Clinical manifestations, diagnosis and course of pneumocystic pneumonia inpatients with blood diseases

Aim. To characterize clinical, diagnostic and course features of pneumonia caused by Pneumocystis carinii (PC) in hematologic inpatients. Materials and methods. 27 patients with blood diseases were studied. 22 of them had acute respiratory insufficiency and 5 had unclear lung affection. The data from bronchoalveolar lavage (BAL), lung biopsy, serum tests for Ig G, IgM anti-PC-antibodies were used for diagnosis of PC-pneumonia. Results. PC-pneumonia was diagnosed in 8 of 27 patients. Clinical manifesta tions characteristic for PC-pneumonia were not found. In 5 patients the dia gnosis was made on the evidence provided by BAL. Lymphocyte count in BAL wa s elevated to 27.7 +/- 87%. Open biopsy of the lung and transbronchial biop sy diagnosed PC-pneumonia in 2 and 1 patients, respectively. Previous BAL e xaminations failed to detect PC-pneumonia in 2 of them. In all the patients PC-pneumonia was associated with another infection (bacterial, cytomegalov iral). Histologically, the picture of the the disease was determined by the severity of the lung affection or ifs complications. 5 of 8 patients faile d treatment with trimetoprim - sulphametoxasole and died. Mal ked respirato ry insufficiency was registered at PC-pneumonia diagnosis in all the lethal cases. Conclusion. Clinical and x-ray pictures of PC-pneumonia in hemoblastosis pa tients are not specific. All such patients,vith symptoms of lung infection resistant to antibacterial and antifungal therapy should be examined for PC -pneumonia.