Download PDF
Klin Padiatr 2006; 218(3): 177-179
DOI: 10.1055/s-2006-933433
Supportive Therapie

© Georg Thieme Verlag Stuttgart · New York

Combined Trimethoprim and Caspofungin Treatment for Severe Pneumocystis Jiroveci Pneumonia in a Five Year Old Boy with Acute Lymphoblastic Leukemia

Kombinierte Trimethoprim/Sulfamethoxazol- und Caspofungin-Behandlung bei schwerer Pneumocystis-jiroveci-Pneumonie bei einem fünfjährigen Jungen mit akuter lymphatischer LeukämieK. Beltz1 , C. M. Kramm1 , H.-J. Laws1 , H. Schroten2 , R. Wessalowski1 , U. Göbel1
  • 1Department of Pediatric Oncology, Hematology, and Immunology, University Hospital Düsseldorf, Düsseldorf, Germany
  • 2Department of General Pediatrics, Center for Pediatric and Adolescent Medicine, University Hospital Düsseldorf, Düsseldorf, Germany
Further Information

Publication History

Publication Date:
10 May 2006 (online)

Also available at
    Permissions and Reprints

Abstract

Caspofungin was used for the first time with trimethoprim/sulfamethoxazole (TMP/SMX) for treatment of high risk Pneumocystis jiroveci pneumonia (PCP) in a pediatric immunocompromised patient. Despite the need for mechanical ventilation, the pediatric patient with relapsed acute lymphoblastic leukemia improved within nine days of treatment and showed no major side effects. The apparent relative lack of toxicity and of pharmacokinetic drug interactions makes caspofungin an attractive agent.

Zusammenfassung

Caspofungin wurde zum ersten Mal in Kombination mit Trimethoprim/Sulfamethoxazol (TMP/SMX) für die Behandlung einer Pneumocystis-jiroveci-Pneumonie (PCP) bei einem pädiatrischen immunsupprimierten Patienten eingesetzt. Trotz Beatmungspflichtigkeit kam es bei dem Patienten mit dem Rezidiv einer akuten lymphatischen Leukämie nach neuntägiger Behandlung zu einer deutlichen Besserung der klinischen Situation ohne größere Nebenwirkungen. Die gute Verträglichkeit und das Fehlen von pharmakokinetischen Interaktionen machen Caspofungin zu einem attraktiven Wirkstoff.

Key words

pneumocystis jiroveci pneumonia - acute respiratory failure - immunosuppression

Schlüsselwörter

Pneumocystis-jiroveci-Pneumonie - akute Ateminsuffizienz - Immunsuppression

References

  • 1 Annaloro C, Della Volpe A, Usardi P, Lambertenghi Deliliers G. Caspofungin treatment of Pneumocystis pneumonia during conditioning for bone marrow transplantation.  Eur J Clin Microbiol Infect Dis. 2005;  20 1-3
    PubMedSearch in Google Scholar
  • 2 Eckert C, Biondi A, Seeger K. et al . Prognostic value of minimal residual disease in relapsed childhood acute lymphblastic leukaemia.  Lancet. 2001;  358 1239-1241
    CrossrefPubMedSearch in Google Scholar
  • 3 Ewig S, Bauer T, Schneider C. et al . Clinical characteristics and outcome of Pneumocystis jiroveci pneumonia in HIV-infected and otherwise immunosuppressed patients.  Eur Respir J. 1995;  8 1548-1553
    PubMedSearch in Google Scholar
  • 4 Groll A H, Lehrnbecher T. New antifungal drugs and the pediatric cancer patient: current status of clinical development.  Klin Padiatr. 2005;  217 158-168
    Thieme ConnectPubMedSearch in Google Scholar
  • 5 Groll A H, Ritter J. Diagnosis and management of fungal infections and pneumocystis pneumonitis in pediatric cancer patients.  Klin Padiatr. 2005;  217 (Suppl 1) S 37-S 66
    PubMedSearch in Google Scholar
  • 6 Groll A H, Walsh T J. Caspofungin: pharmacology, safety and therapeutic potential in superficial and invasive fungal infections.  Expert Opin Investig Drugs. 2001;  10 1545-1558
    CrossrefPubMedSearch in Google Scholar
  • 7 Harms D O, Janka-Schaub G E. Co-operative study group for childhood acute lymphblastic leukemia (COALL): long-term follow-up of trials 82, 85, 89 and 92.  Leukemia. 2000;  14 2234-2239
    CrossrefPubMedSearch in Google Scholar
  • 8 Pagano L, Fianchi L, Mele L. et al . Pneumocystis jiroveci pneumonia in patients with malignant haematological diseases: 10 years' experience of infection in GIMEMA centres.  Br J Haematol. 2002;  117 379-386
    CrossrefPubMedSearch in Google Scholar
  • 9 Powles M A, Liberator P, Anderson J. et al . Efficacy of MK-991 (L-743, 872), a semisynthetic pneumocandin, in murine models of Pneumocystis jiroveci.  Antimicrob Agents Chemother. 1998;  42 1985-1989
    CrossrefPubMedSearch in Google Scholar
  • 10 Roblot F, Godet C, Le Moal G. et al . Analysis of underlying diseases and prognosis factors associated with Pneumocystis jiroveci pneumonia in immunocompromised HIV-negative patients.  Eur J Clin Microbiol Infect Dis. 2002;  21 523-531
    CrossrefPubMedSearch in Google Scholar
  • 11 Yang C H, Yang L J, Jaing T H, Chan H L. Toxic epidermal necrolysis following combination of methotrexate and trimethoprim-sulfamethoxazole.  Int J Dermatol. 2000;  39 621-623
    CrossrefPubMedSearch in Google Scholar
  • 12 Zahar J R, Robin M, Azoulay E. et al . Pneumocystis jiroveci pneumonia in critically ill patients with malignancy: a descriptive study.  Clin Infect Dis. 2002;  35 929-934
    CrossrefPubMedSearch in Google Scholar

Christof M. KrammMD 

Moorenstraße 5

40225 Düsseldorf

Phone: +49/2 21/8 11 76 62

Fax: +49/2 11/8 11 76 34

Email: kramm@uni-duesseldorf.de