- Respiratory System:
1.1 Bacteria
1.1.1- Streptococcus pneumoniae (can still be infected despite vaccination)
Preventive treatment with broad-spectrum antibiotics: such as fluoroquinolones (Levofloxacin 500mg qd or Ciprofloxacin 500mg bid)
1.1.2- Pseudomonas aeruginosa (especially in neutropenic patients)
Add antipseudomonal penicillin (such as Piperacillin-tazobactam) once Pseudomonas aeruginosa is confirmed
1.1.3- Nocardia (chronic granulomatous changes, case: renal transplant patient with purulent sputum cough for 1 month, CT showing “cavity + halo sign,” confirmed by sputum culture)
Prevention for heart/lung transplant patients (highest incidence, about 1-3%)
- Long-term intensified immunosuppressants (such as triple therapy with Tacrolimus + Mycophenolate mofetil + Steroids, or after anti-thymocyte globulin therapy)
- History of Nocardia infection (reinfection risk up to 20%), preventive medication: TMP-SMX (Trimethoprim-Sulfamethoxazole) 480mg qd or 960mg thrice weekly.
- Mycobacteria (tuberculous/non-tuberculous mycobacteria, imaging may be atypical) In China, for patients on long-term immunosuppressants, post-transplant, or HIV-infected, prevention after evaluation; generally treat with anti-tuberculosis therapy after confirmation.
Preferred preventive regimen (6-9 months of Isoniazid): Isoniazid (INH) 5mg/kg/d (max 300mg/d) + Vitamin B6 25-50mg/d
1.2 Fungi
1.2.1 Pneumocystis pneumonia (PJP)
Use Trimethoprim-Sulfamethoxazole (SMZ-TMP)
Trimethoprim-Sulfamethoxazole tablets, also known as TMP-SMX, are sulfonamide antibiotics, the first choice for treating Pneumocystis jirovecii pneumonia and also used for its prevention.
- Applicable population: all patients receiving high-intensity immunosuppression (such as cyclophosphamide, high-dose steroids).
- Regimen: SMZ-TMP 480mg (1 tablet) once daily or every other day (for patients with normal renal function).
- Mechanism: Prevention of Pneumocystis pneumonia (PJP) and urinary tract infections.
- Note: Reduce dosage or switch to inhaled pentamidine if GFR <30ml/min
1.3 Others
1.3.1 Toxoplasma gondii (rare but fatal, often involving brain and lungs simultaneously)
Preventive treatment also uses Trimethoprim-Sulfamethoxazole (SMZ-TMP)
2. Skin and Mucous Membranes
- Herpes Zoster (VZV)
- Recommendation: All LN patients should receive recombinant zoster vaccine (Shingrix) (preferably before immunosuppression).
- During treatment onset: Use Acyclovir or Brivudine (avoid nephrotoxic drugs such as Fosfomycin).
After onset, treatment with traditional Chinese medicine Gualou Honghua Powder combined with Loulu Shengma Decoction plus modifications can be used.
- 3. Fungal infection prevention
- Oral candidiasis
- Regimen: Fluconazole 100mg once weekly (for long-term steroid users) or Nystatin oral rinse.
3. Urinary System
Routine treatment after infection; preventive medication is the same as for Streptococcus pneumoniae pneumonia.