No abstract available.
B-Lymphocytes* ; Drug Therapy* ; Lymphoma, B-Cell* ; Pneumocystis jirovecii* ; Pneumocystis* ; Pneumonia*

Child ; Guidelines as Topic ; Humans ; Pneumonia, Pneumocystis ; diagnosis ; therapy

Pneumocystis carinii pneumonia is caused by Pneumocystis carinii. It usually occurs in premature or debilitated infants. Recently sporadic cases of human disease in patients who have been on long term steroid therapy, cytotoxic drug therapy, immunosuppressive drug were significantly increased. We recently experienced 35 cases of Pneumocystis carinii pneumonia in infants of an institution for foreign adoption in three epidemic period of Feb.1979, Mar. 1980, and Jan. 1980. The clinical review of 35 cases was made. Patients' age was between 1 to 4 months. Twenty-one cases (60%) occurred in 2-month-old infants. Many patients were included in poor weight gain and development. The common symptoms were tachypnea, cyanosis, restlessness, cough, diarrhea in order of frequency. The roentgenological findings were classified into three groups. normal finding, pulmonary emphysema only, and various forms of pneumonic infiltration. The roentgenological findings were somewhat characteristic. The most common finding (24 cases) showed streaky and mottled densities which began in both hill and were spreaded peripherally. The pneumonic infiltrations were spared peripheral lung, but progressed to total involvement. The prominence between alveolar and interstitial infiltration was almostly equal when patients were admitted. Nineteen cases (54%) showed pulmonary emphysema.
Cough ; Cyanosis ; Diarrhea ; Drug Therapy ; Humans ; Infant ; Lung ; Pneumocystis carinii ; Pneumonia ; Pneumonia, Pneumocystis ; Psychomotor Agitation ; Pulmonary Emphysema ; Tachypnea ; Weight Gain

We experienced a 61-year old man with Pneumocystis carinii pneumonia who had been diagnosed as having relapsed acute myelogenous leukemia(AML). He developed severe dyspnea in the nadir state after reinduction chemotherapy. His chest X-ray showed bilateral interstitial pneumonia in both lung fields. We started ventilator therapy and obtained sputum through the endotracheal tube. Typical P. carinii cysts were found in the sputum by Giemsa stain. No other organisms were found in thelavage sediments. From clinical observation and the presence of typical P. carinii cysts, the patient was diagnosed as having P. carinii pneumonia and was treated with sulfamethoxazole/trimethoprim and glucocorticoid. This was the first reported case of P. carinii pneumonia in an AML patient undergoing chemotherapy in Korea.
Azure Stains ; Drug Therapy ; Dyspnea ; Humans ; Korea ; Leukemia ; Leukemia, Myeloid, Acute* ; Lung ; Lung Diseases, Interstitial ; Middle Aged ; Pneumocystis carinii* ; Pneumocystis* ; Pneumonia ; Pneumonia, Pneumocystis* ; Sputum ; Thorax ; Ventilators, Mechanical

BACKGROUND: Pneumocystis is difficult to culture or detect in laboratory environments. Its ecology including the timing and method of transmission as well as environmental sources and communicability remain unclear. METHODS: We retrospectively evaluated the pattern and treatment outcome of Pneumocystis jirovecii pneumonia (PCP) in children with acute lymphoblastic leukemia (ALL) who received chemotherapy. RESULTS: A total of 56 patients with ALL were evaluated. While on chemotherapy, all patients received PCP prophylaxis. PCP were found in a total of 6 patients, including definite PCP in 2, probable PCP in 2, and possible PCP in 2 patients. There were no significant differences in sex, age group, National Cancer Institute risk group, or pneumocystis prophylaxis type between PCP and non-PCP groups. However, there was a significant statistical difference in the times of ALL diagnosis. Regarding recent chemotherapy at the time of PCP diagnosis, there were one induction, one consolidation, and four maintenance cases. All PCP patients were treated with high-dose sulfamethoxazole (100 mg/kg/day) and trimethoprim (20 mg/kg/day) intravenously. Five patients survived, while one patient with endotracheal mechanical ventilation therapy died due to respiratory failure in spite of aggressive treatment. CONCLUSION: Pediatric PCP became extremely rare due to routine prophylaxis in clinical practice of pediatric malignancy. Nevertheless, we analyzed patients with acute lymphoblastic leukemia who had received PCP prophylaxis for 14 years, and analyzed the clustered outbreaks of PCP. It is still important to emphasize the need for prophylaxis and to increase the level of attention and isolation under environmental and personal risk factors.
Child ; Compliance ; Diagnosis ; Disease Outbreaks ; Drug Therapy ; Ecology ; Humans ; Methods ; National Cancer Institute (U.S.) ; Pneumocystis jirovecii ; Pneumocystis* ; Pneumonia ; Pneumonia, Pneumocystis* ; Precursor Cell Lymphoblastic Leukemia-Lymphoma* ; Respiration, Artificial ; Respiratory Insufficiency ; Retrospective Studies ; Risk Factors ; Sulfamethoxazole ; Treatment Outcome ; Trimethoprim

Pnuemocystis jirovecii pneumonia (PJP) is one of leading causes of acute respiratory failure in patients infected with human immunodeficiency virus (HIV), and the mortality rate remains high in mechanically ventilated HIV patients with PJP. There are several reported cases who received extracorporeal membrane oxygenation (ECMO) treatment for respiratory failure associated with severe PJP in HIV-infected patients. We report a patient who was newly diagnosed with HIV and PJP whose condition worsened after highly active antiretroviral therapy (HAART) initiation and progressed to acute respiratory distress syndrome requiring veno-venous ECMO. The patient recovered from PJP and is undergoing treatment with HAART. ECMO support can be an effective life-saving salvage therapy for acute respiratory failure refractory to mechanical ventilation following HAART in HIV-infected patients with severe PJP.
Antiretroviral Therapy, Highly Active* ; Extracorporeal Membrane Oxygenation* ; HIV ; Humans ; Mortality ; Pneumocystis jirovecii* ; Pneumocystis* ; Pneumonia* ; Respiration, Artificial ; Respiratory Distress Syndrome, Adult* ; Respiratory Insufficiency ; Salvage Therapy

Pnuemocystis jirovecii pneumonia (PJP) is one of leading causes of acute respiratory failure in patients infected with human immunodeficiency virus (HIV), and the mortality rate remains high in mechanically ventilated HIV patients with PJP. There are several reported cases who received extracorporeal membrane oxygenation (ECMO) treatment for respiratory failure associated with severe PJP in HIV-infected patients. We report a patient who was newly diagnosed with HIV and PJP whose condition worsened after highly active antiretroviral therapy (HAART) initiation and progressed to acute respiratory distress syndrome requiring veno-venous ECMO. The patient recovered from PJP and is undergoing treatment with HAART. ECMO support can be an effective life-saving salvage therapy for acute respiratory failure refractory to mechanical ventilation following HAART in HIV-infected patients with severe PJP.
Antiretroviral Therapy, Highly Active ; Extracorporeal Membrane Oxygenation ; HIV ; Humans ; Mortality ; Pneumocystis jirovecii ; Pneumocystis ; Pneumonia ; Respiration, Artificial ; Respiratory Distress Syndrome, Adult ; Respiratory Insufficiency ; Salvage Therapy

Adult ; Aged ; Aged, 80 and over ; Child ; Female ; Humans ; Male ; Middle Aged ; Pneumocystis carinii ; Pneumonia, Pneumocystis ; drug therapy ; etiology ; mortality ; Risk Factors

Acute respiratory failure with diffuse pulmonary infiltration was occurred in a patient with malignant lymphoma 1month after the 8th CHOP chemotherapy. The ground glass and consolidation appearances on chest C-T in this immunodeficient patient could be presented in many clinical situations such as pneumonia by opportunistic infections(fungal, parasites, viral, and usual bacterial pathogens), anti-tumor drug's pulmonary toxicity and tumor invasion. And the other diseases of acute interstitial pneumonitis, alveolar proteinosis, BOOP, pulmonary edema and alveolar hemorrhage, which could present the same radiological findings, should included in differential diagnosis. This patient was diagnosed as the opportunistic pneumonia by Pneumocystis carinii and probably Cytomegalovirus through bronchoalveolar lavage and transbronchial lung biopsy.
Biopsy ; Bronchoalveolar Lavage ; Cryptogenic Organizing Pneumonia ; Cytomegalovirus ; Diagnosis, Differential ; Drug Therapy* ; Glass ; Hemorrhage ; Humans ; Lung ; Lung Diseases, Interstitial ; Lymphoma* ; Parasites ; Pneumocystis carinii ; Pneumonia ; Pulmonary Edema ; Respiratory Insufficiency ; Thorax

A boy, aged 6 years and 11 months, was admitted due to nephrotic syndrome for 2 years, cough for 1 month, and shortness of breath for 15 days. The boy had a history of treatment with hormone and immunosuppressant. Chest CT after the onset of cough and shortness of breath showed diffuse ground-glass opacities in both lungs. Serum (1, 3)-beta-D glucan was tested positive, and the nucleic acid of cytomegalovirus was detected in respiratory secretions. After the anti-fungal and anti-viral treatment, the child improved temporarily but worsened again within a short period of time.
Child ; Cough/etiology* ; Cytomegalovirus Infections/therapy* ; Dyspnea/etiology* ; Extracorporeal Membrane Oxygenation ; Humans ; Male ; Nephrotic Syndrome/complications* ; Pneumonia, Pneumocystis/therapy* ; Respiratory Distress Syndrome/therapy*