[Acute respiratory failure secondary to Pneumocystis carinii pneumonia in children]. / Fracaso respiratorio agudo secundario a neumonía por Pneumocystis carinii en la infancia.

OBJECTIVE: The objective of this study was to ascertain the clinical and epidemiological characteristics of Pneumocystis carinii pneumonia (PCP) cases admitted to the Pediatric Intensive Care Unit (PICU). PATIENTS AND METHODS: A retrospective study was carried out on the 8 PCP cases admitted to the PICU from July 1991 to September 1994. The variables studied were: age, sex, geographic origin, associated pathology, immunological status, clinical manifestations, biochemical data, radiology, findings in bronchoalveolar lavage fluid (BAL), response to therapy and clinical follow-up. RESULTS: Age of the patients varied between 3 months and 9 years and there were 5 males and 3 females. Associated pathologies included AIDS (4 cases), severe combined immunodeficiency (SCID), Job's syndrome, and immunodeficiencies secondary to non-Hodgkin's lymphoma (NHL) and acute lymphoid leukemia (ALL), one case of each. Four cases appeared in a 22 day period. All cases but one suffered acute respiratory failure and needed mechanical ventilation. Diagnosis was established by means of BAL in every case. All cases showed a bilateral diffuse alveolo-interstitial pattern on chest films. Treatment was trimethoprim-sulfamethoxazole. In the acute illnesses, 2 patients died (cases of terminal SCID and NHL). CONCLUSIONS: To date, epidemic presentation of PCP has not been reported in our community. Four of our cases, with no demonstrable previous relation, appeared over a short period of time. We have not found a relationship between LDH levels and severity, as expressed by mechanical ventilation time. Every AIDS case survived the acute episode and CD4 counts were normal in most cases.