PNEUMOCYSTIS JIROVECI IN BRAIN TUMOR PATIENTS

What is it about?

At the Pencer Brain Tumour Centre at Princess Margaret, there is no established protocol regarding PCP prophylaxis in glioma patients on corticosteroids, as it is felt that the incidence of PCP is rare and side effects of prophylaxis can impact patient's overall well being during treatment. Retrospective assessment of our cohort of patients with primary brain tumours from January 1st 2008 to December 31st 2013 will help determine the incidence of PCP infection in this population in the absence of prophylaxis and will allow evaluation of factors associated with PCP infection, including the dose and the duration of corticosteroid treatment, CD4 count and systemic therapy.

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Photo by Nhia Moua on Unsplash

Photo by Nhia Moua on Unsplash

Why is it important?

Pneumocystis jiroveci pneumonia (PCP) can be a highly lethal infection in patients with HIV or other immunodeficiencies, with a mortality rate estimated at 50%. The use of corticosteroids has been associated with 80-94% of PCP cases in the non-HIV population. In two-thirds of cases, the infection clinically presents during the tapering of steroids, likely reflecting an infection that is unmasked as the patient regains the ability to mount an immune response. The precise influence of dose and duration of corticosteroid treatment regarding susceptibility to PCP infection remains a controversial question. Some studies suggest that patients with brain tumours on steroids for more than 5 weeks are at high risk of PCP, especially during the tapering period. Generally, patients who receive steroid treatment for more than 4 weeks at a dose equivalent to 20 mg of prednisone per day are considered for PCP prophylaxis at most cancer centres, but there is variability across institutions.

Perspectives