MARKEDLY REDUCED MORTALITY ASSOCIATED WITH CORTICOSTEROID-THERAPY OF PNEUMOCYSTIS-CARINII PNEUMONIA IN CHILDREN WITH ACQUIRED-IMMUNODEFICIENCY-SYNDROME

Background: Pneumocystis carinii pneumonia is a common opportunistic i nfection in pediatric acquired immunodeficiency syndrome (AIDS). Morta lity rates of 34% have been reported for the acute infection, with muc h higher mortality rates occurring in the presence of respiratory fail ure. Corticosteroids reduce the morbidity and mortality in adults with AIDS and P carinii pneumonia. We report herein our experience with co rticosteroids 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 chil dren treated in a similar manner, but without corticosteroids (group 2 ). Results: The two groups had similar ages, initial serum lactate deh ydrogenase levels, and initial alveolar-arterial difference in partial pressure of oxygen. There was a significant (P<.0001) reduction in th e need for mechanical ventilation and in mortality in the corticostero id-treated group. Conclusion: Corticosteroid therapy during acute infe ction with P carinii in young children with AIDS appears to significan tly reduce morbidity (as measured by the need for mechanical ventilati on) and mortality.