Pneumonia occurs commonly in immunocompromised patients and is often due to P. carinii. Because most normal children have antibodies to P. carinii, P. carini. pneumonia probably represents a reactivation of a latent infection. The natural habitat and mode of transmission of P. carinii are poorly understood. Patients present acutely with fever, dyspnea, a nonproductive cough, and scant rales. Arterial blood gas analysis may reveal hypoxia or an increased alveolar-arterial (A-a) gradient. The serum LDH level may be elevated. Early, the chest x-ray may be normal. Later, the classical appearance is of symmetrical interstitial infiltrates in the mid and lower lung zones. Pneumocystis carinii occurs in premature and debilitated infants, AIDS patients, those receiving organ transplants, and those with inherited immunodeficiencies. Diagnosis is usually made by lung biopsy. The specimen should be stained with methenamine-silver nitrate or toluidine blue. Serologic tests are of limited value because many normal individuals have antibodies. Treatment is with trimethoprim-sulfamethoxazole or pentamidine isethionate. In patients with respiratory compromise (Po2 <70 mmHg or A-a gradient >35 mmHg on room air) the addition of steroids has been shown to be beneficial.
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