[PAGID] Pneumocystis in HIGM

[Jack Bleesing]

Keeping it short and to the point:

- BMT

- Agrressive treatment leading up and post BMT, including
anti-inflammatory therapy

- Evaluation and Propylaxis for co-morbid infections (viral, fungal,
etc)

I have battling PCP in a patient with XLP. It seemed in this patient
that his PCP wasn't as much an issue of failure of standard therapy as
an rather robust inflammatory/LPD component. Things got better on
optimized steroid therapy (after aggressively looking for other
organism).

J


>>> lkobryn at emory.edu 7/5/2007 11:39:20 PM >>>


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)