Pneumocystis carinii pneumonia: the steroid dilemma

Article Abstract:

Before 1981, the microorganism Pneumocystis carinii caused pneumonia infrequently, in patients with impaired immunity. However, in 1981 and thereafter, the epidemiology of P. carinii pneumonia (PCP) changed in association with the rising incidence of AIDS. PCP is the most common severe opportunistic infection in AIDS patients, and develops in 80 percent of these patients. The death rate associated with AIDS-related PCP is 45 percent and rises to 100 percent with the development of respiratory failure. The outcome from an attack of PCP depends on several factors, including early diagnosis, prompt treatment with antibiotics, the severity of immunodeficiency, lung function, and occurrence of other infections. Patients with PCP can be effectively treated with the antibiotics sulfamethoxazole and trimethoprim, or pentamidine given in aerosol form. A recent study examined the effectiveness of adding the steroid agent methylprednisolone to the standard treatment of PCP. Although the addition of the steroid initially produced beneficial responses, such as the reversal of respiratory failure, in patients with PCP, it did not appear to improve survival. Other studies showed that corticosteroids prevented the development of acute respiratory failure, and prednisolone decreased the rate of death due to PCP. Corticosteroids are anti-inflammatory agents and may produce their beneficial effect in PCP by preventing inflammatory processes in the lung. However, corticosteroids also have an adverse effect on several types of immune cells. These latter effects of corticosteroids may be responsible for the recurrence of PCP and respiratory failure. Further studies are needed to evaluate the usefulness of corticosteroids in treating PCP. (Consumer Summary produced by Reliance Medical Information, Inc.)

Pneumocystis carinii, editorial

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Pneumocystis carinii pneumonia in human immunodeficiency virus-infected patients

Article Abstract:

Infection with the human immunodeficiency virus (HIV) is often associated with Pneumocystis carinii pneumonia (PCP). PCP develops in 80 percent of HIV-infected patients who are not receiving drugs to prevent P. carinii infection. Although the infection is usually confined to the lungs, it may spread to other sites in the body. Some common symptoms of PCP include fever, rapid or difficult breathing, cough, weight loss, discomfort, and night sweats. The duration of symptoms does not reflect the severity of the disease. Poor prognosis is associated with rapid respiratory rate, increased levels of the enzyme lactate dehydrogenase, increased numbers of granulocytes or granular white blood cells in the lung tissue, respiratory failure, and the need for mechanical ventilation. Expected chest X-ray findings, nonspecific tests, and the definitive diagnosis of PCP are discussed. Various characteristics of P. carinii are also reviewed, including its taxonomy or classification, requirements for culture or laboratory growth, and microscopic features. Drugs used to treat PCP include pentamidine and a combined regimen of sulfamethoxazole and trimethoprim. The adverse reactions to these agents and routes of administration are discussed, as is the use of corticosteroids and other alternate therapies. (Consumer Summary produced by Reliance Medical Information, Inc.)

Diagnosis, HIV infection, HIV infections

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Steroids for Pneumocystis carinii pneumonia and respiratory failure in the acquired immunodeficiency syndrome: a reassessment

Article Abstract:

AIDS is often complicated by Pneumocystis carinii pneumonia (PCP), which is fatal in 23 percent of cases, mainly due to respiratory failure. Respiratory failure in PCP is associated with a poor outcome; in one study it was fatal in all patients who required respiratory support. Recently, studies showed that steroids added to standard treatment for PCP improved the survival of patients with respiratory failure. In the current study, the effectiveness of adding corticosteroids to standard treatment of PCP was assessed in 20 patients with AIDS and respiratory failure caused by PCP. Respiratory failure was initially reversed in 14 patients, although nine of these patients suffered a relapse of respiratory failure after the steroids were discontinued. Eight patients survived and remained well three months or more after treatment. However, only 25 percent of patients who required respiratory support were still living three months after treatment. These findings show that steroids can initially reverse respiratory failure due to PCP in patients with AIDS, but survival is limited, due to relapse of respiratory failure and other complications of AIDS. Thus, more studies are needed to evaluate the role of steroids in treating respiratory failure due to PCP in patients with AIDS. (Consumer Summary produced by Reliance Medical Information, Inc.)

Causes of, Respiratory insufficiency

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