Abstract Details

Title Occurrence of pneumocystis pneumonia in patients with neurological disease on immunosuppression: a single-center investigation

Topic Infectious Disease

Presentation(s) P4 - Poster Session 4 (5:30 PM-6:30 PM)

Poster/Presentation
Number 4-007

Objective Confirmed cases of PCP at a tertiary referral center from 2007-2016 were retrospectively reviewed to determine the incidence of PCP in patients with primary neurological conditions and associated risk factors.

Background Pneumocystis pneumonia (PCP) is opportunistic infection caused by Pneumocystis jirovecii. PCP is well known to affect patients with human immunodeficiency virus (HIV) but is also increasingly found in patients who are immunosuppressed for prevention of transplant rejection, treatment of malignancy, or treatment of an inflammatory disorder. Currently, the incidence of PCP in patients with underlying neurological conditions is not well established. Thus the necessity of PCP prophylaxis for the treatment of immune-mediated neurological conditions is uncertain.

Design/Methods NA

Results A total of 209 patients were identified with PCP: 67 patients with HIV and 142 without. Of the non-HIV PCP patients, 122 had a non-neurological primary diagnosis including 73 (59.8%) with active malignancy and 49 (40.2%) with non-malignant conditions. The remaining 20 patients had primary neurological diagnoses. Among them, 16 patients had central nervous system (CNS) diagnoses, 14 of which were brain malignancies, 1 case of neuromyelitis optica and 1 case of CNS vasculitis. The remaining 4 patients suffered peripheral nervous system (PNS) disorders which included 2 patients with myasthenia gravis (both of which also had underlying malignancies), 1 with polymyositis, and 1 with an untreated inflammatory myopathy and idiopathic pulmonary fibrosis. Active malignancy was present in 80% of patients with neurological diagnoses.

Conclusions The overall incidence of PCP in non-neoplastic primary neurological disorders is very low, raising doubt about the value of routine PCP prophylaxis. Alternatively, PCP prophylaxis should be considered for patients with brain malignancies.

Authors/Disclosures
PRESENTER	No disclosure on file
Mary A. Willis, MD, FAAN	Dr. Willis has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Bristol Myers Squibb.
Tiffany Lee	No disclosure on file
Sana Syed, DO (Edward Elmhurst Neurosciences)	No disclosure on file

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