Pneumocystis carinii pneumonia: Pitfalls of prophylaxis

Pneumocystis carinii pneumonia (PCP) occurs commonly in immunocompromised patients. Sulfamethoxazole-trimethoprim (SMX-TMP) is effective prophylaxis, although PCP may still occur despite apparently adequate use. We report three cases of PCP which highlight some of the pitfalls of prophylaxis.     

Pneumocystis carinii pneumonia in preterm infants: report of two cases successfully diagnosed by non-bronchoscopic bronchoalveolar lavage

We present two cases of Pneumocystis carinii pneumonia in apparently immunocompetent preterm infants presenting with unexplained respiratory distress associated with a predominantly interstitial process on the chest radiograph. Definite diagnosis was promptly established on the detection of cyst forms in the lung fluid obtained by non-bronchoscopic bronchoalveolar lavage, and a favourable outcome was achieved.     

Pneumocystis carinii pneumonitis in haemophagocytic lymphohistiocytosis

We report on a 10-y-old boy who developed Pneumocystis carinii pneumonitis (PCP) as the dominant symptom at the onset of haemophagocytic lymphohistiocytosis (HLH). PCP is a common infection in patients with combined primary immunodeficiencies or acquired immunodeficiency syndrome but it has rarely been observed at the onset of HLH. Typically, HLH presents as a febrile syndrome associated with cytopenia and hepatosplenomegaly. Repeated bone marrow aspirates, spleen or lymph node biopsies are sometimes required to reveal haemophagocytosis. Because of the significant immunosuppression during treatment of HLH, prophylaxis of PCP with co-trimoxazole is recommended. However, de-arranged immune response in HLH renders the patients susceptible to opportunistic infections, even before the introduction of immunosuppressants. Conclusion: We suggest that in patients with unclear respiratory symptoms, it is worth considering a differential diagnosis of HLH.     

Marasmus and pneumocystis carinii pneumonia in institutionalised infants

An endemic of interstitial plasmacell pneumonia due to pneumocystis carinii, leading to 68 deaths in an orphanage, is described. Artifical nutrition led to severe intestinal infections with prolonged diarrhoea, followed by atrophy of the upper intestinal mucosa and marasmus. The IgG levels fell below 200mg% by the 3rd to 4th month of life, which is one of the preconditions for an infection with pneumocystis carinii.Infants with much higher levels of immune-globulins could not survive before the advent of antibiotics. Epidemics with pneumocystis carinii were therefore not seen prior to World War II.Interstitial plasmacell pneumonia leads to immunity in those infants who survive and is therefore clearly distinct from the pneumocystosis, which occurs in congenital immunodeficiency syndromes and in patients who undergo persistent therapeutic immunosuppression.This study has been supported by NIH grant Al-06404.     

Diagnosis of pneumocystis carinii pneumonia using an endobronchial brushing technique

By examining the endobronchial brushings from 65 infants and children with interstitial pneumonia—characterized by a severe hypoxia and diffuse lung infiltrates — we have detected the cysts of pneumocystis carinii in 17 of 21 subsequently confirmed cases. The rapid diagnosis and subsequent specific treatment have allowed the recovery of 18 of these children. The particular significance of this article is the youth of the patients, whose ages ranged from 4 months to 15 years.     

儿童肾病合并肺孢子菌肺炎3例临床分析

目的 提高对肺孢子菌肺炎(PCP)的认识.方法 回顾分析3 例肾病并发PCP患儿的临床资料.结果 3例患儿的共同特点是,PCP起病急,临床以发热、咳嗽起病,伴有低氧血症,症状与体征不平行;早期临床表现无特异性,易漏诊,并发PCP前患儿均长期或大量应用免疫抑制剂、足量泼尼松口服疗程达8周及以上;免疫功能检查均有不同程度的CD4细胞比例下降.结论 提高对PCP的认识,做到早期诊断;适当控制免疫抑制剂应用、改善患儿生活环境、针对高危人群定期检测CD4细胞水平以及酌情应用复方磺胺甲基异噁唑预防均有利于降低肺孢子菌肺炎的发病率.     

Spontaneous improvement of pneumocystis carinii pneumonia in childhood acute lymphocytic leukemia

Until recently, Pneumocystis carinii pneumonitis was the most common cause of death in patients with leukemia in remission. Prior to the advent of effective antimicrobial agents, this disease was virtually 100% fatal in the cancer patient undergoing immunosuppressive therapy. The spontaneous improvement of P carinii pneumonitis in a child with acute lymphocytic leukemia suggests a higher incidence of P carinii pneumonitis in immunocompromised patients than is commonly realized.     

Pneumocystis carinii pneumonia in a girl with a midbrain glioma

A 7-year-old girl with a midbrain glioma contracted Pneumocystis carinii pneumonia (PCP) the absence of cytotoxic or corticosteroid therapy. Gliomas are known to cause immunosuppression, in and PCP prophylaxis should be considered for patients with these tumors.     

An outbreak of Pneumocystis carinii pneumonia at a pediatric hospital.

Eleven cases of Pneumocystis carinii pneumonia were diagnosed during a 3 1/2-year period at a pediatric hospital where this infection had never been identified previously despite appropriate studies. The incidence of infection was 3.0, 7.4, and 4.2 cases per 1,000 patient months in children being treated for acute leukemia, neuroblastoma, and rhabdomyosarcoma, respectively. The outbreak coincided with increased intensity of chemotherapy for these malignancies. Ten of the patients had received four or more chemotherapeutic agents within three months of the onset of infection. Because no exogenous source of the epidemic was found, latent endogenous infection activated by immunosuppression was presumed to be the ultimate cause of the outbreak. Increased intensity of chemotherapy may result in P carinii outbreaks and may be an indication for anti-Pneumocystis prophylaxis with trimethoprim/sulfamethoxazole in patients at risk.     

噬血细胞综合征合并耶氏肺孢子虫和巨细胞病毒共感染肺炎1例报告

耶氏肺孢子虫肺炎是由机会性感染病原——耶氏肺孢子虫感染引起的肺部感染性疾病,常发生于免疫功能低下患儿,易合并巨细胞病毒感染。本文报道2019年2月深圳市儿童医院收治的1例非获得性免疫缺陷综合征(AIDS)患儿耶氏肺孢子虫肺炎合并巨细胞病毒感染病例。该病例为有免疫抑制的婴儿,临床表现为发热、咳嗽,迅速进展为呼吸衰竭,行高通量测序在支气管肺泡灌洗液(BALF)中检测出耶氏肺孢子虫而确诊,经甲氧苄氨嘧啶/磺胺甲基异噁唑(TMP/SMZ)和更昔洛韦抗感染治疗后好转,现报告如下。     

The use of intravenous pentamidine for the prophylaxis of Pneumocystis pneumonia in pediatric patients

Pneumocystis jiroveci pneumonia was common in the immunocompromised host before the widespread use of prophylaxis. When trimethoprim–sulfamethoxazole is not tolerated, prophylaxis with intravenous pentamidine (IVP) may be initiated. We performed a retrospective analysis of all pediatric patients who received IVP regarding efficacy, safety, and reason for initiation. Of 106 patients included in our analysis, one patient tested positive for Pneumocystis DNA. Adverse events were reported in 18% of IVP courses, and main reason for initiation was cytopenia (59%). We found IVP to be effective and safe, and recommend the use of IVP in pediatric patients in whom first‐line prophylaxis is contraindicated.     

Pneumocystis pneumonia in children receiving chemotherapy

Pneumocystis pneumonia (PCP) is a serious complication of chemotherapy-induced immunosuppression. Trimethoprim-sulfamethoxazole (TMP-SMZ) given twice daily, 3 days every week is considered the best form of prophylaxis for PCP. We evaluated PCP prophylaxis in all children up to 18 years of age undergoing cancer chemotherapy over a 2-year period. Four children were diagnosed with PCP over 24 months. Two of 12 children on intravenous pentamidine, 1 of 143 on TMP-SMZ and 1 of 36 on dapsone for PCP prophylaxis developed PCP. Intravenous pentamidine may not be as effective as previously considered and should be used with caution.     

新生儿重症监护病房一起肺炎克雷伯杆菌医院感染暴发临床分析

目的探讨新生儿医院感染暴发的临床特点、原因以及预防和控制措施。方法回顾性分析新生儿重症监护病房(NICU)发生的一起肺炎克雷伯杆菌肺炎医院感染暴发事件。结果 2010年9月3日至2010年10月3日期间,NICU连续发现12例痰培养肺炎克雷伯杆菌阳性患儿,最终7例确定医院感染。患儿胎龄(28.5±2.6)周(25~32周),出生体质量(941.4±309.8)g(620~1540 g),发生医院感染时的住院时间为(31.7±12.8)d(11~45 d)。总医院感染发生率2.41%,早产儿医院感染发生率为5.79%。胎龄28周的极早早产儿医院感染发生率达到50.00%,超低出生体质量儿医院感染发生率为42.86%。所有痰培养结果均显示为多重耐药肺炎克雷伯杆菌,对青霉素类及三代头孢菌素类抗生素耐药率达到75%~100%,碳青酶烯类耐药率达到58.3%,哌拉西林/他唑巴坦耐药性最低为25.0%。所有患儿均治愈出院,无死亡病例。结论胎龄28周的极早早产儿及超低出生体质量新生儿是NICU医院感染暴发的高危人群。引起医院感染暴发的肺炎克雷伯杆菌耐药性已经突变至耐碳青霉烯类,需引起高度重视。规范的医疗行为是有效的医院感染防控措施,可以显著降低NICU早产儿医院感染率及死亡率。     

Pneumocystis carinii pneumonia in children. Apropos of 33 cases

From 1964 to 1983, thirty-three children have developed Pneumocystis carinii pneumonia (18 boys and 15 girls). The affection appears before 1 year of age in 73% of the cases (mean +/- SD: 6,12 +/- 4,6 months). The predisposing factors for the disease include hypotrophy (7), immune deficiency (26: 79%) (12 congenital and 14 acquired). The thymodependant lymphocytic system is concerned in 15 cases (46%) with only 5 neoplasic origins. The onset of the disease is in the first year of immuno-suppresive treatment in 71% of the cases. It is acute in 27% of the cases. Polypnea is found in 94% of the cases, cyanosis 73%, fever 70%, respiratory distress 64%. Distal endobronchial brushing associated with distal bronchopulmonary lavage and surgical pulmonary biopsy seem the best methods of direct positive diagnosis. The specific serology is less useful. Among the 20 treated children, 7 were cured (35%). The global mortality rate is still high (79%). The new proposed therapeutic schema includes either pentamidine as a "starter" effect (4 mg/kg/d IM/ X 5 d) associated with pyrimetamine-sulfadoxine (1,25 mg PYR/25 mg SUL/kg/d every 8 days) or trimethoprim-sulfamethoxazole (20 mg TMP/100 mg SMZ/kg/d X 14 d; efficient plasmatic TMP: 5 to 10 micrograms/ml). Chemoprophylaxy must be followed by all "high risk" patients during the totality of the immunosuppressive period (PYR-SUL every 15 days associated with folinic acid).