PNEUMOCYSTIS CARINII PNEUMONIA IN THE ACQUIRED IMMUNODEFICIENCY SYNDROME
Int Conf AIDS 1985 Apr 14-17; 1:23 (abstract no. S4A)
Stuart M Garay, M Belenko, F Schwiep, D Kamelhar, J Greene New York University Medical Center, New York City, New York.
Between 11/80 and 12/84 205 AIDS patients presented with PCP: drug abusers-85, homosexual men-105, heterosexual females without drug abuse-3 and transfusion related-2. Bronchoscopic diagnosis of PCP was made in all but 3 cases: transbronchial biopsy (96%) and/or alveolar lavage (75%). Touch imprints were positive in 79% of 130 cases. The initial presentation included fever >101ºF (97%) cough (85%) and dyspnea (76%). The mean admission WBC count was 5500/mm3 the mean A-a 02, gradient was 44 torr. Chest x-ray infiltrates were: bilateral interstitial-102, mixed interstitial/alveolar-45, peri-hilar interstitial-26,
unilateral alveolar/interstitial-24 and normal-8. Treatment for more than 4 days was implemented in 200 patients: trimethoprim-sulfamethoxazole (TAS) alone-75; pentamidine (P) alone-20; TMS followed by P(TMS/P)-30 because of TMS toxicity and 75 because of no response. One hundred and fifty-eight patients (77%) survived their initial episode of PCP. The survival rate was: TMS alone 97%; P alone-81%, TMS/P due to toxicity-98%; TMS/P due to poor response -53%. The mean response time (days) with TMS versus P was afebrile-5 vs 8, p02 increment of 10 torr-8 vs 12, chest x-ray improvement 12 vs 13. TMS complications included leukopenia-36, rash-34, fever-14, thrombocytopenia-6, azotemia-2, SGOT elevation-6. Pentadimine complications
included azotemia-10, SGOT elevation-6, leukopenia-3, hypoglycemia-5, hypotension-5 and fever-4.
