Empfehlungen zur Prävention der Pneumocystis-carinii-Pneumonie bei Kindern und Jugendlichen mit neoplastischen Erkrankungen

Zusammenfassung.

Die Pneumocystis-carinii-Pneumonie (PCP) ist eine der wichtigsten opportunistischen Infektionen bei Kindern und Jugendlichen mit bösartigen Erkrankungen. Hohes Erkrankungsrisiko und eine beträchtliche Mortalität haben zur Chemoprophylaxe bei Patienten mit hämatologischen Neoplasien und nach allogener hämatopoetischer Stammzelltransplantation geführt. Bei autolog transplantierten Patienten und Patienten mit soliden Tumoren und dosisintensiver Chemotherapie kann aufgrund der ausgeprägten T-Zell-Depletion von einem ähnlich hohen Infektionsrisiko ausgegangen werden. Seit mehr als zwei Jahrzehnten steht mit der Gabe von Trimethoprim/Sulfamethoxazol (TMP/SMX) eine bei krebskranken Kindern und Jugendlichen evaluierte, im Allgemeinen gut verträgliche und nahezu 100 % effektive Chemoprophylaxe der PCP zur Verfügung. Sekundäre, nachgewiesenermaßen weniger wirksame und vorwiegend bei HIV-infizierten Patienten evaluierte Verfahren umfassen die Gabe von Dapson bzw. Atovaquone und die Inhalation von aerosolisiertem Pentamidin-Isethionat. Die vorliegende Arbeit gibt eine Übersicht über die Epidemiologie der PCP bei Kindern und Jugendlichen mit bösartigen Erkrankungen bzw. hämatopoetischer Stammzelltransplantation sowie die verfügbaren Verfahren der Chemoprophylaxe und enthält Empfehlungen zu Indikationen und Modalitäten der Chemoprophylaxe der PCP auf der Basis der Literatur.

Pneumocystis carinii pneumonitis (PCP) is one of the most important opportunistic infections in children and adolescents with cancer. Its high frequency and a considerable mortality have led to primary chemoprophylaxis in patients with hematological malignancies and following allogeneic hematopoietic stem cell transplantation. Although less well characterized, patients with autologous stem cell transplantation and patients with dose-intensive chemotherapy for pediatric solid tumors may have a similarly high risk for PCP based on their profound T-cell depletion. For more than two decades, effective chemoprophylaxis for PCP has been available. Trimethoprim and sulfamethoxazole (TMP/SMX) is the prophylactic modality of first choice. The combination has been shown to be almost 100 % efficacious in pediatric cancer patients at highest risk, and it is usually well tolerated in this setting. Secondary alternatives to TMP/SMX include oral dapsone, oral atovaquone, and aerosolized pentamidine-isethionate. These modalities are less effective than TMP/SMX, and have been evaluated predominantly in HIV-infected patients. This article reviews epidemiology and current approaches to chemoprophylaxis for PCP in children and adolescents with cancer and/or hematopoietic stem cell transplantation, and provides evidence-based guidelines for indications and modalities of PCP prophylaxis in this population.

Schlüsselwörter

Krebserkrankung - Empfehlungen - Kinder - Jugendliche - Mykosen - Pneumocystis carinii - Pentamidin - Dapson - Trimethoprim/Sulfamethoxazol - Atovaquone

Key words

Cancer - children - mycoses - recommendations - Pneumocystis carinii - trimethoprim/sulfamethoxazole - pentamidine - dapsone - atovaquone

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