A clinical and pathological study of children with pneumocystis carinii pneumonia

Abstract

The commonest causes of admission to University Teaching Hospital - Children wing are gastroenteritis, respiratory infections, anaemia, malnutrition and malaria. Twenty-eight percent of these admissions are seropositive for HIV-1. Since 1990 respiratory infections have constituted 28% of the total admissions and out of these, about 28% of the respiratory infections are associated with HIV, 11% of whom die during their hospital stay. A significant number of children infected with HIV develop Pneumocystis Carinii Pneumonia (PCP) in their first year of life, which can be fatal. Tuberculosis, cytomegalovirus pneumonitis and PCP are very difficult to distinguish clinically in HIV infected children because of overlapping symptoms. Studies from Zambia and West Africa show that Childhood respiratory diseases are the most common cause of Paediatric hospital admissions. Due to limitations in the current clinical and laboratory criteria used for the diagnosis of respiratory diseases in children accurate information on the specific aetiologies of fatal illnesses are not available. Since Tuberculosis, bacterial pneumonia and PCP have overlapping clinical features, misdiagnosis may occur making management of such patients difficult. Treatment and Prevention of PCP is one of the most important health issues among HIV infected children. The clinical picture of PCP can be severe in HIV infected children such that intensive therapy with intravenous cotrimoxazole in combination with a steroid and inhaled pentamidine may be required. Knowing the actual aetiology of lung diseases in children is important in developing practical diagnostic, therapeutic, prophylactic protocols and for epidemiological surveillance and control. This study was carried out to define the clinical presentation and pathological findings of PCP in Zambian Children, and to try and find an easy method of diagnosis. There has been no study done in Zambia to understand the presentation of PCP in HIV infected Children. This descriptive study conducted a clinical - pathological study of 264 childhood deaths from pulmonary disease at the University Teaching Hospital. Post mortem lung material were obtained and subjected to histo-pathological examination, and polymerase chain reaction (PCR) for Pneumocystis Carinii Deoxyribonucleic Acid (DNA). From the oropharyngeal washings DNA was extracted and PCR performed to detect the presence of P.carinii.