Therapeutic effect of direct hemoperfusion with a polymyxin B-immobilized fiber column in the treatment of HIV-negative severe pneumocystis pneumonia.
BACKGROUND
Direct hemoperfusion with a polymyxin B-immobilized fiber column (PMX-DHP) has been shown to improve oxygenation in cases of diffuse alveolar damage, but little is known about its effectiveness in treating pneumocystis pneumonia (PCP) in HIV-negative immunosuppressed patients.


OBJECTIVE
This study was aimed at investigating the effect of PMX-DHP in treating non-HIV-related PCP.


METHODS
Between October 2005 and September 2008, 6 patients with non-HIV-related PCP were treated with 2 sessions of PMX-DHP at an attending physician's discretion when severe hypoxemia developed despite conventional treatments including high-dose corticosteroid, whereas 9 patients in a similar condition were treated without PMX-DHP. Changes in oxygenation and radiographic findings in the PMX-DHP group and adverse events associated with PMX-DHP were investigated retrospectively, as were the outcomes for both treatment groups.


RESULTS
There was an improvement in PaO(2)/FiO(2) during each PMX-DHP session, from 148.8 ± 52.5 to 188.2 ± 79.3 mm Hg (p = 0.02). After 2 sessions of PMX-DHP, an improvement in PaO(2)/FiO(2), from 131.8 ± 37.4 to 213.3 ± 87.3 mm Hg, was observed (p = 0.04), but no significantly different improvement was detected on the following day. The radiographic findings improved in 4 patients during PMX-DHP. The in-hospital mortality was similarly high in both groups (50% in the PMX-DHP group vs. 67% in the non-PMX-DHP group). No significant adverse events associated with PMX-DHP were observed except for advanced thrombocytopenia in 1 patient.


CONCLUSIONS
PMX-DHP may serve as an adjunct in the treatment of non-HIV-related PCP, temporarily alleviating severe hypoxemia even in cases refractory to conventional treatments.
Department of Respiratory Medicine, Kobe City Medical Center General Hospital, Kobe, Japan. ryotkw@kcgh.gr.jp
Ryo
R
Tachikawa
Keisuke
K
Tomii
Kimihiko
K
Murase
Hiroyuki
H
Ueda
Yuka
Y
Harada
Yoko
Y
Kida
Kyosuke
K
Ishihara
D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D005260:Female; D018023:HIV Seronegativity; D006464:Hemoperfusion; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000097:blood; D011020:Pneumonia, Pneumocystis / Q000097:blood / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000628:therapy*; D011112:Polymyxin B / Q000008:administration & dosage*; D014057:Tomography, X-Ray Computed
D000900:Anti-Bacterial Agents; D011112:Polymyxin B; D010100:Oxygen