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Does cytomegalovirus predict a poor prognosis in Pneumocystis carinii pneumonia treated with corticosteroids? A note
A M Jensen1, J D Lundgren, T Benfield
1Department of Infectious Diseases, Hvidovre Hospital, University of Copenhagen, Denmark.
Objective:
To examine the importance of cytomegalovirus (CMV) in bronchoalveolar lavage (BAL) fluid of patients with HIV-associated Pneumocystis carinii pneumonia (PCP) treated with adjunctive corticosteroids (CS).
Design:
Analysis of clinical data during a 5-year period.
Setting:
Department of infectious diseases where clinical and paraclinical data on patients suspected of having PCP have been sampled prospectively.
Patients:
148 consecutive patients with a first episode of PCP in a 5-year period.
Main Outcome Measure:
Vital status 3 months after diagnosis of PCP.
Results:
Patients with PCP treated with adjunctive CS who had CMV cultured from BAL fluid had a two times higher mortality within 3 months from bronchoscopy than others (p = 0.08). This difference could not be explained by differences in CD4 count, PO2 or PCO2 at time of bronchoscopy.
Conclusion:
With the accepted usage of adjunctive CS in severe PCP, the role of CMV as a pulmonary copathogen may have changed. Active CMV infection may be an important cause of failing treatment of severe PCP in those treated with adjunctive CS.