PNEUMOCYSTIS-CARINII PNEUMONIA IN HEART-TRANSPLANT RECIPIENTS

Seven cases of Pneumocystis carinii pneumonia (PCP) (two in 1988, thre e in 1989, one in 1990 and one in 1991) have been observed in a group of 241 heart transplant recipients tranplanted in Pavia, Italy, from N ovember 1985 through December 1991. Median time to onset of symptoms w as 100 days after transplantation (range 59-333 days). Diagnosis was a chieved in all patients by cytological examination of bronchoalveolar lavage (BAL) fluid and/or transbronchial biopsy. Clinical and roentgen ographic features were remarkably similar in all PCP-affected heart tr ansplant recipients. A dry, persistent hacking cough associated with d yspnoea was consistently observed. Fever ranged from 37.6 to 39.4-degr ees-C, median leukocyte count and median arterial oxygen saturation (S aO2) values were 7,300/mm3 (range 3,000-16,000/mm3) and 61% (range 49. 3-93%), respectively. Median CD4+ count at the onset of symptoms was 2 11/mm3 (range 28-739/mm3). The only patient experiencing a recurrence of PCP had a CD4+ cell count of 28/mM3 at the end of treatment with tr imethoprim-sulfamethoxazole (TMP-SMX). In all patients human cytomegal ovirus was isolated from BAL fluids; however, treatment with TMP-SMX a lone (20 mg/kg/day of TMP) was consistently followed by a complete rec overy.