Empirically Treated Pneumocystis Carinii Pneumonia in London, 1983–1989

1992 ◽  
Vol 3 (4) ◽  
pp. 285-287 ◽  
Author(s):  
E J Beck ◽  
P D French ◽  
M H Helbert ◽  
D S Robinson ◽  
F M Moss ◽  
...  
Keyword(s):  
Pneumocystis Carinii Pneumonia ◽  
Lymphocyte Count ◽  
Severe Disease ◽  
Pneumocystis Carinii ◽  
Fatal Outcome ◽  
Case Fatality ◽  
Medical Intervention ◽  
Arterial Oxygen ◽  
Oxygen Gradient ◽  
Over Time

For 227 episodes of Pneumocystis carinii pneumonia (PCP) treated at St Mary's between 1983 and 1989, factors predictive of fatal outcome were age, haemoglobin levels, peripheral lymphocyte count and alveolar-arterial oxygen gradient. Case fatality for the 47 empirically-treated episodes was significantly higher compared with the 180 cytologically proven episodes (55% vs 18%, χ2 = 25.7, P<0.0001). Case fatality for episodes which could not be bronchoscoped was significantly higher compared with bronchoscopy negative cases (66% vs 25%, χ2 = 4.5, P<0.05). Predictive factors for fatal outcome differed significantly for cases which could not be bronchoscoped and cytologically proven cases: haemoglobin level (10.7 g/dl vs 12.0 g/dl, P<0.001), lymphocyte count (0.64 × 109/l vs 0.87×109/l, P=0.05) and oxygen gradient (77.7 mmHg vs 58.9 mmHg, P<0.02). Such differences were not observed between bronchoscopy negative and cytologically proven cases. Case fatality decreased significantly over time ( b = –0.39, SE=0.14, P<0.05). Total and non-fatal first time episodes displayed an inverse relationship between oxygen gradient and time ( r = −0.22, P<0.006 and r = −0.24, P<0.01, respectively). Mean oxygen gradient of fatal episodes for sequential years increased significantly from 73 mmHg in 1983 to 102 mmHg in 1989 ( r = 0.92, P<0.01). This suggests that medical intervention as well as presentation with less severe disease both contributed to improved case fatality over time.

Improved Outcome of Pneumocystis Carinii Pneumonia in AIDS Patients: A Multifactorial Treatment Effect

1992 ◽  
Vol 3 (3) ◽  
pp. 182-187 ◽  
Author(s):  
E J Beck ◽  
P D French ◽  
M H Helbert ◽  
D S Robinson ◽  
F M Moss ◽  
...  
Keyword(s):  
Pneumocystis Carinii Pneumonia ◽  
Medical Diagnosis ◽  
Pneumocystis Carinii ◽  
Arterial Oxygen ◽  
Disease Course ◽  
Aids Patients ◽  
Oxygen Gradient ◽  
Most Significant Change ◽  
Patient Presentation ◽  
Over Time

Factors determining the outcome of an episode of Pneumocystis carinii pneumonia (PCP) in 149 AIDS patients treated at St Mary's Hospital were identified and their importance on improved survival evaluated between 1984 and 1989. The proportion of fatal episodes of PCP decreased over time. Fatal compared with non-fatal episodes had lower mean alveolar-arterial oxygen gradient (82.5 mmHg vs 53.8 mmHg, P<0.001), mean haemoglobin level (11.2g/dl vs 12.1 g/dl, P=0.01), mean lymphocyte count (0.68 times 109/l vs 0.92 times 109/l, P=0.05) and more coinfections (31% vs 5%, P<0.001). Over time, the most significant change which occurred was a reduction in alveolar-arterial oxygen gradient at time of first presentation with PCP (r=−0.37, P<0.001). Mean alveolar-arterial oxygen gradient declined from 79.9 mmHg in 1984 to 45.3 mmHg in 1989 (r= −0.88, P=0.02), independently of zidovudine therapy or PCP prophylaxis. Patients were being treated at an earlier stage in their disease course as indicated by their reduced alveolar arterial oxygen gradient. This is due either to earlier patient presentation, earlier medical diagnosis or both. The widespread introduction of zidovudine and PCP prophylaxis may further contribute to improve morbidity and mortality patterns in the future.

scholarly journals The Role of Aerosol Pentamidine Prophylaxis

1993 ◽  
Vol 4 (2) ◽  
pp. 67-69
Author(s):  
E L C Ong
Keyword(s):  
Cell Count ◽  
Pneumocystis Carinii Pneumonia ◽  
Lymphocyte Count ◽  
Pneumocystis Carinii ◽  
Total Lymphocyte Count ◽  
First Episode ◽  
Cd4 Cell Count ◽  
Drug Of Choice ◽  
Cd4 Cell

Pneumocystis carinii pneumonia (PCP) is the most frequent opportunistic infection in patients with AIDS, occurring in 80% and recurring in 50% of patients within 12 months of the first episode. Prophylaxis for PCP is recommended if the CD4+ cell count is <200×106/l or 20% of the total lymphocyte count, or after an episode of PCP. The most effective prophylactic agent currently is trimethoprim-sulphamethoxazole and should be the drug of choice but alternatives such as aerosol pentamidine are being increasingly used for patients who cannot tolerate this combination or other oral preparations. If aerosol pentamidine is used and administered via a Respigard II Marquest nebulizer, the dosage should be higher than the currently recommended monthly dosage of 300 mg.

scholarly journals Dynamic change in lymphocyte count in the early stage is a potential predictor of the severity of COVID-19

2020 ◽  
Author(s):  
Xi Zhang ◽  
Yonghao Du ◽  
Lei Shi ◽  
Tianyan Chen ◽  
Yingren Zhao ◽  
...  
Keyword(s):  
Lymphocyte Count ◽  
Early Stage ◽  
Dynamic Change ◽  
Severe Disease ◽  
Chest Ct ◽  
Dynamic Changes ◽  
Potential Predictor ◽  
Illness Onset ◽  
Over Time ◽  
Severe Patient

Abstract Background Lymphopenia is associated with COVID-19 severity. Herein we describe the dynamic changes in lymphocyte count during hospitalization and explore a possible association with the severity of COVID-19.Methods In this retrospective study, 13 non-severe COVID-19 patients diagnosed at admission were enrolled. One patient progressed to severe disease. Dynamic changes in lymphocyte count and CT score of all patients were analyzed.Results Lymphocyte count changed significantly in the non-severe patients over time (admission vs day 5, P=0.685; day 5 vs day 15, P<0.001). Lymphocyte count of the severe patient fluctuated, and even decreased within the first 12 days post-admission, before increasing gradually. Chest CT scores of nine (75%) non-severe patients on the 5th day of hospitalization were higher than at admission, but decreased gradually thereafter (admission vs day 5, P<0.001, day 5 vs day 15, P=0.004). In the severe patient, CT score continued to increase for 2 weeks after admission, before decreasing gradually.Conclusions Non-severe COVID-19 patients had significantly increased lymphocyte count and decreased CT score 1 week after illness onset. Dynamic change in lymphocyte count in the early stages of COVID-19 may be helpful to identify the patients who are more likely to develop severe or critical illness.

Adjuvant Corticosteroid Therapy for Pneumocystis Carinii Pneumonia in Aids Patients

1992 ◽  
Vol 26 (9) ◽  
pp. 1127-1133 ◽  
Author(s):  
Catherine J. Sistek ◽  
Cindy J. Wordell ◽  
Stephen P. Hauptman
Keyword(s):  
Sample Size ◽  
Outcome Measures ◽  
Corticosteroid Therapy ◽  
Pneumocystis Carinii Pneumonia ◽  
Expert Panel ◽  
Pneumocystis Carinii ◽  
National Institutes Of Health ◽  
Arterial Oxygen ◽  
Aids Patients ◽  
Systemic Corticosteroids

OBJECTIVE: To review published abstracts, case reports, and journal articles and evaluate data examining the use of systemic corticosteroids as adjuvant treatment for Pneumocystis carinii pneumonia (PCP) in patients with AIDS. DATA SOURCES: Computerized online databases, peer-reviewed journals from January 1986 through September 1991, and personal communication with a National Institutes of Health correspondent. STUDY SELECTION: The authors identified 13 reports pertinent to this review. By author consensus, five studies were selected for analysis based on sample size, controlled study design, and clinical outcome measures. Recommendations of an expert panel from the National Institutes of Health and the University of California also are discussed. DATA EXTRACTION: Data are presented based on the methodologic strength of the studies reviewed. Studies are assessed on sample size, inclusion criteria, comparative cohort populations, specific patient outcome measures, and statistical analysis. DATA SYNTHESIS: Results of the study analysis support the use of systemic corticosteroids as early adjunctive therapy for AIDS patients with moderate-to-severe PCP who have an initial arterial oxygen partial pressure of <70 mm Hg or an alveolar-arterial gradient >35 mm Hg on room air. Improved outcomes included decreased mortality, respiratory failure, and deterioration of oxygenation. Data evaluated have shown that adjuvant corticosteroid therapy is most effective when initiated within 72 hours of beginning specific antipneumocystis therapy. A small, but sometimes significant, increased rate of infection in steroid-treated patients was noted. CONCLUSIONS: Based on the literature reviewed, early systemic adjuvant corticosteroid therapy can benefit patients with moderate-to-severe AIDS-related PCP. The steroid regimen used in the largest controlled trial and recommended by the expert panel is prednisone 40 mg bid (days 1–5), then 40 mg/d (days 6–10), then 20 mg/d (days 1–21).

scholarly journals Epidemiology and Trends of Pertussis among Infants: United States, 2000–2015

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S5-S5 ◽  
Author(s):  
Catherine Bozio ◽  
Tami Skoff ◽  
Tracy Pondo ◽  
Jennifer Liang
Keyword(s):  
Negative Binomial ◽  
Severe Disease ◽  
Age Distribution ◽  
Age Groups ◽  
Case Fatality ◽  
Annual Average ◽  
Young Infants ◽  
Hospitalization Rates ◽  
The Impact ◽  
Over Time

Abstract Background Pertussis, a cyclic respiratory disease, causes the greatest morbidity and mortality among infants, particularly those too young to be vaccinated. Following a resurgence of pertussis in the 1990s, a recommendation was made in 2012 to vaccinate during every pregnancy in order to prevent infant disease. We describe pertussis trends from 2000–2015 among U.S. infants aged &lt;1 year. Methods We analyzed infant pertussis cases reported through the National Notifiable Diseases Surveillance System from 2000 to 2015. Incidence rates (cases per 100,000 population) among various age groups (&lt;2, 2– &lt;4, 4– &lt;6, and 6–&lt;12 months) were calculated using National Center for Health Statistics population estimates as denominators. Negative binomial regression was used to estimate the annual average percent change with a linear trend; P &lt; 0.05 was significant. Results From 2000 to 2015, 48,909 infant pertussis cases and 255 deaths were reported; infants aged &lt;2 months accounted for 38.7% of cases. The age distribution of infant cases was stable from 2000 to 2009 but changed from 2010 to 2015 (Fig. 1), as the proportion of cases aged 4–&lt;12 months increased annually on average by 4.7% (P &lt; 0.001). Annual incidence was highest among &lt;2 month olds; however, rates increased among older infants (Fig. 2): 7% average annual increase among infants aged 4–&lt;6 months and 11% among infants aged 6–&lt;12 months (P &lt; 0.001 for each). The proportion of infants hospitalized decreased over time in each age group (P &lt; 0.001 for all) with the largest annual average declines among 4–&lt;6 (−5.1%) and 6–&lt;12 month (−5.9%) olds. For all age groups, hospitalization rates were relatively stable, but non-hospitalization rates increased (P &lt; 0.05 for all). The case–fatality ratio (CFR) was highest among &lt;2 month olds (1.6%); CFRs decreased over time among &lt;2 and 2–&lt; 4 month olds (P &lt; 0.05 for each). Conclusion Pertussis incidence remains highest among infants aged &lt;4 months, although the age distribution appears to be changing. Decreasing proportions of infants hospitalized may suggest a true decline in disease severity or an increase in reporting of less severe disease. Ongoing monitoring of infant pertussis is needed to better understand the impact of vaccinating pregnant women to prevent pertussis in young infants. Disclosures All authors: No reported disclosures.

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