PLoS ONE (Jan 2020)

Rituximab identified as an independent risk factor for severe PJP: A case-control study.

  • Anat Zalmanovich,
  • Ronen Ben-Ami,
  • Galia Rahav,
  • Danny Alon,
  • Allon Moses,
  • Karen Olshtain-Pops,
  • Miriam Weinberger,
  • Pnina Shitrit,
  • Michal Katzir,
  • Bat-Sheva Gottesman,
  • Michal Chowers

DOI
https://doi.org/10.1371/journal.pone.0239042
Journal volume & issue
Vol. 15, no. 9
p. e0239042

Abstract

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ObjectivePneumocystis jirovecii pneumonia (PJP) was reported among immunosuppressed patients with deficits in cell-mediated immunity and in patients treated with immunomodulatory drugs. The aim of this study was to identify risk-factors for PJP in noninfected HIV patients.MethodsThis retrospective, test negative, case-control study was conducted in six hospitals in Israel, 2006-2016. Cases were hospitalized HIV-negative patients with pneumonia diagnosed as PJP by bronchoalveolar lavage. Controls were similar patients negative for PJP.ResultsSeventy-six cases and 159 controls were identified. Median age was 63.7 years, 65% males, 34% had hematological malignancies, 11% inflammatory diseases, 47% used steroids and 9% received antilymphocyte monoclonal antibodies. PJP was independently associated with antilymphocyte monoclonal antibodies (OR 11.47, CI 1.50-87.74), high-dose steroid treatment (OR 4.39, CI 1.52-12.63), lymphopenia (OR 8.13, CI 2.48-26.60), low albumin (OR 0.15, CI 0.40-0.54) and low BMI (OR 0.80, CI 0.68-0.93).ConclusionIn conclusion, rituximab, which is prescribed for a wide variety of malignant and inflammatory disorders, was found to be significant risk-factor for PJP. Increased awareness of possible PJP infection in this patient population is warranted.