Pneumocystis pneumonia in the acquired immune deficiency syndrome (AIDS) - abstract

ABSTRACT

We present a retrospective analysis of Pneumocystis carinii pneumonia (PCP) in patients with AIDS at our institution. Data were collected by chart and radiological review. Since February 1983 we have treated 24 patients with AIDS and PCP. All except three were homosexual males, with seventeen (17 percent) having PCP as the initial manifestation of AIDS. All patients had CXR changes on presentation. Three had atypical changes including lobar consolidation and multiple cavities. Arterial pO2 on room air ranged from 33 to 83 (av. 59). Diagnosis was made in 28 of 30 episodes (93 percent) using bronchoalveolar lavage. One patient was positive on induced sputum, and one had a positive open lung biopsy. Other respiratory pathogens were also isolated in 20 of 30 episodes (67 percent). Therapy was initiated with trimethoprim-sulpha (T-S) or pentamidine (P). Seven of 21 episodes (33 percent) were successfully treated with T-S alone vs one of nine (11 percnet) with P alone. Eight of 21 (38 percent) experienced adverse effects with T-S vs six of nine (67 percent) with P. Adjunctive steriod therapy was required in 11 of 30 episodes (37 percent) with four deaths subsequently. Overall, six of 30 episodes (20 percent) resulted in death, three in association with concomitant CMV infection. Six of 24 patients (25 percent) had two or more episodes of PCP occurring within 5-17M. (av. 9M) of successful therapy. Our experience parallels that reported from other centres in North America (AU)