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Education And Debate

Lesson of the Week: Unsuspected Pneumocystis carinii pneumonia and vertically acquired HIV infection in infants requiring intensive care

BMJ 1994; 308 doi: (Published 12 February 1994) Cite this as: BMJ 1994;308:462
  1. R C Tasker,
  2. K Wilkinson,
  3. T J Slater,
  4. V Novelli
  1. Paediatric Intensive Care Unit, Hospital for Sick Children, Great Ormond Street, London WC1N 3JH
  2. Department of Paediatric Infectious Disease, Hospital for Sick Children, London WC1N 3JH
  1. Correspondence to: Dr Tasker.
  • Accepted 23 July 1993

Infants with Pneumocystis carinii pneumonia may be the first family members to be diagnosed as having HIV infection, particularly as some mothers are unaware of their own infection

The condition of infants with acute respiratory distress may deteriorate to the point of needing assisted mechanical ventilation, particularly during seasonal outbreaks of respiratory syncytial virus infection. In some of these children the course of their illness may have been complicated by secondary bacterial infection or aspiration of gastric contents. Alternatively, the underlying infection may have been particularly virulent or the host unusually susceptible - for example, infants with some degree of chronic lung disease of prematurity or an underlying congenital heart disease. In practice, having excluded respiratory syncytial virus, most physicians choose antimicrobial treatment to cover the common community acquired respiratory pathogens in the age group. We describe three such cases in infants aged 8 weeks, 4 months, and 5 months in whom the aetiological agent and underlying disease - Pneumocystis carinii pneumonia and vertically acquired HIV infection - were unsuspected as their condition deteriorated.

Case reports

Case 1

An 8 week old black girl was admitted to a general paediatric ward with a brief history of irritability and vomiting after feeding. When aged 4 weeks she had been admitted and treated with antibiotics for seven days. On this occasion she was tachypnoeic with a respiratory rate up to 80 breaths/minute. She was later noted to be hypoxic breathing room air and was treated with supplemental oxygen. Throughout her initial stay in hospital she received intravenous cefuroxime. The working diagnosis was an acute respiratory illness complicated by aspiration of gastric contents. On general examination her length and weight were just above the 10th centile for age and her head circumference was between the 50th and 90th centile. She had a palpable spleen tip.

Case 1:

Radiographs showing …

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