Pneumocystis carinii pneumonia in HIV-negative patients with haematologic disease.
Since 1990, Pneumocystis carinii pneumonia (PCP) was diagnosed in 15 adult HIV-negative haematologic patients in our hospital. None of them had received PCP prophylaxis. All except one had been treated with prednisone. Symptoms usually started after stopping or tapering. In six patients the diagnosis of PCP was delayed because of confounding bacterial isolates from blood, sputum or urine leading to unsuccessful antibiotic treatment. PCP was diagnosed by demonstrating pneumocysts in bronchoalveolar lavage fluid. In four patients additional fungal or viral pathogens were identified. The infections were not clustered. The patients were treated with co-trimoxazole and, in case of a pO2 < 60 mmHg, with prednisone. Three patients died (20%); they all had a coinfection with cytomegalovirus and/or aspergillus. The others recovered completely. There were no relapses. Primary PCP prophylaxis should be considered in patients with lympho-proliferative disease and exposure to prednisone.
van der Lelie
J
J
Dept. of Internal Medicine, University of Amsterdam, The Netherlands.
Venema
D
D
Kuijper
E J
EJ
van Steenwijk
R P
RP
van Oers
M H
MH
Thomas
L L
LL
von dem Borne
A E
AE
D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000890:Anti-Infective Agents / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D001424:Bacterial Infections / Q000097:blood / Q000150:complications / Q000188:drug therapy / Q000652:urine; D001992:Bronchoalveolar Lavage Fluid / Q000382:microbiology; D003937:Diagnosis, Differential; D005260:Female; D018023:HIV Seronegativity; D006402:Hematologic Diseases / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000150:complications; D011020:Pneumonia, Pneumocystis / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D011241:Prednisone / Q000627:therapeutic use; D012008:Recurrence; D013183:Sputum / Q000382:microbiology; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use; D014777:Virus Diseases / Q000150:complications
D000900:Anti-Bacterial Agents; D000890:Anti-Infective Agents; D000893:Anti-Inflammatory Agents; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D011241:Prednisone