Pneumocystis carinii pneumonia in patients with cancer. An increasing incidence

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Abstract
Background. The incidence of Pneumocystis carinii pneumonia (PCP) is increasing in patients with cancer. Possible nosocomial transmission from patients with acquired immune deficiency syndrome to those with cancer has been advocated. Methods. Retrospectively, 17 patients with cancer were reviewed who had 20 PCP episodes that occurred during a 3-year period (1988–1990). Results. Twelve patients had a hematologic malignant lesion, and five had a solid tumor as their underlying disease. Cytotoxic and/or immunosuppressive drugs were used in 16 patients (94%). The clinical presentation varied from fulminant to inapparent pneumonia. Clinical improvement and survival after appropriate therapy occurred in 12 patients (70%), whereas the remaining 5 patients died within 4 weeks of trimethoprim-sulfamethoxazole treatment initiation. In two patients, pentamidine was substituted. Complications of treatment occurred in six patients (35%). When survivors were compared with nonsurvivors, there was no difference in mean age, leukocyte counts, arterial oxygen tension, or duration of symptoms before treatment. Conclusions. In this series, nosocomial transmission of PCP was unlikely. Prophylaxis after a first episode of PCP should be considered in patients who will remain immunosuppressed.