Pneumocystis carinii Pneumonia: A Comparison Between Patients with the Acquired Immunodeficiency Syndrome and Patients with Other Immunodeficiencies

Abstract

Clinical features of 49 episodes of P. carinii pneumonia in patients with the acquired immunodeficiency syndrome were compared with those of 39 episodes in patients with other immunosuppressive diseases. At presentation, patients with the syndrome were found to have a longer median duration of symptoms (28 vs. 5 days, P = 0.0001), lower mean respiratory rate (23.4 vs. 30, P = 0.005), and higher median room air arterial O2 tension (69 vs. 52 mm Hg, P = 0.0002). The survival rate from 1979 to 1983 was similar for the 2 groups (57 and 50%, respectively). Patients with the syndrome had a higher incidence of adverse reactions to trimethoprimsulfamethoxazole (22 of 34 vs. 2 of 17, P = 0.0007). Survivors with the syndrome at initial presentation had a significantly lower respiratory rate, and higher room air arterial O2 tension, lymphocyte count, and serum albumin level compared to nonsurvivors. P. carinii pneumonia presents as a more insidious disease process in patients with the syndrome, and drug therapy in these patients is complicated by frequent adverse reactions.