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Journal article
Risk factors associated with Pneumocystis jirovecii pneumonia in juvenile myositis in North America
Rheumatology (Oxford, England), v 60(2), pp 829-836
01 Feb 2021
PMID: 32889531
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Abstract
Objectives Pneumocystis jirovecii pneumonia (PJP) is associated with significant morbidity and mortality in adult myositis patients; however, there are few studies examining PJP in juvenile myositis [juvenile idiopathic inflammatory myopathy (JIIM)]. The purpose of this study was to determine the risk factors and clinical phenotypes associated with PJP in JIIM. Methods An research electronic data capture (REDCap) questionnaire regarding myositis features, disease course, medications and PJP infection characteristics was completed by treating physicians for 13 JIIM patients who developed PJP (PJP+) from the USA and Canada. Myositis features and medications were compared with 147 JIIM patients without PJP (PJP-) from similar geographic regions who enrolled in National Institutes of Health natural history studies. Results PJP+ patients were more often of Asian ancestry than PJP- patients [odds ratio (OR) 8.7; 95% CI 1.3, 57.9]. Anti- melanoma differentiation associated protein 5 (MDA5) autoantibodies (OR 12.5; 95% CI 3.0, 52.4), digital infarcts (OR 43.8; 95% CI 4.2, 460.2), skin ulcerations (OR 12.0; 95% CI 3.5, 41.2) and interstitial lung disease (OR 10.6; 95% CI 2.1, 53.9) were more frequent in PJP+ patients. Before PJP diagnosis, patients more frequently received pulse steroids, rituximab and more immunosuppressive therapy compared with PJP- patients. Seven PJP+ patients were admitted to the intensive care unit and four patients died due to PJP or its complications. Conclusions PJP is a severe infection in JIIM that can be associated with mortality. Having PJP was associated with more immunosuppressive therapy, anti-MDA5 autoantibodies, Asian race and certain clinical features, including digital infarcts, cutaneous ulcerations and interstitial lung disease. Prophylaxis for PJP should be considered in juvenile myositis patients with these features.
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Details
- Title
- Risk factors associated with Pneumocystis jirovecii pneumonia in juvenile myositis in North America
- Creators
- Sara E. Sabbagh - Medical College of WisconsinJessica Neely - University of California, San FranciscoAlbert Chow - Loma Linda University Children's HospitalMarietta DeGuzman - Baylor College of MedicineJamie Lai - Baylor College of MedicineSvetlana Lvovich - St. Christopher's Hospital for ChildrenTara McGrath - University of British ColumbiaMaria Pereira - Baylor College of MedicineIago Pinal-Fernandez - Johns Hopkins MedicineJordan Roberts - Boston Children's HospitalKelly Rouster-Stevens - Emory UniversityHeinrike Schmeling - University of CalgaryAnjali Sura - University of Michigan–Ann ArborGabriel Tarshish - Children's Hospital at MontefioreLori Tucker - University of British ColumbiaLisa G. Rider - National Institute of Environmental Health SciencesSusan Kim - University of California, San FranciscoCARRA JDM Workgrp
- Publication Details
- Rheumatology (Oxford, England), v 60(2), pp 829-836
- Publisher
- Oxford Univ Press
- Number of pages
- 8
- Grant note
- ZIA AR041203 / National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) of the National Institutes of Health; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Institute of Arthritis & Musculoskeletal & Skin Diseases (NIAMS) ZIAES101074; ZIAES101081 / National Institute of Environmental Health Sciences (NIEHS) of the National Institutes of Health CARRA
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Pediatrics
- Web of Science ID
- WOS:000765919200057
- Scopus ID
- 2-s2.0-85102212098
- Other Identifier
- 991019167460604721
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- Collaboration types
- Domestic collaboration
- International collaboration
- Web of Science research areas
- Rheumatology