Pneumocystis jiroveci prophylaxis in patients undergoing Bendamustine treatment: the need for a standardized protocol

Pneumocystis jiroveci pneumonia (PJP) has been increasingly described as a serious opportunistic infection in HIV seronegative patients with malignancy, as a consequence of immunosuppression from chemotherapy. The standard method for diagnosing PJP is demonstration of Pneumocystis in either bronchoalveolar lavage fluid or induced sputum. Testing with either specimen has a sensitivity ranging from 80 to 95% [1, 2]. Trimethoprim/ sulpfamexazole (TMP/SMX) is the gold standard for treatment and prophylaxis of PJP. The death rate due to PJP ranges between 10 and 20% in patients with HIV [3]. This infection carries a worse prognosis in the HIV seronegative population with a mortality rate of 30 to 60%, possibly as a consequence of late diagnosis and delayed treatment [4].