title: [Pneumocystis pneumonia in patients with Hodgkin lymphoma].
abstract: OBJECTIVE
  To assess the results of diagnosing and treating Pneumocystis pneumonia (PP) in patients with Hodgkin lymphoma (HL) over 15 years.
  
  
  METHODS
  In 1999 to 2013, PP occurred in 22 (3%) of 741 HL patients receiving programmed polychemotherapy (PCT). The male/female ratio was 1:1.1; median age was 32 (18-65) years. Advanced stages (IIB-IV) of the disease were seen in 82% of the patients. The diagnosis of PP was established when Pneumocystis (more than 5 cysts in the specimen) was detected in the lavage fluid by indirect immunofluorescence assay.
  
  
  RESULTS
  PP developed after 4 or more cycles of PCT. Along with Pneumocystis, all the cases were found to have additional pathogens: herpes virus in 72% and bacteria and fungi in 33%. All the patients received combined antimicrobial therapy using high doses of intravenous trimethoprim-sulfamethoxazole. Ten (45%) patients required mechanical ventilation (MV). The total mortality in PP was 32% (7 patients died); moreover, none of the patients without MV died whereas the mortality among those who had MV was 70% (7 of the 10 patients died). High death rates (80%) were noted among the patients with recurrent and resistant HL.
  
  
  CONCLUSIONS
  PP should be prevented with trimethoprim-sulfamethoxazole in patients with LH during PCT. If respiratory failure and X-ray signs of interstitial pneumonia appear, there is a need for fibrobronchoscopy with bronchoalveolar lavage and comprehensive microbiological testing of lavage fluid.
authors.forename: T N
authors.initials: TN
authors.lastname: Moiseeva
authors.forename: L S
authors.initials: LS
authors.lastname: Al-Radi
authors.forename: N N
authors.initials: NN
authors.lastname: Sharkunov
authors.forename: N G
authors.initials: NG
authors.lastname: Chernova
authors.forename: G A
authors.initials: GA
authors.lastname: Klyasova
authors.forename: A N
authors.initials: AN
authors.lastname: Gracheva
authors.forename: E A
authors.initials: EA
authors.lastname: Baryakh
authors.forename: D S
authors.initials: DS
authors.lastname: Maryin
authors.forename: I V
authors.initials: IV
authors.lastname: Shitareva
authors.forename: U L
authors.initials: UL
authors.lastname: Julakyan
authors.forename: I E
authors.initials: IE
authors.lastname: Kostina
authors.forename: M N
authors.initials: MN
authors.lastname: Sinitsina
authors.forename: G M
authors.initials: GM
authors.lastname: Galstyan
authors.forename: S K
authors.initials: SK
authors.lastname: Kravchenko
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001992:Bronchoalveolar Lavage Fluid / Q000382:microbiology; D005260:Female; D019084:Fluorescent Antibody Technique, Indirect; D006689:Hodgkin Disease / Q000188:drug therapy / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011020:Pneumonia, Pneumocystis / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D012121:Respiration, Artificial; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000008:administration & dosage / Q000627:therapeutic use*; D055815:Young Adult
chemical_list: D015662:Trimethoprim, Sulfamethoxazole Drug Combination