Prognostic factors and life expectancy in children with acquired immunodeficiency syndrome and Pneumocystis carinii pneumonia
L. J. Bernstein, M. R. Bye and A. Rubinstein
Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY 10461.
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.
