PEDIATRICS Vol. 25 No. 3 March 1960, pp. 468-476
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PNEUMOCYSTIS CARINII PNEUMONIA

Report of a Case and Review of the Recent Literature

Joyce F. Wilson M.D.1, Gwendolyn Crass M.D.2, and Bettie L. Garza M.S.3

1 Department of Pediatrics, University of Texas Medical Branch Hospitals
2 Department of Pathology, University of Texas Medical Branch Hospitals
3 Department of Microbiology, University of Texas Medical Branch Hospitals

PNEUMOCYSTIS pneumonia, considered by Jirovec in 1954 to be "one of the most serious medical problems in the whole of Europe," has until quite recently received little attention in the United States. This entity, which occurs endemically or epidemically within hospital nurseries, appears to have a predilection for premature or dystrophic infants, although it has been reported several times in adult subjects. Three recent review articles describe the taxonomy of the parasite as being controversial and the mode of transmission unknown. Definitive ante-mortem diagnosis is difficult. Treatment is unsatisfactory and mortality ranges from 15 to 100%. During the past few years over 2,000 cases of interstitial plasma cell pneumonia attributed to Pneumocystis carinii have been described from Czechoslovakia, Germany, Austria, Switzerland, Hungary, Yugoslavia, Denmark, France, Italy, Sweden, Finland, Scotland, England, Canada, Australia, Brazil, Chile, the United States, and most recently from South Africa.

The first case of interstitial plasma cell pneumonia in the United States was reported in 1955 by Lunseth et al. Although their patient, a 7-week-old male, manifested clinical symptoms consistent with plasmacytic pneumonia, no characteristic alveolar exudate was demonstrated, and no mention was made of Pneumocystis carinii as the causative agent. Kitto in 1957 reviewed lung sections from nine infants who had died of interstitial pneumonia during a 7-year period at a North Dakota hospital. He found a 4frac12-month-old female in whom the pulmonary alveolar septae were infiltrated with monocytic cells, many of which had the appearance of plasma cells. It was believed that the interstitial infiltration of plasma cells coupled with the history of recurrent respiratory tract infection justified the presumptive diagnosis of interstitial plasma cell pneumonia; however, he stated, "no staining techniques to demonstrate the presence of the parasite in lung sections were attemped."

As seen in Table I, only eight deaths due to interstitial plasma cell pneumonia in which Pneumocystis carinii has been unequivocally demonstrated have been reported from the United States: one from Connecticut, two from Oklahoma, one from Georgia, one from Arizona, one from California, one from Louisiana, and the case here reported from Texas.

Submitted on June 15, 1959
Accepted on August 10, 1959