PNEUMOCYSTIS-CARINII PNEUMONIA IN HIV-NEGATIVE PATIENTS WITH HEMATOLOGIC DISEASE

Since 1990, Pneumocystis carinii pneumonia (PCP) was diagnosed in 15 a dult HIV-negative haematologic patients in our hospital, None of them had received PCP prophylaxis. All except one had been treated with pre dnisone. Symptoms usually started after stopping or tapering. In six p atients the diagnosis of PCP was delayed because of confounding bacter ial isolates from blood, sputum or urine leading to unsuccessful antib iotic treatment. PCP was diagnosed by demonstrating pneumocysts in bro nchoalveolar lavage fluid, In four patients additional fungal or viral pathogens were identified, The infections were not clustered. The pat ients were treated with co-trimoxazole and, in case of a pO(2) < 60 mm Hg, with prednisone. Three patients died (20%); they all had a coinfec tion with cytomegalovirus and/or aspergillus. The others recovered com pletely, There were no relapses. Primary PCP prophylaxis should be con sidered in patients with lympho-proliferative disease and exposure to prednisone.