THERAPEUTIC APPROACH TO CONCURRENT PCP AND PULMONARY TB IN PEOPLE LIVING WITH HIV/AIDS WITH VARIOUS DRUG HYPERSENSITIVITY REACTIONS

Ketut Suryana

doi:10.22159/ijpps.2020v12i5.37247

Abstract

Pneumocystis Carinii Pneumonia (PCP) and Pulmonary Tuberculosis (PTB) are the most frequent Opportunistic Infection (OI) in People living with HIV/AIDS (PLWHA), especially whose CD4 counts<200 cells/mL. There is no pathognomonic sign and symptom of pneumocystis, radiographic imaging (chest radiograph) and blood examination. An intractable microorganism cannot be isolated or sustained in culture. The diagnosis of PCP is complicated, based on the presumptive diagnosis. PCP should be treated optimally as soon as possible in order not to be fatal. We report a complicated case of a female 26 y-old, diagnosed with HIV infection on Highly Active Anti Retro Viral Therapy (HAART), PTB on Anti Tuberculosis Drugs (ATD) concurrent with PCP. She also has a history of various Drug Hypersensitivity Reactions (DHR) include Rifampycin, Ciprofloxacin and Cotrimoxazole. DHR is unpredictable, and Clindamycin and Primaquin are the recommended alternative drugs for PCP, the strategic therapy is by Desensitization Protocols.

Highlights

Acquired Immunodeficiency Syndrome (AIDS) is a syndrome caused by the Human Immunodeficiency Virus (HIV) infection
Cluster of Differentiation (CD)-4 lymphocytes, which plays an important role in the immune system is the main target of HIV infection [1,2,3]
Pneumocystis Carinii Pneumonia (PCP) is one of the most frequent Opportunistic Infection (OI) that might occur in immunocompromised patients, especially in people living with HIV/AIDS (PLWHA) with a CD4 lymphocyte counts less than 200 cells/μL [15, 16]

Summary

INTRODUCTION

Acquired Immunodeficiency Syndrome (AIDS) is a syndrome caused by the Human Immunodeficiency Virus (HIV) infection. The diagnosis was HIV infected patient (WHO stage IV) on HAART She was diagnosed with PTB concurrent with PCP. On the third day treatment (Clindamycin Rapid Desensitization Protocols), at the step-4, cumulative time: 90 minutes, drug concentration 8/48, dose: 400 mg (Threshold dose) and cumulative dose: 750 mg, the patient complained a skin rash, itching. On the fourth day treatment, the Clindamycin using dose 300 mg (6/48) every 30 min until the usual daily dose was reached It was continued for 21 d with some suggestions to be aware of DHR risk. The final regimen was Clindamycin 300 mg every 30 min until the usual daily dose was reached (Rapid Desensitization Protocols) and Primaquin 15 mg once daily was continued as an outpatient until 21 d, with some suggestions to be aware of DHR risk

DISCUSSION

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CONCLUSION