea. METHODS: The medical records of 17 PCP patients undergoing SCT between Feb. 1998 and Feb. 2000 were reviewed. The diagnosis of PCP was confirmed through the demonstration of Pneumocystis carinii via either cytology of brochoalveolar lavage (BAL) or histological technique of lung biopsy. CMV disease and CMV infection were confirmed by BAL culture and antigenemia respectively. RESULTS: Seventeen patients were all recipients of allogeneic SCT and 7 of 17 patients were performed non-sibling SCT. Patients presented with symptoms including brief period (4~23 days) of fever (76%), dyspnea (70%), cough (64%), and signs such as rale (58.8%). Sixteen patients (94%) had been receiving immunosuppressive agent such as cyclosporine A (64%) or FK506 (35%) without PCP prophylaxis. Eleven patients (64%) were treated with corticosteroid with mean dose of 16 mg/day prednisolone and mean duration of 4.6 months after post-SCT period. Twelve patients were co-infected with CMV. Another co-infected microorganisms were Pseudomonas aeruginosa, Mycobacterium tuberculosis, herpes simplex virus, parainfluenza virus. Average duration of treatment with trimethoprim-sulfamethoxazole (TMP/SMX) was 21+/-9 days. Four patients died, and three of them were related with PCP. CONCLUSION: PCP developed frequently in patients who were taking immunosuppressive drug due to graft versus host disease or were not taking TMP/SMX prophylaxis. High risk patients showing fever, cough, or dyspnea should be considered to take early bronchoscopic intervention for detection of PCP. When treat for PCP, it also be considered to the possibility of co- infection such as CMV.