AEGiS-14IAC: Pneumocisis carinii pneumonia treated with surfactant.

14th International AIDS Conference


Barcelona, Spain - July 7-12, 2002

DonateNow
Print this article

Pneumocisis carinii pneumonia treated with surfactant.

Int Conf AIDS 2002 Jul 7-12; 14:(abstract no. B10224)

Bernardi S, Palma P, Perrotta D, Marano M, Cursi L, Pirozzi N, Rossi P, Castelli-Gattinara G
Bambino Gesu Hospital, Rome, Italy

BACKGROUND: Pneumocistis carinii pneumonia is one of the most serious diseases in children with HIV. It can represent the first sign of infection in children under one year of age and, in this cases, it is related to a poor prognosis. Several supportive treatments as steroids and surfactant can improve the outcome.

METHODS: A 5 month old child was admitted to the intensive care unit for fever and progressive respiratory failure. Lymphopenia with a low CD4+ cells percentage (13%) and positive HIV virological tests lead to the diagnosis of AIDS, CDC class C-3. Chest X-ray showed diffuse and micro-nodular opacity. BAL showed PC. After the first days of sustained treatment (TMP-SMZ 100 mg/kg + Meropenem 100 mg/kg + Amikacine 15 mg/kg + Fluconazole 5 mg/kg + Prednisone 1 mg/kg) clinical conditions and respiratory indexes were progressively worsening, with increasing hypercapnia. Nitric oxid (from 35ppm to 5ppm in 15') produced only a transient improvement. A dose of 50 mg/kg of animal surfactant (CUROSURF*) was given through the endotracheal tube after 48 hours with a subsequent and rapid improvement of the oxygenation indexes and of X-ray imaging. Patient was extubated after 6 days.

RESULTS: 1st day h20: DO2A-a=118, OI=9.3, VI=1280, PaO2/FiO2=172 2nd day h08: DO2A-a=127, OI=8.7, VI=1764, PaO2/FiO2=206 - Nitric Oxid 2nd day h20: DO2A-a=184. OI=9.2, VI=1095, PaO2/FiO2=163 3rd day h08: DO2A-a=167, OI=6.3, VI=720, PaO2/FiO2=183 3rd day h22: (pre-S) DO2A-a201, OI=14, VI=960, PaO2/FiO2=100 4th day h04: (4h post-S) DO2A-a=145, OI=5, VI=882, PaO2/FiO2=280 4th day h06: (6h post-S) DO2A-a=114, OI=3.7, VI=720, PaO2/FiO2=282 5th day h08: DO2A-a=133, OI=3.7, VI=340, PaO2/FiO2=265 6th day h08: PaO2/FiO2=342, extubated

CONCLUSIONS: Animal derived surfactant given endobrochially can improve outcome of Pneumocistis carinii pneumonia in children and reduce time of mechanical ventilation.

Keywords: AEGIS, Pneumonia, Pulmonary Surfactants, Respiration, Artificial, Surface-Active Agents, Acquired Immunodeficiency Syndrome, Pneumonia, Pneumocystis, curosurf, Child, HumanKWDaegis,pneumonia,pulmonarysurfactants,respiration,artificial,surface-activeagents,acquiredimmunodeficiencysyndrome,pneumonia,pneumocystis,curosurf,child,human

020707
B10224

Copyright © 2002 - International AIDS Society (IAS). Reproduction of this abstract (other than one copy for personal reference) must be cleared through the IAS.