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. 2021 Oct;27(10):2734-2736.
doi: 10.3201/eid2710.210620.

Nocardiosis in Immunocompromised Patients on Alternative Pneumocystis Prophylaxis

Alfredo G Puing, David J Epstein, Niaz Banaei, Aruna K Subramanian, Anne Y Liu

Nocardiosis in Immunocompromised Patients on Alternative Pneumocystis Prophylaxis

Alfredo G Puing et al. Emerg Infect Dis. 2021 Oct.

Abstract

Prophylactic trimethoprim/sulfamethoxazole (TMP/SMX) prevents Pneumocystis jirovecii pneumonia and nocardiosis in immunocompromised patients but sometimes is avoided because of purported allergies or side effects. Of 25 immunocompromised patients receiving alternative prophylaxis in whom nocardiosis developed, 16 subsequently tolerated TMP/SMX treatment. Clinicians should consider TMP/SMX allergy evaluation and rechallenging to assess patient tolerance.

Keywords: Nocardia; Pneumocystis jirovecii; bacteria; drug allergy; fungi; immunocompromised; respiratory infections; sulfa; trimethoprim/sulfamethoxazole.

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Figures

Figure
Figure
Reasons for TMP/SMX avoidance and TMP/SMX rechallenge outcomes among immunocompromised patients in whom TMP/SMX prophylaxis for Pneumocystis jirovecii pneumonia prophylaxis was avoided, Stanford, California, USA. *Failed TMP/SMX introduction because of rash or GI symptoms that were not severe. †Developed intractable nausea and vomiting after TMP/SMX was introduced and did not tolerate rechallenge. GI, gastrointestinal; TMP/SMX, trimethoprim/sulfamethoxazole.
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