Markedly Reduced Mortality Associated With Corticosteroid Therapy of Pneumocystis carinii Pneumonia in Children With Acquired Immunodeficiency Syndrome
Michael R. Bye, MD;
Anne Marie Cairns-Bazarian, DO;
Jeffrey M. Ewig, MD
Arch Pediatr Adolesc Med. 1994;148(6):638-641.
Abstract
Background
Pneumocystis carinii pneumonia is a common opportunistic infection in pediatric acquired immunodeficiency syndrome (AIDS). Mortality rates of 34% have been reported for the acute infection, with much higher mortality rates occurring in the presence of respiratory failure. Corticosteroids reduce the morbidity and mortality in adults with AIDS and P carinii pneumonia. We report herein our experience with corticosteroids in P carinii pneumonia in pediatric AIDS.
Methods
When the data on adults were published, we began treating our patients with corticosteroids. We compared these children (group 1) with those children treated in a similar manner, but without corticosteroids (group 2).
Results
The two groups had similar ages, initial serum lactate dehydrogenase levels, and initial alveolar-arterial difference in partial pressure of oxygen. There was a significant (P<.0001) reduction in the need for mechanical ventilation and in mortality in the corticosteroid-treated group.
Conclusion
Corticosteroid therapy during acute infection with P carinii in young children with AIDS appears to significantly reduce morbidity (as measured by the need for mechanical ventilation) and mortality.
(Arch Pediatr Adolesc Med. 1994;148:638-641)
Author Affiliations
From the Division of Pediatric Pulmonary Medicine, Department of Pediatrics, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY. Dr Bye is now with Columbia Presbyterian Medical Center, New York, NY.
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