       Document 0209
 DOCN  M9640209
 TI    Pneumocystis carinii pneumonia in patients without acquired
       immunodeficiency syndrome: associated illness and prior corticosteroid
       therapy [see comments]
 DT    9604
 AU    Yale SH; Limper AH; Division of Pulmonary and Critical Care Medicine and
       Internal; Medicine, Mayo Clinic Rochester, Minnesota 55905, USA.
 SO    Mayo Clin Proc. 1996 Jan;71(1):5-13. Unique Identifier : AIDSLINE
       MED/96133636
 CM    Comment in: Mayo Clin Proc 1996 Jan;71(1):102-3
 AB    OBJECTIVE: To determine the clinical spectrum of immunosuppressive
       conditions and systemic corticosteroid therapy associated with the
       development of Pneumocystis carinii pneumonia in a consecutive series of
       patients without acquired immunodeficiency syndrome (AIDS). DESIGN: We
       retrospectively analyzed a consecutive series of 116 patients without
       AIDS who were assessed at Mayo Medical Center for a first episode of P.
       carinii pneumonia between 1985 and 1991. METHODS: Medical records were
       examined to determine underlying immunosuppressive disorders, premorbid
       corticosteroid dosage and duration of therapy, associated infections,
       and subsequent respiratory failure and in-hospital mortality. RESULTS:
       Conditions associated with a first episode of P. carinii pneumonia were
       hematologic malignant disorders (30.2%), organ transplantation (25.0%),
       inflammatory disorders (22.4%), solid tumors (12.9%), and miscellaneous
       conditions (9.5%). Regardless of the associated underlying disease,
       corticosteroids had been administered systemically in 105 patients
       (90.5%) within 1 month before the diagnosis of P. carinii pneumonia. The
       median daily corticosteroid dose was equivalent to 30 mg of prednisone;
       however, 25% of patients had received as little as 16 mg of prednisone
       daily. The median duration of corticosteroid therapy was 12 weeks before
       the development of pneumonia; however, P. carinii pneumonia developed
       after 8 weeks or less of corticosteroid therapy in 25% of these
       patients. Respiratory failure occurred in 43%, and in-hospital mortality
       was 34% for patients with P. carinii pneumonia in conditions other than
       AIDS. CONCLUSION: Although these results do not suggest that premorbid
       administration of corticosteroids is the only factor that contributes to
       the development of P. carinii pneumonia in these patients, they show
       that, in this large consecutive series, systemic corticosteroid therapy,
       even in moderate doses, was administered to most patients during the
       month preceding the onset of P. carinii pneumonia. Consideration should
       be given to instituting P. carinii prophylaxis (when not
       contra-indicated) in patients for whom prolonged systemic corticosteroid
       therapy is prescribed.
 DE    Adrenal Cortex Hormones/ADMINISTRATION & DOSAGE/*ADVERSE EFFECTS
       AIDS-Related Opportunistic Infections/ETIOLOGY  Human  Immunosuppressive
       Agents/ADMINISTRATION & DOSAGE/*ADVERSE EFFECTS  Opportunistic
       Infections/*ETIOLOGY/MICROBIOLOGY/*PREVENTION &  CONTROL/THERAPY
       Pneumonia, Pneumocystis carinii/*ETIOLOGY/MICROBIOLOGY/  *PREVENTION &
       CONTROL/THERAPY  Respiration, Artificial  Retrospective Studies
       Support, Non-U.S. Gov't  Support, U.S. Gov't, P.H.S.  Survival Analysis
       JOURNAL ARTICLE

       SOURCE: National Library of Medicine.  NOTICE: This material may be
       protected by Copyright Law (Title 17, U.S.Code).

