Cytomegalovirus pneumonia co-infection with pneumocystis jiroveci pneumonia in HIV exposed infants admitted with suspected pneumocystis jiroveci pneumonia

Abstract

Background: Cytomegalovirus (CMV) and pneumocystis Jiroveci (PIP) are common causes of severe pneumonia in infants with human immuno-deficiency virus (HIV). Both CMV and PIP are associated with high mortality but the prevalence and effect of CMV pneumonia coinfection with PIP in our environment is poorly understood. Aim: To establish the prevalence of CMV pneumonia co-infection with PIP in HIV exposed and / or infected infants presenting with suspected PIP and the effect of such co-infection on disease outcome. Design: A prospective descriptive study. Setting: Paediatric wards, Pelonomi Regional Hospital, Bloemfontein. Subjects: Eight infants aged 2-6 months who were HIV exposed and / or infected admitted with suspected PIP from 1st July 2009 to 1st August 2009 and from 1st October 2009 through to 1st December 2009. Methods: Blood and sputum specimens were collected using aseptic techniques. These were venous and arterial blood samples and non invasive induced sputum samples respectively. A diagnosis of probable CMV pneumonia was assumed if the peripheral blood CMV viral load was greater than 10,000 copies / ml together with a positive CMV result on induced sputum using shell vial culture (SVC) test. PIP was diagnosed by indirect immuno-fluorescencce test using induced sputum specimen. Main outcome measured: Prevalence of CMV Pneumonia / PJP Co-infection in HIV exposed infants presenting with signs and symptoms resembling PIP, and the effect of such co-morbidity on disease outcome. As a secondary outcome, the influences of bactrim prophylaxis, anti-retroviral therapy (ART) and CD4% lymphocytes on the prognosis of these infants were also considered. Results: The prevalence of CMV pneumonia alone was 50%, and that of CMV PneumonialPIP co-infection was 12.5%, while PIP alone was 25%. All patients with either CMV Pneumonia alone or PIP alone survived and were discharged home. Clinically, CMV pneumonia / PIP co-infection had a poor outcome since the affected patient died after prolonged mechanical ventilation and hospital stay, but this fmding was not statistically significant ( CJ = 2.2%-47.1 %, p = 0.49). Conclusion: CMV Pneumonial PIP Co-infection is prevalent (12.5%) in our setting and seems to carry a poor prognosis. CMV pneumonia alone is highly prevalent (50%) but under - diagnosed. Clinically, it seems that PIP alone has excellent prognosis. It is recommended that more research be carried out in this field over a longer period of time with larger sample population to achieve a conclusive result.