[Acute respiratory failure secondary to Pneumocystis carinii pneumonia in children].

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.