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Published on: February 23, 2014
[Pneumocystis pneumonia in infants]
M Craiu1, Iustina Stan, I Cernătescu
1Institutul de Ocrotire a Mamei şi Copilului, Alfred Rusescu, Clinica 1 Pediatrie. mcraiu@yahoo.com
Insights
Pneumocystis infection (PCP) is rare in infants but presents with severe respiratory distress. Early diagnosis and treatment, including ventilation and Co-trimoxazole, significantly improve survival rates, especially in vulnerable infants.
Area of Science:
- Pediatric Infectious Diseases
- Pulmonology
- Critical Care Medicine
Context:
- Pneumocystis pneumonia (PCP) is an opportunistic infection that can be severe in infants.
- This study focuses on infants admitted to a specific clinic between 2004 and 2005.
- PCP incidence was observed at 1.5 per 1000 pediatric admissions.
Purpose:
- To describe the clinical and evolutive features of Pneumocystis infection in hospitalized infants.
- To identify risk factors, diagnostic methods, and treatment outcomes for infant PCP.
- To understand the impact of socioeconomic factors, such as abandonment, on PCP presentation.
Summary:
- The study analyzed 17 infant cases (10 male, 7 female) with PCP, with risk factors including prematurity, low birth weight, and abandonment.
- Key clinical signs included tachypnea, dyspnea, cyanosis, and diffuse pulmonary involvement on radiography; pneumothorax and pneumomediastinum were noted complications.
- Diagnosis was confirmed via microscopic examination of respiratory secretions; treatment involved mechanical ventilation and intravenous Co-trimoxazole, resulting in an 85.7% survival rate.
Impact:
- Highlights the severity of PCP in non-HIV-infected infants, particularly those from disadvantaged backgrounds.
- Emphasizes the importance of prompt diagnosis and aggressive management, including respiratory support.
- Suggests a potential link between increased PCP cases and the prevalence of abandoned children in institutional care.
Abstract:
The goal of this study is to present the clinical and evolutive features of Pneumocystis infection (PCP) in infants admitted in our clinic. We summarise these aspects from 17 cases (10 male and 7 female infants), admitted between 1st January 2004 and 31st May 2005. PCP infection is rare. It represents 1,5/1000 children (17 cases of 11328 total patients) admitted in our hospital. The risk factors for PCP were age between 6 weeks and 6 months (average 3,38 months) low birth weight (average = 2428 grams), low weight for age, prolonged hospital admission (88,23% of the 17 infants were abandoned in nursery). Only one of them had HIV infection and none presented neoplastic disease. The most prominent clinical aspect was tachypnea (average 78 breath/minute, maximum 130). 16 (94,11%) had difficult breathing with chest in-drawing and flaring of ala nasi. 14 (82,35%) had generalised cyanosis. Only two (11,72%) infants had fever. Radiologic aspects were evocative, with diffuse pulmonary involvement in almost all cases (88,23%). 6 infants (35,29%) had pneumothorax and 2 (11,76%) presented pneumomediastinum. Positive diagnosis was made by microscopic examination of secretions from endotracheal tube aspiration (Grocott methenamine silver stain and Romanowsky stain). 14 infants were ventilated with a good outcome--12 surviving infants (85,7%). All infants had a full course of intravenous Co-trimoxazole. The deceased infants had more risk factors--congenital heart disease 1 case, severe cerebral palsy with organic epilepsy 2 cases. The apparent increase of PCP cases can be related to the number of abandoned children in Romanian pediatric hospitals and nurseries.
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