THERAPEUTIC APPROACH TO CONCURRENT PCP AND PULMONARY TB IN PEOPLE LIVING WITH HIV/AIDS WITH VARIOUS DRUG HYPERSENSITIVITY REACTIONS
Pneumocystis Carinii Pneumonia (PCP) and Pulmonary Tuberculosis (PTB) are the most frequent Opportunistic Infection (OI) in People living with HIV/AIDS (PLWHA), especially whose CD4 counts<200 cells/mL. There is no pathognomonic sign and symptom of pneumocystis, radiographic imaging (chest radiograph) and blood examination. An intractable microorganism cannot be isolated or sustained in culture. The diagnosis of PCP is complicated, based on the presumptive diagnosis. PCP should be treated optimally as soon as possible in order not to be fatal. We report a complicated case of a female 26 y-old, diagnosed with HIV infection on Highly Active Anti Retro Viral Therapy (HAART), PTB on Anti Tuberculosis Drugs (ATD) concurrent with PCP. She also has a history of various Drug Hypersensitivity Reactions (DHR) include Rifampycin, Ciprofloxacin and Cotrimoxazole. DHR is unpredictable, and Clindamycin and Primaquin are the recommended alternative drugs for PCP, the strategic therapy is by Desensitization Protocols.
2. Caceres NDA, Viera MMC, Vieira IF, Monteleone VF, Neto LJM, Bonafe S. Opportunistic infections in AIDS patients. Int Med J 2015;7:1-17.
3. Asma HS, Mustafa M, Chan YY, Zaidah AR, Nurhaslindawati AR, Sarimah A, et al. Pneumocystis pneumonia among HIV patients in malaysia. Southeast Asian J Trop Public Health 2009;40:1293-7.
4. Lee N, Lawrence D, Pate B, Ledot S. HIV-related pneumocystis jirovecii pneumonia managed with caspofungin and veno-venous extracorporeal membrane oxygenation rescue therapy. Br Med J Case Rep 2017. Doi:10.1136/bcr-2017-221214.
5. Ngwenya S. Pnejmocystis carinii pneumonia; last lives in pregnancy: chemoprophylaxis saves lives. Pulm Res Respir Med Open J 2016;3:41-4.
6. Yanagisawa K, Nojima Y. HIV and pneumocystis pneumonia (PCP): an up to date. J Infect Dis Ther 2015;3:1-2.
7. Unprasert P, Permpalung N, Srivali N, Bischof EF, Edmonds LC. Pneumocystis pneumonia during primary HIV infection: a case report and review of the literature. J Infect Chemother 2013. Doi:10.1007/s10156-013-0568-y.
8. Janmeja AK, Mohapatra PR, Shivaprakash MR, Khurana A, Aggarwal D. Concurrent Infection of pneumocystis pneumonia and pulmonary tuberculosis in an HIV-seronegative patient. Indian J Chest Dis Allied Sci 2008;50:369-71.
9. Castro JG, Manzi G, Espinoza L, Campos M, Boulanger C. Concurrent PCP and TB pneumonia in HIV infected patients. Scand J Infect Dis 2007;39:1054-8.
10. Scherer K, Brockow K, Aberer W, Gooi JH, Demoly P, Romano A, et al. Desensitization in delayed drug hypersensitivity reactions-an EAACI position paper of the drug allergy interest group. Allergy 2013;68:844-52.
11. Minhajat R, Djaharuddin I, Halim R, Benyamin AF, Bakri S. Drugs hypersensitivity reaction in patients with human immunodeficiency virus (HIV) infection. J Allergy Ther 2017;8:1.
12. Macy E, Romano A, Khan D. Practical management of antibiotic hypersensitivity in 2017. J Allergy Clin Immunol Pract 2017;5:577-86.
13. Sanchez LDLV, Alenazy LA, Neuer MG, Castells MC. Drug hypersensitivity and desentizations: mechanisms and new approaches. Int J Mol Sci 2017;18:1316. Doi:10.3390/ijms18061316.
14. Benito N, Moreno A, Miro JM, Torres A. Pulmonary infections in HIV-infected patients: an update in the 21st century. Eur Respir J 2012;39:730-45.
15. Monteiro MLR, Rocha LP, Silva ACSD, Pereira LHM, Silva MVC, Correa RRM, et al. Pulmonary coinfection by pneumocystis jiroveci, cryptococcus neoformans and cytomegalovirus in HIV patient without antiretroviral treatment. Rev Patol Trop 2018;47:199-206.
16. Gigliotti F, Wright TW. Immunopathogenesis of pneumocystis carinii pneumonia. Expert Rev 2005;7:1-16.
17. Pate MB, Smith JK, Chi DS, Krishnaswamy G. Regulation and dysregulation of immunoglobulin E: a molecular and clinical perspective. Clin Mol Allergy 2010;8:1-13.
18. Sumintarti, Ruslin M, Yusuf H. Oral hairy leukoplakia manifestations related to CD4 count in HIV/AIDS patients at Dr Wahidin Sudirohusodo hospital. Int J Appl Pharm 2019;11:57-9.
19. Ide H, Yamaji Y, Tobino K, Okahisa M, Murakami K, Goto Y, et al. Pneumocystis jirovecii pneumonia in an immunocompetent Japanese man: a case report and literatire review. Case Report Pulmonol 2019. Doi:10.1155/2019/3981681.
20. Castro JG, Bryant MM. Management of pneumocystis jirovecii pneumonia in HIV infected patients: current options, challenges and future directions. HIV/AIDS Res Palliative Care 2010;2:123-34.
21. Schrijvers R, Gilissen L, Chiriac AM, Demoly P. Pathogenesis and diagnosis of delayed-type drug hypersensitivity reactions, from bedside to bench and back. Clin Trans Allergy 2015;5:31.
22. Messad D, Sahla H, Benahmed S, Godard P, Bousquet J, Demoly P. Drug provocation test in patients with a history suggesting an immediate drug hypersensitivity. Ann Intern Med 2004;140:1001-6.
23. Huang L, Cattamanchi A, Davis L, den Boon S, Kovacs J, Meshnick S, et al. HIV-associated pneumocystis pneumonia. Proc Am Thorac Soc 2011;8:294-300.
24. Davis CM, Shearer WT. Diagnosis and management of HIV drug hypersensitivity. J Allergy Clin Immunol 2008;121:826-32.
25. Thong BY. Clinical applications of drug desensitization in the Asia Pasific region. Asia Pasific Allergy 2011;1:2-11.
26. Cernadas JR, Brockow K, Romano A, Aberer W, Torres MJ, Bircher A, et al. General considerations on rapid desensitization for drug hypersensitivity–a consensus statement. Allergy 2010. Doi:10.1111/j.1398-9995.2010.02441.x
27. Rial Prado MJ, Rico DMA, Cosgaya CA, Cuesta HJ. A new rush schedule for cotrimoxazole desensitization: a report of 2 cases. J Investig ALlergol Clin Immunol 2018;28:267-9.
28. Groot HD, Mulder WMC, Tereehorst I. Utility of desensitization for allergy to antibiotics. Neth J Med 2012;70:58-62.
29. Tamay Z, Gokcay G, Dilek F, Balci MC, Ozeeker D, Demirkol M, et al. Rapid desensitization for immediate hypersensitivity to galsulfase therapy in patients with MPS VI. JIMD Reports 2016. Doi:10.107/8904_2016_542.
30. Riedla MA, Casillas AM. Adverse drug reactions: types and treatment options. Am Fam Physician 2003;68:1781-90.
31. Absar M, Daneshvar H, Beall G. Desensitization to trimethoprim/sulfamethoxazole in HIV-infected patients. J Allergy Clin Immunol 1994;93:1001-5.
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