Recurrent Pneumocystis carinii colonization in a heart-lung transplant recipient on long-term trimethoprim-sulfamethoxazole prophylaxis.

Abstract

INTRODUCTION:

In the setting of organ transplantation, prior to prophylaxis, Pneumocystis carinii pneumonia (PCP) had been a common clinical problem, particularly in heart-lung and lung recipients who receive long-term immunosuppressive therapy to prevent allograft rejection. Continuous oral trimethoprim-sulfamethoxazole (TMP-SMX) has been highly effective in preventing PCP in these patients.

REPORT:

In this paper we report a case of recurrent Pneumocystis carinii infection in a chronic (> 15 years) heart-lung allograft recipient on long-term TMP-SMX prophylaxis. Twice, in 1995 and again in 1998, Pneumocystis carinii infection was diagnosed by bronchoalveolar lavage (BAL), in the same patient, despite continued oral TMP-SMX (960 mg TMP/4800 mg SMX per week) prophylaxis. The subject was not lymphopenic (his CD4 count was 569/mm3) and there was no associated deterioration in pulmonary function, nor evidence of hypoxemia.

CONCLUSION:

This case demonstrates that asymptomatic Pneumocystis carinii lung infections may recur in chronic heart-lung transplant recipients who take standard oral PCP prophylaxis.

• Authors: J L Faul, O A Akindipe, G J Berry, R L Doyle, J Theodore
• Journal: The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation (J Heart Lung Transplant) Vol. 18 Issue 4 Pg. 384-7 (Apr 1999) ISSN: 1053-2498 [Print] United States
• PMID: 10226906 (Publication Type: Case Reports, Journal Article)

Chemical References

• Anti-Bacterial Agents
• Anti-Infective Agents
• Immunosuppressive Agents
• Clindamycin
• Trimethoprim, Sulfamethoxazole Drug Combination

Topics

• Administration, Oral
• Anti-Bacterial Agents (therapeutic use)
• Anti-Infective Agents (administration & dosage, therapeutic use)
• Bronchoalveolar Lavage Fluid (microbiology)
• CD4 Lymphocyte Count
• Clindamycin (therapeutic use)
• Forced Expiratory Volume (physiology)
• Heart-Lung Transplantation
• Humans
• Immunosuppressive Agents (administration & dosage, therapeutic use)
• Male
• Middle Aged
• Opportunistic Infections (diagnosis)
• Pneumocystis (growth & development)
• Pneumocystis Infections (diagnosis)
• Pulmonary Gas Exchange (physiology)
• Recurrence
• Trimethoprim, Sulfamethoxazole Drug Combination (administration & dosage, therapeutic use)
• Vital Capacity (physiology)