Pneumocystis cariniiPneumonia

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Abstract
One hundred eleven patients received renal transplants at this Center from November 1962 through December 1965. During the follow-up period through March 1966 of 3 to 40 months, 55 patients (50%) have expired, and 51 of these were studied by us at autopsy. Pneumonia was present in 41 of the 51 autopsied cases and was associated with Pneumocystis carinil in 10 (24%). The development of pneumocystis pneumonia aopeared to be related to unusually long term prednisone therapy in doses of 40 mgm/day or greater. Pneumocystis pneumonia was characterized by an insidious onset, dry cough, cyanosis, low grade to moderate fever, bilateral alveolar infiltrates, and blood gas studies compatible with an alveolar capillary block. Concomitant pulmonary infections were present in 9 of the 10 Pneumocygtis pneumonia cases at autopsy, including cytomegalovirus, Pseudomonas, nocardia, aspergillus and histoplasma. Cytomegalo-virus, although present in 7 of the 10 Pneumocystis cases, was no more frequent than in the total autopsled series, 27/51 (53%). Pneumocystis pneumonia was diagnosed pre-mortem by means of stained smears of tracheal aspirates in 1 of the 4 cases studied by this method. Two Pneumocystis cases were treated with pyrimethamine, folinic acid and sulfadiazine. Although both patients expired, suggestive evidence of improvement in each case justifies further studies on this mode of therapy. In 1 patient an unidentified sporozoan parasite was found at autopsy in the heart, liver and mesenterlc and peripancreatic fat.