Background Formerly known as pneumocystis carinii and more recently pneumocystis jiroveci, pneumoncystis pneumonia is a potentially life threatening opportunistic infection that occurs in immunocompromised patients. In rheumatology our patients are immunocompromised both due to their underlying condition and drug treatments required. With advancements in available drug treatments we are becoming more aware of the need for prohalaxis and early recognition of opportunistic infection.
Objectives To determine the Incidence of Pneumocystis in Rheumatology Patients within our Trust
Methods A Retrospective analysis of all positive virology samples for pneumocystis in the Northern Health and Social Care Trust between February 2011- September 2015.
Results 2498 samples were received from the Trust in total. 90 of these were positive for pneumocystis pneumonia. 38 were paediatric patients and 52 adults. 1 adult was not identifiable and therefore excluded, resulting in 51 positive adults. Of these 9 were primary rheumatology patients (17.6%). 6 patients had rheumatoid arthritis (4 seropositive, 1 seronegative, 1 unknown). The remaining patients had psoriatic arthritis, polymyalgia rheumatica and dermatomyositis. At the time of diagnosis all but one of the patients were on immunosuppressive medications. None of the patients had received biologic treatments. 7 of the patients were receiving oral Prednisolone or had received intra-muscular depomedrone within 4 weeks of diagnosis. 6 of the patients were receiving Prednisolone plus a DMARD (5 Methotrexate, 1 Salazaparin). One patient was receiving Methotrexate mono therapy (dose 15mg) and one patient had no active rheumatology treatment for 6 months prior to diagnosis due to recurrent infections (previously having received Leflunomide for several years). The minimum dose of oral prednisolone at time of diagnosis was 7mg, with the maximum dose being 25mg. The minimum dose of Methotrexate was 15mg with maximum dose being 22.5mg. Mortality rate for rheumatology patients was 44.4% compared to overall mortality rate of 43% for all positive patients.
Conclusions Rheumatology patients are at risk of opportunistic infections and accounted for 17.6% of Pneumocystis pneumonia within our Trust. The mortality rate is high and was higher in our group of patients than the general population affected. There are currently no guidelines available to advise on prevention or prohalaxis of pneumocystis. Biologics had not been used in our cohort of patients however there is concern that with the increased availability and usage of biologics we may see an increase in incidence of opportunistic infections. This study highlights the need for more investigation and guidance on pneumocystis prohalaxis in rheumatology patients
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Disclosure of Interest None declared