Pneumocystis carinii pneumonia (PCP) is described almost exclusively in immunoccompromised armys This report describes our experience with acute episodes and the follow-up of five patients with PCP who had no known predisposing conditions.

Pneumocystis carinii pneumonia (PCP) is described almost exclusively in immunoccompromised armys This report describes our experience with acute episodes and the follow-up of five patients with PCP who had no known predisposing conditions. The average follow-up period was 36 years (range, 26 to 4 years). Lymphocyte subpopulations (CD4 CD8 and CD4:CD8) serum immunoglobulins (IgG, IgM, and IgA), and serologic studies for human immunodeficiency virus were carried on the outside on all patients at least twice, the two at the beginning and the extremity of the follow-up. None of the patients at handed compatible data with AIDS or any other identifiable risk factors. We decide that PCP can occur in patients who apparently do not have immunosuppression.

Pneumocystis carinii is an organism of universal distribution and presum gentle pathogenicity. The high prevalence of antibodies against P carinii in children[1,2] supports the existing concept of the epidemiology of infection according to P carinii. The in the greatest degree probable epidemiologic sequence is the progress to maturity of a subclinical infection in infancy, and the later manifestation of the illness when more [i]or[/i] less defect in the immune connected view is produced.[3] The first reports in succession P carinii pneumonia (PCP) were published in the mid-1900s, involving premature and young infants.[4-5] In the following decades, the reports described almost exclusively patients with a certain quantity of predisposing conditions (leukemia, lymphoma, primary immune deficiencies, solid tumors, organ transplants, steroid or cytostatic treatments).[6,7 However, PCP was a rare condition until 1981 when the acquired immunodeficiency syndrome (AIDS) was described. There since has been a significant rise in the rate of cases, becoming the mostly common infection complicating AIDS.[8,9]

Since P carinii was first described, solely exceptional reports have been published forward pneumonia by this microorganism in patients with no previous predisposing illness.[10-15] We believe that it is interesting to share our experience with acute episodes and the follow-up of five patients with PCP who had no known predisposing conditions.

METHODS

Between July 1987 and October 1988 five patients with no known immunocompromising condition were diagnosed at our hospital as having PCP These patients were evaluated during the acute pneumonic episode, and later, a follow-up was carried revealed in periodic visits to the Pneumology Outpatient Department. The initial evaluation included serum immunoglobulins (IgG, IgM, and IgA) and a quantity of lymphocyte subpopulations, serologic thought for human immunodeficiency virus (HIV), search for collagenvascular and neoplastic disease indicators, and comput tomography (CT) of the chest and abdomen. During the follow-up lymphocyte subpopulations, serum rimmunoglobulins (IgG, IgM, and IgA), and serologic application of mind for HIV were evaluated.

The PCP diagnosis was established according to the identification of typical organisms in specimens obtained through fiberoptic bronchoscopy (FB) in four cases, transthoracic needle aspiration (TNA) in sum of two units cases, and thoracentesis in single case (Table 1). The FB was performed (with the Olympus FB 10-OES) and techniques used for taking specimens were identical to those described by means of other authors.[16-19] Bronchoalveolar lavage (BAL)[16] was performed by the agency of wedging the tip of the FB into the third-generation bronchus of the middle lobe or lingula or alternatively in the area shown onward the chest radiograph that contained principally lung infiltrates. At least 50 ml of saline solution was installed and then suctioned afterward. Samples for bacterial agricultures were obtained with a telescoping plugg catheter (TPC) using the technique of Wimberley et al.[17] A FB 21C forceps was used to perform the transbronchial biopsy (TBB)[18] and a 22G spinal needle uniteed to a 5-ml syringe, was used for the TNA.[19] Specimens were immediately transported in sterile containers for bacterial, fungal, and parasitologic studies. In each case, toluidine sad O and modified Giemsa stains (Table 1) were used to identify P carinii.

Up to the conclusion of 1989, lymphocyte subpopulations were analyzed through indirect immunofluorescence, using monoclonal antibodies of the OKT series against CD4 and CD8 In the last 2 years of the follow-up lymphocyte subpopulations were measured at means of flow cytometrry (FACScan Analysis, Becton Dickison). Investigations of the anti-HIV-1 antibody (HIVAG 1 Abbott Laboratories) were carried disclosed on all five patients at least twice--both at the beginning and the extremity of the follow-up by enzyme immunoassay (EIA). In sum of two units patients, the serum was proofed for antibodies against the coma and core proteins of the HIV-1 by means of a second-generation recombinant EIA (ENVACOR HIV 1 Abbot Laboratories); and in another patient, for the mien of proteins against HIV-1, through Western-blot (NEW LAV BLOT 1 Diagnostics Pasteur). Investigations of the HIV-1 antigen (Abbott Recombinant HIV 1 EIA) were also made in four patients; and, in single in kind of the patients, anti-HIV-2 antibody by means of EIA (ELAVIA II, Diagnostics Pasteur) was determined (Table 2)

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