Background: Pneumocystis cariniipneumonia is a common opportunistic infection in pediatric acquired immunodeficiency syndrome (AIDS). Mortality rates of 34% have been reported for the acute infection, with much higher mortality rates occurring in the presence of respiratory failure. Corticosteroids reduce the morbidity and mortality in adults with AIDS andP cariniipneumonia. We report herein our experience with corticosteroids in P carinii pneumonia in pediatric AIDS. Methods: When the data on adults were published, we began treating our patients with corticosteroids. We compared these children (group 1) with those children treated in a similar manner, but without corticosteroids (group 2). Results: The two groups had similar ages, initial serum lactate dehydrogenase levels, and initial alveolar-arterial difference in partial pressure of oxygen. There was a significant (P Conclusion: Corticosteroid therapy during acute infection withP cariniiin young children with AIDS appears to significantly reduce morbidity (as measured by the need for mechanical ventilation) and mortality. (Arch Pediatr Adolesc Med. 1994;148:638-641)

https://jamanetwork.com/HttpHandlers/ArticlePdfHandler.ashx?journal=peds&articleId=517182&pdfFileName=archpedi_148_6_018.pdf

Markedly reduced mortality associated with corticosteroid therapy of Pneumocystis carinii pneumonia in children with acquired immunodeficiency syndrome.

Treatment with either rhDNase or high-frequency oscillation has been shown to be effective in improving the physical and transport properties of airway secretions in cystic fibrosis (CF). The objects of this in vitro study was to examine whether combined treatment with oscillation and rhDNase results in greater change of CF sputum spinnability than either treatment by itself. Aliquots of sputum (0.4 g) from eight CF patients were subjected to the following protocols for 15 minutes and then followed for a total of 30 minutes: 1) incubation with 0.04 ml DNase 50 micrograms rhDNase/normal saline (10% dilution) at 37 degrees C to achieve 5 micrograms DNase/g of sputum final concentration; 2) airflow oscillation at 27 Hz similar to the airflow magnitude produced by a commercial high-frequency chest compression (HFCC) device; 3) negative control with no treatment; 4) positive (dilution) control, incubating with 10% saline by volume; 5) combination of DNase and oscillation, and 6) combination of saline and oscillation. For each protocol, sputum spinnability (in mm, mean +/- SD) was measured by means of a filancemeter at baseline, 15, and 30 minutes. Treatment with DNase decreased spinnability significantly more than either saline or oscillation at 15 and 30 minutes (P < 0.02 and P < 0.04, respectively). Incubation with saline or oscillation of CF sputum for 15 and 30 minutes decreased spinnability significantly compared with control. The combination of DNase and oscillation decreased spinnability significantly more than treatment with DNase alone (3.74 +/- 0.45 vs. 6.54 +/- 0.73 at 15 minutes, P < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Effects of combined treatment with rhDNase and airflow oscillations on spinnability of cystic fibrosis sputum in vitro

Effect of corticosteroids on survival of children with acquired immunodeficiency syndrome and Pneumocystis carinii -related respiratory failure

Opportunistic infections and other clinical manifestations of hiv disease in children

Pneumocystis carinii pneumonia (PCP) is the most common opportunistic infection in adults and children infected with the human immunodeficiency virus (HIV). Without prophylaxis, half of all these children will develop PCP at sometime during their illness. The disease is associated with high mortality and a poor prognosis for long-term survival in this patient population. In infants and young children, PCP may be a primary infection, compared with reactivation of a latent infection that is usually the case in older children and adults. Clinical features, radiographic findings and diagnostic strategies are similar in children and adults. Although alternative agents are being investigated, trimethoprimsulfamethoxazole (TMP-SMX) and pentamidine remain the standard therapeutic agents. Insufficient data are available to recommend routine adjunctive corticosteroids in children with acquired immunodeficiency syndrome (AIDS), PCP, and significant respiratory disease. Prophylaxis against PCP occurrence or recurrence is indicated for HIV-infected children and infants under 1 year of age, children with less than 20% T4 helper lymphocytes, those meeting age-related Centers for Disease Control (CDC) guidelines for prophylaxis, and those with a history of suspected or documented PCP. The CDC recommends intermittent TMP-SMX for PCP prophylaxis in children with AIDS.

Pneumocystis carinii Pneumonia in Human Immunodeficiency Virus-Infected Infants and Children

We present our experience with 54 episodes of Pneumocystis carinii pneumonia in 50 young children with AIDS, all but one representing congenitally acquired infection. Findings at history and physical examination are not helpful in suggesting the diagnosis. The diagnosis is suggested by marked hypoxemia, diffuse disease on chest radiograph, and elevated serum LDH level. Because important aspects of the history may be withheld, a high index of suspicion may be necessary for the correct diagnosis. The mortality rate for ventilated patients was 50%. Pediatr Pulmonal 1990; 9:251–253.

Pneumocystis carinii pneumonia in young children with AIDS.

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Pneumocystis carinii pneumonia in young children with AIDS.