title: Ineffectiveness of trimethoprim-sulfamethoxazole prophylaxis and the importance of bacterial and viral coinfections in African children with Pneumocystis carinii pneumonia.
abstract: African human immunodeficiency virus type 1 (HIV-1)-infected children were evaluated to define the burden of Pneumocystis carinii pneumonia (PCP) and its interaction with bacterial and viral pathogens. P. carinii was identified in 101 (43.7%) of 231 episodes of pneumonia among 185 HIV-1-infected children (median age, 4.5 months; range, 1.7-27.3 months). Receipt of trimethoprim-sulfamethoxazole (TMP-SMX) prophylaxis was not associated with a significant reduction (36%; 95% confidence interval [CI], -15.4% to 64.5%) in isolation of P. carinii among children considered to have received adequate prophylaxis (37.7% of children) compared with children who had never received any prophylaxis (48.5% of children). However, deaths among children with PCP who had been taking TMP-SMX prophylaxis were markedly reduced (98.6%; 95% CI, 89.1%-99.8%) compared with children who were not taking prophylaxis. Concurrent P. carinii infection was observed in 6 of 18, 11 of 26, and 4 of 6 HIV-1-infected children who had bacteremia, a respiratory virus isolated, or Mycobacterium species isolated, respectively.
authors.affiliation: National Health Laboratory Service/University of the Witwatersrand/Medical Research Council Respiratory and Meningeal Pathogens Research Unit, Wits Health Consortium, Johannesburg, South Africa. shabirm@mail.saimr.wits.ac.za
authors.forename: Shabir A
authors.initials: SA
authors.lastname: Madhi
authors.forename: Clare
authors.initials: C
authors.lastname: Cutland
authors.forename: Kuraisha
authors.initials: K
authors.lastname: Ismail
authors.forename: Cathryn
authors.initials: C
authors.lastname: O'Reilly
authors.forename: Archana
authors.initials: A
authors.lastname: Mancha
authors.forename: Keith P
authors.initials: KP
authors.lastname: Klugman
mesh_terms: D000349:Africa; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis; D002675:Child, Preschool; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D011020:Pneumonia, Pneumocystis / Q000150:complications / Q000517:prevention & control*; D016896:Treatment Outcome; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use*; D014777:Virus Diseases / Q000150:complications / Q000517:prevention & control*
chemical_list: D000890:Anti-Infective Agents; D015662:Trimethoprim, Sulfamethoxazole Drug Combination