[PAGID] CGD prophylaxis

[Chinen, Javier]

We have kept two XL-CGD patients with Bactrim hypersensitivity on Dicloxa for over 5 years, with no increase of bacterial infections.
My vote is for continuing Itraconazole, although with plenty of discussion of pros and cons with the family. In our CGD series, we have several cases developing fungal infections (penumonia and ostoemyelitis) on Itraconazole prophylaxis, though they were X-linked, and I can't confirm compliance.
Javier
 

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Today's Topics:

   1. CGD pregnancy (Jordan Orange)
   2. Re: CGD pregnancy (Antonio Condino)
   3. Re: CGD pregnancy (Luigi Notarangelo)
   4. Re: CGD pregnancy (Dr. Esther de Vries)


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Message: 1
Date: Wed, 6 Feb 2008 00:31:58 -0500
From: Jordan Orange <orange at mail.med.upenn.edu>
Subject: [PAGID] CGD pregnancy
To: pagid at list.clinimmsoc.org
Message-ID: <3EF1933E-BFDD-4BFB-9A99-97DF3FB24515 at mail.med.upenn.edu>
Content-Type: text/plain; charset="us-ascii"; Format="flowed";
	DelSp="yes"

Dear Colleagues,

I currently have a 27yo patient with autosomal recessive CGD who  
would like become pregnant.

Does anyone have experience with this situation?

I have many concerns.

One small, but practical concern is that both TMP/SMX and  
itraconazole are pregnancy category C.  If she were to become  
pregnant, is there an acceptable alternative prophylactic regimen  
which would be safer for the fetus?  Alternatively, should TMP/SMX  
and itraconazole be continued?

This patient and her family have an appropriate fear of CGD, as her  
younger sister died of fungal pneumonia 3 years ago.

Thank you for reading this message and for any advice you might be  
able to offer.

Best regards,

Jordan

Jordan Orange MD/PhD
Assistant Professor of Pediatrics
University of Pennsylvania School of Medicine
Children's Hospital of Philadelphia, Division of Immunology
3615 Civic Center Blvd,  ARC-1016H
Philadelphia, PA 19104
(Voice) 267-426-5622
(Fax) 267-426-5727
www.orangelab.org




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Message: 2
Date: Wed, 06 Feb 2008 08:55:26 -0200
From: Antonio Condino <condino at icb.usp.br>
Subject: Re: [PAGID] CGD pregnancy
To: Jordan Orange <orange at mail.med.upenn.edu>
Cc: pagid at list.clinimmsoc.org
Message-ID: <1202295326.47a9921e3f557 at webmail.icb.usp.br>
Content-Type: text/plain; charset=ISO-8859-1

Hi Jordan

This is an unusual situation, but we have to start getting prepared to manage it
more frequently from now on, since our CGD patients are living better and
longer.

My sugestion is to focus on the mother health and keep with the same
prophilaxis. You know we do have other drug alternatives, but they all
represent a potential risk during pregnancy.

So the mother shoud be aware about that and make a decision.

All best wishes

Condino

-- 
Antonio Condino MD PhD 
Associate Professor
Department of Immunology
Institute of Biomedical Sciences
University of Sao Paulo
1730 Lineu Prestes Avenue 1730
Sao Paulo - SP. ZIP 05508-900.
Brazil
Tel 55 11 3091-7387
Fax 55 11 3091-7224



Citando Jordan Orange <orange at mail.med.upenn.edu>:


> Dear Colleagues,

> 

> I currently have a 27yo patient with autosomal recessive CGD who  

> would like become pregnant.

> 

> Does anyone have experience with this situation?

> 

> I have many concerns.

> 

> One small, but practical concern is that both TMP/SMX and  

> itraconazole are pregnancy category C.  If she were to become  

> pregnant, is there an acceptable alternative prophylactic regimen  

> which would be safer for the fetus?  Alternatively, should TMP/SMX  

> and itraconazole be continued?

> 

> This patient and her family have an appropriate fear of CGD, as her  

> younger sister died of fungal pneumonia 3 years ago.

> 

> Thank you for reading this message and for any advice you might be  

> able to offer.

> 

> Best regards,

> 

> Jordan

> 

> Jordan Orange MD/PhD

> Assistant Professor of Pediatrics

> University of Pennsylvania School of Medicine

> Children's Hospital of Philadelphia, Division of Immunology

> 3615 Civic Center Blvd,  ARC-1016H

> Philadelphia, PA 19104

> (Voice) 267-426-5622

> (Fax) 267-426-5727

> www.orangelab.org

> 

> 

> 

> 

> 



----------------------------------------------------------------
Instituto de Ci?ncias Biom?dicas da USP (IMP/WEBMAIL)




------------------------------

Message: 3
Date: Wed, 06 Feb 2008 08:28:14 -0500
From: "Luigi Notarangelo" <luigi.notarangelo at childrens.harvard.edu>
Subject: Re: [PAGID] CGD pregnancy
To: pagid at list.clinimmsoc.org
Message-ID: <C3CF201E.8C3E%luigi.notarangelo at childrens.harvard.edu>
Content-Type: text/plain; charset="iso-8859-1"

Years back, I had a similar case (mine was a p67 deficiency). In the absence
of anti-fungal prophylaxis, she developed severe aspergillosis during
pregnancy.
If that counts...

Gigi


On 2/6/08 12:31 AM, "Jordan Orange" <orange at mail.med.upenn.edu> wrote:


>  Dear Colleagues,

> 

> I currently have a 27yo patient with autosomal recessive CGD who would like

> become pregnant.

> 

> Does anyone have experience with this situation?

> 

> I have many concerns. ?

> 

> One small, but practical concern is that both TMP/SMX and itraconazole are

> pregnancy category C. ?If she were to become pregnant, is there an acceptable

> alternative prophylactic regimen which would be safer for the fetus?

> ?Alternatively, should TMP/SMX and itraconazole be continued?

> 

> This patient and her family have an appropriate fear of CGD, as her younger

> sister died of fungal pneumonia 3 years ago.

> 

> Thank you for reading this message and for any advice you might be able to

> offer.

> 

> Best regards,

> 

> Jordan

> 

>  

> Jordan Orange MD/PhD

> Assistant Professor of Pediatrics

> University of Pennsylvania School of Medicine

> Children's Hospital of Philadelphia, Division of Immunology

> 3615 Civic Center Blvd,? ARC-1016H

> Philadelphia, PA 19104

> (Voice) 267-426-5622

> (Fax) 267-426-5727

> www.orangelab.org

> 

> 

> 

>  

> 

> 



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Message: 4
Date: Wed, 6 Feb 2008 16:31:22 +0100
From: "Dr. Esther de Vries" <esid at estherdevries.nl>
Subject: Re: [PAGID] CGD pregnancy
To: <pagid at list.clinimmsoc.org>
Message-ID: <002001c868d5$54d028f0$9b00000a at Esther>
Content-Type: text/plain; charset="us-ascii"

Dear Jordan Orange,

 

This is not an answer to your question, but this email reminds me of a
question concerning the ESID meeting in October that I still have. Andrew
Cant has contacted you about the title of your talk during the ESID meeting
itself in the NK-cell session. I still haven't had an answer to that from
him or you, and we want to print the 2nd announcement. Can you please send
me the title asap? Thanks very much, Esther de Vries

 

-----Oorspronkelijk bericht-----
Van: pagid-bounces at list.clinimmsoc.org
[mailto:pagid-bounces at list.clinimmsoc.org] Namens Jordan Orange
Verzonden: woensdag 6 februari 2008 6:32
Aan: pagid at list.clinimmsoc.org
Onderwerp: [PAGID] CGD pregnancy

 

Dear Colleagues,

 

I currently have a 27yo patient with autosomal recessive CGD who would like
become pregnant.

 

Does anyone have experience with this situation?

 

I have many concerns.  

 

One small, but practical concern is that both TMP/SMX and itraconazole are
pregnancy category C.  If she were to become pregnant, is there an
acceptable alternative prophylactic regimen which would be safer for the
fetus?  Alternatively, should TMP/SMX and itraconazole be continued?

This patient and her family have an appropriate fear of CGD, as her younger
sister died of fungal pneumonia 3 years ago.

 

Thank you for reading this message and for any advice you might be able to
offer.

 

Best regards,

 

Jordan

 

Jordan Orange MD/PhD

Assistant Professor of Pediatrics

University of Pennsylvania School of Medicine

Children's Hospital of Philadelphia, Division of Immunology

3615 Civic Center Blvd,  ARC-1016H

Philadelphia, PA 19104

(Voice) 267-426-5622

(Fax) 267-426-5727

www.orangelab.org

 

 





 

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