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August 1991, Vol 145, No. 8 >
Article | August 1991

Predicting Risk of Pneumocystis carinii Pneumonia in Human Immunodeficiency Virus—Infected Children FREE

Richard M. Rutstein, MD
[+] Author Affiliations

Accepted for publication January 28, 1991.

Reprints not available.


Am J Dis Child. 1991;145(8):922-924. doi:10.1001/archpedi.1991.02160080100028.
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Comments

• Effective prophylaxis exists against Pneumocystis carinii pneumonia, a major cause of illness and death among human immunodeficiency virus—infected children and adults. While adults with CD4 counts less than 0.2 × 109/L are at highest risk for Pneumocystis carinii, clinical or laboratory markers of high risk in children infected with the human immunodeficiency virus have not yet been established. A chart review of 13 infants with perinatally acquired human immunodeficiency virus infection and children with Pneumocystis carinii pneumonia revealed that infants younger than 12 months developed Pneumocystis carinii pneumonia despite CD4 counts that were normal by adult standards. In contrast to the markedly increased serum IgG levels seen in most children infected with the human immunodeficiency virus, five children with Pneumocystis carinii pneumonia had IgG levels less than 3.0 g/L. Twelve patients had preexisting symptoms consistent with human immunodeficiency virus infection before the episode of Pneumocystis carinii pneumonia. In addition to clinical symptoms, low IgG levels and CD4 counts adjusted for age may serve to identify those children who are most at risk for Pneumocystis carinii pneumonia and therefore candidates for prophylaxis. Prophylaxis should be offered to all infants under age 12 months with proven, or clinical symptoms compatible with, human immunodeficiency virus infection. For children older than 12 months, CD4 counts less than 0.3 × 109/L appear to be predictive of risk for Pneumocystis carinii pneumonia, and these children should also receive prophylaxis.

(AJDC. 1991;145:922-924)

REFERENCES

1 +
Centers for Disease Control. AIDS Weekly Surveillance Report . (January 30) , 1989;;1-5.
2 +
Scott GB, Hutto C, Makuch RW, et al.  Survival in children with perinatally acquired human immunodeficiency virus type 1 infection . N Engl J Med . 1989;;321:1791-1796.
Link to Article
3 +
Hughes WT, KuhnS, Chaudhary S, et al. Successfulchemoprophylaxis for Pneumocystis carinii pneumonia . N Engl J Med . 1977;;297:1419-1426.
Link to Article
4 +
Hughes WF, Rivera GK, Schell MJ, Thornton D, Lott L.  Successful intermittent chemoprophylaxis for Pneumocystis carinii pneumonitis . N Engl J Med . 1987;;316:1627-1632.
Link to Article
5 +
Leoung GS, Montgomery AB, McGinty E, Feigal DW, LymphoMed Consortium Investigators. Double-blinded randomized trial of aerosol pentamidine for secondary prophylaxis of Pneumocystis carinii pneumonia. Proceedings of the Fifth International Conference on AIDS; June 4-9, 1989; Montreal, Canada
6 +
Fischl MA, Dickinson GM, La Voie L.  Safety and efficacy of sulfamethoxazole and trimethoprin chemoprophylaxis for Pneumocystis carinii pneumonia in AIDS . JAMA . 1988;;259:1185-1189.
Link to Article
7 +
Kovacs JA, Masur H.  Prophylaxis of Pneumocystis carinii pneumonia: an update . J Infect Dis . 1989;;160:882-886.
Link to Article
8 +
Phair JP, Munoz A, Detels R, et al.  The risk of Pneumocystis carinii pneumonia among men infected with human immunodeficiency virus type 1 . N Engl J Med . 1990;;322:161-165.
Link to Article
9 +
Centers for Disease Control.  Guidelines for prophylaxis against Pneumocystis carinii pneumonia for persons infected with human immunodeficiency virus . MMWR . 1989;;38:1-9.
10 +
Bernstein LA, Bye MR, Rubinstein A.  Prognostic factors and life expectancy in children with acquired immunodeficiency syndrome and Pneumocystis carinii pneumonia . AJDC . 1989;;143:775-778.
11 +
Sanders-Laufer D, Burroughs M, Marshall F, et al.  Pneumocystis carinii pneumonia in "low risk" HIV-infected children . Pediatr Res . 1990;;27:183.
12 +
Bagarazzi ML, Connor E, McSherry GD, Oleske JM.  PCP among HIV infected children: ten years experience . Pediatr Res . 1990;;27:166.
13 +
Leibovitz E, Riguard M, Pollack H, et al.  Pneumocystis carinii pneumonia in infants with the human immunodeficiency virus with more than 450 CD4 lymphocytes per cubic millimeter . N Engl J Med . 1990;;323:531-533.
Link to Article
14 +
Centers for Disease Control.  Classification system for human immunodeficiency virus (HIV) in children under 13 years of age . MMWR . 1987;;36:225-230.
15 +
O'Rouke S, Plaeger-Marshall S, Gillespie S, et al. T cell parameters by age in normal and HIV-infected children. Presented at the Sixth International Conference on AIDS; June 1990; San Francisco, Calif.
16 +
Denn TN, Niven P, Skuia C, et al.  Age related changes of lymphocyte phenotypes in healthy children . Pediatr Res . 1990;;27:155.
17 +
Rubinstein A.  Pediatric AIDS . Curr Probl Pediatr . 1986;; 26:387-392.
18 +
Blanche S, Le Deist F, Fischer A, et al.  Longitudinal study of 18 children with perinatal LAV/HTLV III infection . J Pediatr . 1986;;109:965-970.
Link to Article
19 +
Johnson JP, Nair P, Hines SF, et al.  Natural history and serologic diagnosis of infants born to human immunodeficiency virus infected women . AJDC . 1989;;143:1147-1153.
20 +
Rao CP, Gelfand EW.  Pneumocystis carinii pneumonitis in patients with hypogammaglobunemia and intact T cell immunity . J Pediatr . 1983;;103:410-412.
Link to Article
21 +
Gordin FM, Simon GL, Wofsky CB, Mills J.  Adverse reactions to trimethoprin-sulfamethoxazole in patients with acquired immunodeficiency syndrome . Ann Intern Med . 1984;;100:495-499.
Link to Article
22 +
Sattler FR, Cowan R, Nielsen DM, Ruskin J.  Trimethoprin-sulfamethoxazole compared with pentamidine for treatment of Pneumocystis carinii pneumonia in the acquired immunodeficiency syndrome . Ann Intern Med . 1988;;109:280-287.
Link to Article

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References

1 +
Centers for Disease Control. AIDS Weekly Surveillance Report . (January 30) , 1989;;1-5.
2 +
Scott GB, Hutto C, Makuch RW, et al.  Survival in children with perinatally acquired human immunodeficiency virus type 1 infection . N Engl J Med . 1989;;321:1791-1796.
Link to Article
3 +
Hughes WT, KuhnS, Chaudhary S, et al. Successfulchemoprophylaxis for Pneumocystis carinii pneumonia . N Engl J Med . 1977;;297:1419-1426.
Link to Article
4 +
Hughes WF, Rivera GK, Schell MJ, Thornton D, Lott L.  Successful intermittent chemoprophylaxis for Pneumocystis carinii pneumonitis . N Engl J Med . 1987;;316:1627-1632.
Link to Article
5 +
Leoung GS, Montgomery AB, McGinty E, Feigal DW, LymphoMed Consortium Investigators. Double-blinded randomized trial of aerosol pentamidine for secondary prophylaxis of Pneumocystis carinii pneumonia. Proceedings of the Fifth International Conference on AIDS; June 4-9, 1989; Montreal, Canada
6 +
Fischl MA, Dickinson GM, La Voie L.  Safety and efficacy of sulfamethoxazole and trimethoprin chemoprophylaxis for Pneumocystis carinii pneumonia in AIDS . JAMA . 1988;;259:1185-1189.
Link to Article
7 +
Kovacs JA, Masur H.  Prophylaxis of Pneumocystis carinii pneumonia: an update . J Infect Dis . 1989;;160:882-886.
Link to Article
8 +
Phair JP, Munoz A, Detels R, et al.  The risk of Pneumocystis carinii pneumonia among men infected with human immunodeficiency virus type 1 . N Engl J Med . 1990;;322:161-165.
Link to Article
9 +
Centers for Disease Control.  Guidelines for prophylaxis against Pneumocystis carinii pneumonia for persons infected with human immunodeficiency virus . MMWR . 1989;;38:1-9.
10 +
Bernstein LA, Bye MR, Rubinstein A.  Prognostic factors and life expectancy in children with acquired immunodeficiency syndrome and Pneumocystis carinii pneumonia . AJDC . 1989;;143:775-778.
11 +
Sanders-Laufer D, Burroughs M, Marshall F, et al.  Pneumocystis carinii pneumonia in "low risk" HIV-infected children . Pediatr Res . 1990;;27:183.
12 +
Bagarazzi ML, Connor E, McSherry GD, Oleske JM.  PCP among HIV infected children: ten years experience . Pediatr Res . 1990;;27:166.
13 +
Leibovitz E, Riguard M, Pollack H, et al.  Pneumocystis carinii pneumonia in infants with the human immunodeficiency virus with more than 450 CD4 lymphocytes per cubic millimeter . N Engl J Med . 1990;;323:531-533.
Link to Article
14 +
Centers for Disease Control.  Classification system for human immunodeficiency virus (HIV) in children under 13 years of age . MMWR . 1987;;36:225-230.
15 +
O'Rouke S, Plaeger-Marshall S, Gillespie S, et al. T cell parameters by age in normal and HIV-infected children. Presented at the Sixth International Conference on AIDS; June 1990; San Francisco, Calif.
16 +
Denn TN, Niven P, Skuia C, et al.  Age related changes of lymphocyte phenotypes in healthy children . Pediatr Res . 1990;;27:155.
17 +
Rubinstein A.  Pediatric AIDS . Curr Probl Pediatr . 1986;; 26:387-392.
18 +
Blanche S, Le Deist F, Fischer A, et al.  Longitudinal study of 18 children with perinatal LAV/HTLV III infection . J Pediatr . 1986;;109:965-970.
Link to Article
19 +
Johnson JP, Nair P, Hines SF, et al.  Natural history and serologic diagnosis of infants born to human immunodeficiency virus infected women . AJDC . 1989;;143:1147-1153.
20 +
Rao CP, Gelfand EW.  Pneumocystis carinii pneumonitis in patients with hypogammaglobunemia and intact T cell immunity . J Pediatr . 1983;;103:410-412.
Link to Article
21 +
Gordin FM, Simon GL, Wofsky CB, Mills J.  Adverse reactions to trimethoprin-sulfamethoxazole in patients with acquired immunodeficiency syndrome . Ann Intern Med . 1984;;100:495-499.
Link to Article
22 +
Sattler FR, Cowan R, Nielsen DM, Ruskin J.  Trimethoprin-sulfamethoxazole compared with pentamidine for treatment of Pneumocystis carinii pneumonia in the acquired immunodeficiency syndrome . Ann Intern Med . 1988;;109:280-287.
Link to Article

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