Korean J Pediatr.  2016 Jun;59(6):252-255. 10.3345/kjp.2016.59.6.252.

Pneumocystis jirovecii pneumonia in pediatric patients: an analysis of 15 confirmed consecutive cases during 14 years

• Kim KR
• Kim JM
• Kang JM
• Kim YJ

• KMID: 2353154
• DOI: http://doi.org/10.3345/kjp.2016.59.6.252

Abstract

PURPOSE
Pneumocystis jirovecii pneumonia occurs in various immunocompromised patients. Despite the prophylaxis strategies in clinical practice, certain patients develop P. jirovecii pneumonia. This study was performed to investigate pediatric cases with P. jirovecii pneumonia in a single center.
METHODS
We identified pediatric patients younger than 19 years with microbiologically confirmed P. jirovecii pneumonia from January 2000 to February 2014. A retrospective chart review was performed.
RESULTS
Fifteen episodes of P. jirovecii pneumonia in 14 patients were identified with median age of 8.3 years (range, 0.4-18.6 years). Among these patients, 11 patients had hematology-oncology diseases, 2 had primary immunodeficiency disorders (one with severe combined immunodeficiency and the other with Wiskott Aldrich syndrome), 1 had systemic lupus erythematosus and 1 received kidney transplant. Four patients were transplant recipients; 1 allogeneic and 2 autologous hematopoietic cell transplant and 1 with kidney transplant. The median absolute lymphocyte count at the diagnosis of P. jirovecii pneumonia was 5,156 cells/mm³ (range, 20-5,111 cells/mm³). In 13 episodes (13 of 15, 86.7%), patients were not receiving prophylaxis at the onset of P. jirovecii pneumonia. For treatment, trimethoprim/sulfamethoxazole was given as a main therapeutic agent in all 15 episodes. Steroid was given in 9 episodes (60%). Median treatment duration was 15 days (range, 4-33 days). Overall mortality at 60 days was 35.7% (5 of 14).
CONCLUSION
Majority of our patients developed P. jirovecii pneumonia while not on prophylaxis. Continuous efforts and more data are needed to identify high risk patients who may get benefit from P. jirovecii pneumonia prophylaxis.

Keyword

Pneumocystis carinii; Pneumocystis jirovecii; Pneumocystis jirovecii pneumonia; Pediatrics; Immunocompromised host

MeSH Terms

Diagnosis
Humans
Immunocompromised Host
Kidney
Lupus Erythematosus, Systemic
Lymphocyte Count
Mortality
Pediatrics
Pneumocystis carinii
Pneumocystis jirovecii*
Pneumocystis*
Pneumonia*
Retrospective Studies
Severe Combined Immunodeficiency
Transplant Recipients
Transplants