Pneumocystis carinii pneumonia in patients with the acquired immunodeficiency syndrome.
Pneumocystis carinii infection remains extremely common in the immunocompromised patient population, particularly in patients with human immunodeficiency virus (HIV) infection, despite the availability of effective prophylaxis. Although most commonly presenting as an acute pneumonia, the organism can infect a multitude of different organs, and thus may pose difficulty in diagnosis. Because effective treatment regimens such as trimethoprim-sulfamethoxazole (TMP-SMX) and parenteral pentamidine are hindered by a high rate of adverse reactions, alternative regimens are continuing to be evaluated. Of greatest promise to date for patients with mild-to-moderate disease are the alternative oral regimens of atovaquone, dapsone with trimethoprim, and clindamycin with primaquine. The addition of corticosteroids to anti-Pneumocystis therapy in patients with severe disease has been shown to improve both the short-term and long-term success of treatment. TMP-SMX and aerosolized pentamidine have been shown to be effective in the primary and secondary prevention of pneumocystosis; prophylactic regimens currently under study include dapsone, dapsone with pyrimethamine, and once-monthly parenteral pentamidine.
Safrin
S
S
Department of Medicine, University of California, San Francisco.
D000163:Acquired Immunodeficiency Syndrome / Q000150:complications*; D006801:Humans; D011020:Pneumonia, Pneumocystis / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D011379:Prognosis