Prevalence of Pneumocystis jirovecii and Mycoplasma pneumoniae in Patients Presenting with Pneumonia at Hospitals in Port Elizabeth

The study was conducted to determine the prevalence of Pneumocystis jirovecii and Mycoplasma pneumoniae in patients presenting with community-acquired pneumonia; in order to improve treatment management programmes. Sputum specimens from 45 patients presenting with pneumonia/symptoms of pneumonia admitted to hospitals in the Port Elizabeth region were assessed. Details of patient's gender; age; HIV and Mycobacterium tuberculosis status were provided by the hospitals. PCRs were performed employing primers directed at the following genes: P. jirovecii for detection of mitochondrial large subunit ribosomal RNA (mtLSUrRNA) and for cotrimoxazole resistance mutation analysis dihrdropteroate synthase (DHPS) and dihydrofolate reductase (DHFR); M. pneumoniae for detection of P1 adhesin and 16SrRNA. Women were seen to be at high risk for community-acquired P. jirovecii colonisation. Overall; prevalence of P. jirovecii was 73(33/45 patients). P. jirovecii was mainly associated with HIV (28/30 P. jirovecii-positive patients for which clinical data were available) and co-colonisation with M. tuberculosis was observed in 10 HIV cases and one HIV-negative patient. DHPS and DHFR primers seriously lacked sensitivity and on six and four PCR products obtained; respectively; no resistanceassociated mutations were found. M. pneumoniae was detected in one patient. The high prevalence of P. jirovecii and presence of M. pneumoniae in cases of pneumonia investigated emphasises that in the absence of definitive diagnoses; it is crucial to monitor treatment responses carefully; especially when first line antibiotic preferences are a-lactams or cephalosporins

Adjunctive Corticosteroid Treatment of Clinical PCP Pneumonia in Infants Less than 18 Months of Age : a Randomized Controlled Trial

"Objectives. To determine the efficacy and safety of adjunctive corticosteroid therapy in clinical PCP pneumonia (Pneumocystis jiroveci pneumonia) in infants exposed to HIV infection. Design. Double blind randomised placebo-controlled trial. Methods: Infants with a clinical diagnosis of PCP; based on an ""atypical"" pneumonia with: 1) hypoxia out of proportion to the clinical findings on auscultation; 2) CRP less than 10 IU; 3) LDH above 500 IU; 4) compatible CXR findings and 5) positive HIV ELISA test were included in the study. Patients were randomised to receive either prednisone or placebo. The protocol provided for the addition of prednisone to the treatment at 48 hours if there was clinical deterioration or an independent indication for steroid therapy. Other treatment was carried out in accordance with established guidelines. in room air. Results. One hundred patients were included; 47 in the prednisone and 53 in the placebo group. Patients in the prednisone group had a 43 better chance of survival than the placebo group (HR 0.57; 95CI 0.30-1.07; p=0.08). No significant differences could be demonstrated between groups in respect of other parameters of recovery. Conclusions. In HIV exposed infants with clinical PCP pneumonia; adjunctive corticosteroid treatment does not appear to add benefit regarding time to recovery or oxygen independency; but early administration may improve survival. A large multi-centred trial is needed to confirm these findings.The primary study endpoint was in hospital survival. Secondary outcome was time from admission to the first day of mean oxygen saturation above 90"