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2015 ; 9
(Suppl 1
): 29-40
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Pneumocystis jirovecii Pneumonia in Rheumatoid Arthritis Patients: Risks and
Prophylaxis Recommendations
#MMPMID26396551
Mori S
; Sugimoto M
Clin Med Insights Circ Respir Pulm Med
2015[]; 9
(Suppl 1
): 29-40
PMID26396551
show ga
Pneumocystis jirovecii infection causes fulminant interstitial pneumonia
(Pneumocystis pneumonia, PCP) in patients with rheumatoid arthritis (RA) who are
receiving biological and/or nonbiological antirheumatic drugs. Recently, we
encountered a PCP outbreak among RA outpatients at our institution.
Hospital-acquired, person-to-person transmission appears to be the most likely
mode of this cluster of P. jirovecii infection. Carriage of P. jirovecii seems a
time-limited phenomenon in immunocompetent hosts, but in RA patients receiving
antirheumatic therapy, clearance of this organism from the lungs is delayed.
Carriers among RA patients can serve as sources and reservoirs of P. jirovecii
infection for other susceptible patients in outpatient facilities. Development of
PCP is a matter of time in such carriers. Considering the poor survival rates of
PCP cases, prophylactic antibiotics should be considered for RA patients who are
scheduled to receive antirheumatic therapy. Once a new case of PCP occurs, we
should take prompt action not only to treat the PCP patient but also to prevent
other patients from becoming new carriers of P. jirovecii. Short-term prophylaxis
with trimethoprim-sulfamethoxazole is effective in controlling P. jirovecii
infection and preventing future outbreaks of PCP among RA patients.