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Larry J. Bernstein, MD; Michael R. Bye, MD; Arye Rubinstein, MD

Am J Dis Child. 1989;143(7):775-778.

Abstract
• Eighteen children with the acquired immunodeficiency syndrome (AIDS) were diagnosed as having Pneumocystis carinii pneumonia (PCP) by either open lung biopsy or bronchoalveolar lavage. Seven patients (39%) died during the acute illness. Alveolar-arterial oxygen gradients at the time of presentation and lactate dehydrogenase levels did not distinguish survivors from nonsurvivors. Total lymphocyte and T4 cell counts were low in children who died during the initial PCP infection but had considerable overlap with survivors. Response to phytohemagglutinin was measured in 5 of the 7 patients who died initially. In these patients, the mean phytohemagglutinin response was 1977 cpm. Of the 11 early survivors, 10 died within 27 months after PCP. Mean phytohemagglutinin response was 46 079 cpm in patients who died within 1 year, and 44 768 cpm in those who died later. Only 1 child is still alive 5 years after PCP illness. Children with AIDS and PCP infection have high initial mortality and poor long-term prognosis. Response to phytohemagglutinin is helpful in predicting who will survive initial PCP infection.

(AJDC. 1989;143:775-778)

Author Affiliations
From the Department of Pediatrics, Divisions of Allergy and Immunology (Drs Bernstein and Rubinstein) and Pulmonology (Dr Bye), Albert Einstein College of Medicine, Bronx, NY.

Footnotes
Accepted for publication January 3, 1989.

Reprint requests to Department of Pediatrics, Albert Einstein College of Medicine, 1300 Morris Park Ave, Forchheimer Bldg, Room 401, Bronx, NY 10461 (Dr Bernstein).

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