[PAGID] Pneumocystis in HIGM

[Berger, Melvin]

we have seen failure of chronic suppression/prophylaxis of histoplasmosis with diflucan, but always thought compliance was an issue because when the patient came in with an exacerbation, it usually responded to increasing the dose and did not require a different agent. Have you tried 
aerosolized pentamidine ?


Melvin Berger, M.D., Ph.D.
Professor of Pediatrics and Pathology
Case Western Reserve University
phone 216 844 3237

Director, Jeffrey Modell Center for Primary Immune Deficiencies
Division of Allergy-Immunology
Rainbow, Babies and Children's Hospital
University Hospitals of Cleveland
RB&C Rm 504, MS 6008B
11100 Euclid Ave.
Cleveland, OH 44106



-----Original Message-----
From: pagid-bounces at list.clinimmsoc.org on behalf of Lisa Kobrynski, MD, MPH
Sent: Thu 7/5/2007 11:39 PM
To: pagid at list.clinimmsoc.org
Subject: [PAGID] Pneumocystis in HIGM
 

I was wondering if anyone had experienced problems with failure of bactrim
prophylaxis in patients with hyperIgM.

One of our hyperIgM patients has had multiple episodes of pneumocystis pneumonia
despite reported compliance with daily bactrim for prophylaxis.  Pneumocystis
was isolated on BAL on at least one occasion and all episodes have been typical
for pneumocystis pneumonitis and resolved with high dose bactrim and steroids. 
He has been tried on Atovoquone and failed this medication as well, and could
not tolerate IV Pentamidine.

Has anyone seen failure of prophylaxis with Bactrim?  
What other prophylactic/therapeutic agents would you recommend?

Thanks

Lisa Kobrynski, MD, MPH
Assistant Professor of Pediatrics
Division of Allergy and Immunology
Emory University
404-727-3575
404-727-5045 (fax)

We have seen failure of chronic suppression of Histo with diflucan


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