Nocardiosis in Immunocompromised Patients on Alternative Pneumocystis Prophylaxis.

Alfredo G Puing,Niaz Banaei,David J Epstein,Anne Y Liu,Aruna K Subramanian

doi:10.3201/eid2710.210620

Alfredo G Puing, Niaz Banaei + Show 3 more

Open Access

https://doi.org/10.3201/eid2710.210620

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Abstract

Prophylactic trimethoprim/sulfamethoxazole (TMP/SMX) prevents Pneumocystis jirovecii pneumonia and nocardiosis in immunocompromised patients but sometimes is avoided because of purported allergies or side effects. Of 25 immunocompromised patients receiving alternative prophylaxis in whom nocardiosis developed, 16 subsequently tolerated TMP/SMX treatment. Clinicians should consider TMP/SMX allergy evaluation and rechallenging to assess patient tolerance.

Highlights

Prophylactic trimethoprim/sulfamethoxazole (TMP/SMX) prevents Pneumocystis jirovecii pneumonia and nocardiosis in immunocompromised patients but sometimes is avoided because of purported allergies or side effects
Alternative agents can be less effective than TMP/SMX at preventing Pneumocystis jirovecii pneumonia (PJP) and opportunistic infections caused by Listeria monocytogenes, Toxoplasma gondii, and Nocardia spp
Secondline PJP prophylaxis regimens can increase the risk for opportunistic infections, such as nocardiosis [2]

Summary

Introduction

Prophylactic trimethoprim/sulfamethoxazole (TMP/SMX) prevents Pneumocystis jirovecii pneumonia and nocardiosis in immunocompromised patients but sometimes is avoided because of purported allergies or side effects. Trimethoprim/sulfamethoxazole (TMP/SMX) is the drug of choice for Pneumocystis jirovecii pneumonia (PJP) prophylaxis in immunocompromised patients [1]. We describe a series of nocardiosis cases in immunocompromised patients who were receiving alternative or no PJP prophylaxis because of TMP/SMX avoidance. We provide the reasons for TMP/SMX avoidance and proportion of patients who subsequently tolerated TMP/SMX.

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