Czynniki ryzyka, obraz kliniczny oraz profilaktyka i leczenie zakażeń Pneumocystis jirovecii u dzieci z chorobami hemato-onkologicznymi: rekomendacje ECIL

Abstract

In this review we present the current knowledge of Pneumocystis jirovecii Pneumonia (PjP) in patients with impaired function of immunology system, and focus on children with hematologic or oncologic diseases. The typical signs and symptoms of PjP are based on malaise, fever, cough, dyspnea and chest pain. The risk factors of infection with Pneumocystis jirovecii (Pj) include acute lymphoblastic leukemia, hematopoietic stem cell transplant, and primary immunodeficiencies. Based on ECIL (European Conference on Infection in Leukemia) guidelines, indications and duration for PjP prophylaxis are discussed and recommendations for drugs and their dosage are presented. For the comparison purposes, recommendations for adult patients are also presented. The most frequent symptoms in imaging studies are those of diffuse interstitial pneumonia, and ground glass opacities in high-resolution chest CT. Based on experience with adults, the strategy chart for the diagnosis of PjP in children is presented and interpretation of results is being discussed. The key role in the diagnostic procedure is examination of the bronchoalveolar lavage (BAL) fluid, which is regarded to be the most sensitive biological material with good negative predictive value. Current available methods to confirm the presence of Pj include immunofluorescent staining, standard staining and real-time PCR. The article was supplemented with recommendations of treatment of PjP in children and adults based on RedBook 2012, and guidelines were adjusted to Polish conditions with respect to license of drug.