Recurrent Pneumocystis carinii colonization in a heart-lung transplant recipient on long-term trimethoprim-sulfamethoxazole prophylaxis.
BACKGROUND
In the setting of organ transplantation, prior to prophylaxis, Pneumocystis carinii pneumonia (PCP) had been a common clinical problem, particularly in heart-lung and lung recipients who receive long-term immunosuppressive therapy to prevent allograft rejection. Continuous oral trimethoprim-sulfamethoxazole (TMP-SMX) has been highly effective in preventing PCP in these patients.


METHODS
In this paper we report a case of recurrent Pneumocystis carinii infection in a chronic (> 15 years) heart-lung allograft recipient on long-term TMP-SMX prophylaxis. Twice, in 1995 and again in 1998, Pneumocystis carinii infection was diagnosed by bronchoalveolar lavage (BAL), in the same patient, despite continued oral TMP-SMX (960 mg TMP/4800 mg SMX per week) prophylaxis. The subject was not lymphopenic (his CD4 count was 569/mm3) and there was no associated deterioration in pulmonary function, nor evidence of hypoxemia.


CONCLUSIONS
This case demonstrates that asymptomatic Pneumocystis carinii lung infections may recur in chronic heart-lung transplant recipients who take standard oral PCP prophylaxis.
Faul
J L
JL
Division of Pulmonary and Critical Care Medicine, Stanford University Medical Center, California 94304-2299, USA.
Akindipe
O A
OA
Berry
G J
GJ
Doyle
R L
RL
Theodore
J
J
D000284:Administration, Oral; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000890:Anti-Infective Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001992:Bronchoalveolar Lavage Fluid / Q000382:microbiology; D018791:CD4 Lymphocyte Count; D002981:Clindamycin / Q000627:therapeutic use; D005541:Forced Expiratory Volume / Q000502:physiology; D016041:Heart-Lung Transplantation; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009894:Opportunistic Infections / Q000175:diagnosis*; D011010:Pneumocystis / Q000254:growth & development; D016720:Pneumocystis Infections / Q000175:diagnosis*; D011659:Pulmonary Gas Exchange / Q000502:physiology; D012008:Recurrence; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000008:administration & dosage / Q000627:therapeutic use*; D014797:Vital Capacity / Q000502:physiology
D000900:Anti-Bacterial Agents; D000890:Anti-Infective Agents; D007166:Immunosuppressive Agents; D002981:Clindamycin; D015662:Trimethoprim, Sulfamethoxazole Drug Combination