[Pneumocystis carinii pneumonia in children. Apropos of 33 cases].

From 1964 to 1983, thirty-three children have developed Pneumocystis carinii pneumonia (18 boys and 15 girls). The affection appears before 1 year of age in 73% of the cases (mean +/- SD: 6,12 +/- 4,6 months). The predisposing factors for the disease include hypotrophy (7), immune deficiency (26: 79%) (12 congenital and 14 acquired). The thymodependant lymphocytic system is concerned in 15 cases (46%) with only 5 neoplasic origins. The onset of the disease is in the first year of immuno-suppresive treatment in 71% of the cases. It is acute in 27% of the cases. Polypnea is found in 94% of the cases, cyanosis 73%, fever 70%, respiratory distress 64%. Distal endobronchial brushing associated with distal bronchopulmonary lavage and surgical pulmonary biopsy seem the best methods of direct positive diagnosis. The specific serology is less useful. Among the 20 treated children, 7 were cured (35%). The global mortality rate is still high (79%). The new proposed therapeutic schema includes either pentamidine as a "starter" effect (4 mg/kg/d IM/ X 5 d) associated with pyrimetamine-sulfadoxine (1,25 mg PYR/25 mg SUL/kg/d every 8 days) or trimethoprim-sulfamethoxazole (20 mg TMP/100 mg SMZ/kg/d X 14 d; efficient plasmatic TMP: 5 to 10 micrograms/ml). Chemoprophylaxy must be followed by all "high risk" patients during the totality of the immunosuppressive period (PYR-SUL every 15 days associated with folinic acid).