Does cytomegalovirus predict a poor prognosis in Pneumocystis carinii pneumonia treated with corticosteroids? A note for caution.
OBJECTIVE
To examine the importance of cytomegalovirus (CMV) in bronchoalveolar lavage (BAL) fluid of patients with HIV-associated Pneumocystis carinii pneumonia (PCP) treated with adjunctive corticosteroids (CS).


METHODS
Analysis of clinical data during a 5-year period.


METHODS
Department of infectious diseases where clinical and paraclinical data on patients suspected of having PCP have been sampled prospectively.


METHODS
148 consecutive patients with a first episode of PCP in a 5-year period.


METHODS
Vital status 3 months after diagnosis of PCP.


RESULTS
Patients with PCP treated with adjunctive CS who had CMV cultured from BAL fluid had a two times higher mortality within 3 months from bronchoscopy than others (p = 0.08). This difference could not be explained by differences in CD4 count, PO2 or PCO2 at time of bronchoscopy.


CONCLUSIONS
With the accepted usage of adjunctive CS in severe PCP, the role of CMV as a pulmonary copathogen may have changed. Active CMV infection may be an important cause of failing treatment of severe PCP in those treated with adjunctive CS.
Jensen
A M
AM
Department of Infectious Diseases, Hvidovre Hospital, University of Copenhagen, Denmark.
Lundgren
J D
JD
Benfield
T
T
Nielsen
T L
TL
Vestbo
J
J
D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000401:mortality; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D001706:Biopsy; D001980:Bronchi / Q000473:pathology; D001992:Bronchoalveolar Lavage Fluid / Q000821:virology; D001999:Bronchoscopy; D017024:Chemotherapy, Adjuvant; D016009:Chi-Square Distribution; D003587:Cytomegalovirus / Q000302:isolation & purification; D003586:Cytomegalovirus Infections / Q000175:diagnosis* / Q000401:mortality; D015497:HIV-1; D006801:Humans; D011020:Pneumonia, Pneumocystis / Q000175:diagnosis* / Q000188:drug therapy / Q000401:mortality; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018709:Statistics, Nonparametric
D000305:Adrenal Cortex Hormones