Pneumocystis carinii pneumonia in infants after heart transplantation.
Although the reported incidence of Pneumocystis carinii pneumonia after heart transplantation in adults ranges from 3% to 40%, data are lacking regarding the incidence in the pediatric heart transplantation population. A retrospective review was performed on 152 infants (0 to 12 months of age) undergoing transplantation from November 1985 through December 1993 who survived at least 6 months after heart transplantation. Patients did not receive postoperative Pneumocystis carinii prophylaxis. Ten episodes (7%) were diagnosed in four neonates and six infants. The mean postoperative time to Pneumocystis carinii diagnosis was 5 months (range 3 to 9 months). Features of Pneumocystis carinii included hypoxia and tachypnea (10 of 10), progressive interstitial infiltrates (8 of 10), and persistent right middle lobe consolidation (1 of 10). Pneumocystis carinii was diagnosed with the use of bronchoscopy in eight cases and by open lung biopsy in two cases. Mean CD4 count available on five patients at the time of Pneumocystis carinii diagnosis was 413/mm3 (range 158 to 1358); 5 of 37 patients receiving antithymocyte induction had Pneumocystis carinii versus 5 of 115 patients who did not receive induction (p = 0.05). Patients were at increased risk for the development of Pneumocystis carinii if they had more than two episodes of rejection during the first year after heart transplantation (p = 0.04). All cases were successfully treated with trimethoprim/sulfamethoxazole. The incidence of Pneumocystis carinii in infant heart transplantation recipients is approximately 7% and appears most frequently in the first 6 months after the operation. Increased risk for Pneumocystis carinii may be related to early antithymocyte induction and increased episodes of rejection.
Janner
D
D
Department of Pediatrics, Loma Linda Medical Center, CA 92354, USA.
Bork
J
J
Baum
M
M
Chinnock
R
R
D000890:Anti-Infective Agents / Q000627:therapeutic use; D001999:Bronchoscopy; D018791:CD4 Lymphocyte Count; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000276:immunology / Q000517:prevention & control; D016027:Heart Transplantation / Q000009:adverse effects*; D006801:Humans; D016867:Immunocompromised Host; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D011010:Pneumocystis / Q000302:isolation & purification; D011020:Pneumonia, Pneumocystis / Q000453:epidemiology* / Q000209:etiology / Q000473:pathology; D011183:Postoperative Complications / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control; D011446:Prospective Studies; D012307:Risk Factors; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use
D000890:Anti-Infective Agents; D007166:Immunosuppressive Agents; D015662:Trimethoprim, Sulfamethoxazole Drug Combination