Which patients should consider chemoprophylaxis against Pneumocystis jiroveci pneumonia (PJP)?

Updated: Apr 24, 2019
  • Author: Shelley A Gilroy, MD, FIDSA; Chief Editor: Pranatharthi Haran Chandrasekar, MBBS, MD  more...
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Answer

Answer

Unlike in patients with HIV infection, no specific PJP prophylaxis guidelines exist for immunocompromised patients without HIV infection. In general, chemoprophylaxis should be considered in any of the following patients:

  • Patients with an underlying primary immune deficiency (eg, severe combined immunodeficiency or hypogammaglobulinemia)

  • Patients with a persistent CD4 count less than 200/µL

  • Solid organ transplant recipients

  • Hematopoietic stem cell transplant (HSCT) recipients, with prophylaxis administered (1) for 6 months after engraftment months or (2) for more than 6 months after HSCT in those who are still receiving immunosuppressive therapy (eg, prednisone, cyclosporine) or who have chronic graft versus host disease

  • Patients receiving daily systemic corticosteroid therapy (at least 20 mg daily for at least 1 month)

  • Patients with cancer, vasculitides, or collagen vascular disorders and others receiving cytotoxic or immunosuppressive treatments such as cyclosporine or the purine analogs fludarabine or cladribine


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