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[Pneumocystis carinii pneumonia]
D Dragomir1, L Tauberg, V Popescu
1Clinica de Pediatrie, Spitalul Clinic Sf. Pantelimon, Bucureşti.
Insights
Pneumocystis pneumonia (PCP) is increasingly common in immunocompromised individuals, including infants and HIV patients. Early diagnosis and treatment are crucial for managing this fungal lung infection.
Area of Science:
- Pediatric Infectious Diseases
- Mycology
- Immunology
Background:
- Pneumocystis pneumonia (PCP) is a significant pediatric concern, rising due to advances in pediatric reanimation and increased use of immunosuppressive therapies.
- HIV infection (acquired immunodeficiency syndrome) also contributes to the growing incidence of PCP in both children and adults.
- Pneumocystis carinii (PC), now identified as a fungus through molecular genetic studies, is the causative agent.
Purpose of the Study:
- To comprehensively review the epidemiology, pathogenesis, pathology, clinical presentation, diagnosis, and management of Pneumocystis pneumonia (PCP) in pediatric patients.
- To highlight the risk factors associated with PCP, including young age, malnutrition, prematurity, chronic debilitating diseases, and iatrogenic immunosuppression.
- To discuss diagnostic modalities and therapeutic strategies for PCP.
Main Methods:
- Review of epidemiological data, pathogen characteristics, and pathological findings of PCP.
- Analysis of clinical manifestations, including common and hypoergic forms in immunocompromised hosts.
- Evaluation of diagnostic tools such as radiological examination, pulmonary scintigraphy, laboratory tests, and seroimmunological techniques.
Main Results:
- PCP presents with characteristic macroscopic (non-aerated lung) and microscopic (alveolo-interstitial pneumonia) features.
- Diagnosis is aided by clinical presentation, radiological findings, detection of parasitic cysts in secretions, and response to therapy.
- Risk factors include biological handicaps, immunosuppression, and HIV infection.
Conclusions:
- PCP is a growing concern in vulnerable pediatric populations, necessitating prompt diagnosis and management.
- Advances in diagnostic techniques, particularly seroimmunology, offer promise for future improvements.
- Effective treatment schemes, prophylaxis, and understanding of prognosis are essential for patient outcomes.
Abstract:
The paper reports on a theme of important pediatric interest, pneumonia with Pneumocystis carinii (PC), a more widespread affection lately, due to the progress in pediatric reanimation, on the one hand (that allowed the survival for a long time of several biologically handicapped infants) and as a consequence of the more and more common use of immunosuppressing therapy, on the other hand (malignant diseases, transplant of organs, etc.); another important role in the increase of the PC pneumonia is played, recently, both in the adult and the child, by the infection with HIV (acquired immunodeficiency syndrome). The authors discuss largely on the pathogenic agent, PC, proved to be a fungus by molecular genetic studies, and on the biological field (small age, dystrophy, prematurity, "debilitating" chronic diseases, long diarrheic diseases, congenital malformations, hospitalization, some infections with long evolution: tuberculosis, Cryptococcus, infection with cytomegalic virus). The paper also deals with epidemiology, pathogeny and pathologic anatomy of the disease (characteristic macroscopic aspect: nonaired lung of high consistency, with whitish infiltrations alternating with congestive zones and the microscopic aspect of alveolo-interstitial pneumonia). The clinical picture includes the common form, met in the biologically handicapped infant and hypoergic hypoimmune form, appearing in all ages in immunodeficient subjects. Radiological examination, pulmonary scintigraphy and a series of laboratory data (with evidence of parasitic cysts) complete the clinical examination, making easier the diagnosis. The techniques of seroimmunological diagnosis offers great hope for the future. The positive diagnosis shows the clinical elements that suggest the presence of the disease, the contribution of the radiologic examination and mainly the presence of the parasite in the bronchitic secretions; the therapeutic response is a retroactive element in the positive diagnosis. The differential diagnosis is presented in detail. The paper concludes with a series of treatment schemes used, prophylaxis, evolution, complications and prognosis of the disease.