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UK paediatric oncology Pneumocystis jirovecii pneumonia surveillance study
Rebecca Hilary Proudfoot1, Bob Phillips2
1Paediatrics, York Hospitals NHS Foundation Trust, York, North Yorkshire, UK rhproudfoot@gmail.com.
Insights
Pneumocystis jirovecii pneumonia (PJP) is rare in children with cancer, with no attributed deaths in a UK study. Breakthrough infections occurred despite prophylaxis, warranting further investigation into treatment strategies.
Area of Science:
- Pediatric Oncology
- Infectious Diseases
- Epidemiology
Background:
- Pneumocystis jirovecii pneumonia (PJP) is a severe complication in immunocompromised patients.
- Data on PJP incidence and mortality in pediatric cancer patients receiving immunosuppressive therapy are limited.
- The influence of prophylaxis on PJP outcomes in this population requires further investigation.
Purpose of the Study:
- To determine the incidence, mortality, and outcomes of PJP in children undergoing cancer treatment in the UK and Ireland.
- To evaluate the utilization and effectiveness of PJP prophylaxis in this high-risk group.
- To identify factors influencing PJP occurrence and outcomes in pediatric oncology patients.
Main Methods:
- Prospective surveillance of suspected and confirmed PJP cases in children with cancer across 20 UK and Ireland pediatric oncology centers.
- Collection of clinical data, including prophylaxis use, treatment, and outcomes.
- Analysis of PJP incidence, mortality rates, and breakthrough infections.
Main Results:
- PJP is rare in pediatric cancer patients, with 32 cases reported over two years.
- No deaths were directly attributed to PJP, contrasting with previous reports of high mortality.
- Breakthrough PJP infections occurred despite co-trimoxazole prophylaxis (11 cases), and some infections occurred without prophylaxis indicated or with its omission due to toxicity concerns.
Conclusions:
- PJP is an infrequent complication in children with malignancies.
- Breakthrough PJP infections suggest potential issues with pathogen resistance or patient compliance.
- Further research is needed on PJP prophylaxis in specific pediatric cancers (AML, NHL) and the clinical impact of co-trimoxazole's potential bone marrow suppressive effects and methotrexate interactions.
Background:
Pneumocystis jirovecii pneumonia (PJP) is a serious infective complication of immunosuppressive therapy. There are insufficient data concerning the incidence or mortality rate in children undergoing treatment for malignancies and how these may be influenced by prophylaxis.
Objective:
Prospective collection of clinical information for all suspected and proven cases of PJP in children with cancer in the UK and Ireland.
Design:
A surveillance survey was undertaken using a key contact at each paediatric oncology Principle Treatment Centre (PTC).
Main Outcome Measures:
To describe the mortality, outcomes and use of prophylaxis in this at-risk group.
Results:
The study confirms that PJP is rare, with only 32 cases detected in the UK over a 2-year period reported from all 20 PTCs. No deaths were directly attributed to PJP, in contrast to previously reported high mortality rates. Breakthrough infection may occur despite prescription of ostensibly adequate prophylaxis with co-trimoxazole; 11 such cases were identified. Six infections occurred in patients for whom prophylaxis was not thought to be indicated. Two infections occurred in patients for whom prophylaxis was specifically omitted due to concerns about potential bone marrow suppression or delayed engraftment.
Conclusion:
PJP in children treated for malignant disease is rare. Breakthrough infection despite prophylaxis with co-trimoxazole may represent pathogen resistance or non-compliance. Further consideration of the use of PJP prophylaxis during acute myeloid leukaemia and non-Hodgkin's lymphoma treatment is warranted, alongside appraisal of the clinical implications of the possible marrow suppressive effects of co-trimoxazole and its interactions with methotrexate.
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