Pneumocystis carinii infections in mothers, infants and non-AIDS elderly adults

Pneumocystis pneumonia has been recognized for more than half a century as a life-threatening infection of infants and children who are immunocompromised or debilitated. More recently, adults with cancer, organ transplantation, AIDS and other immunocompromising underlying diseases have become the major target for this opportunistic infection. The limited knowledge of pneumocystis pneumonia in pregnant women and the possibility of vertical transplacental transmission of P. carinii is limited to the study of a few cases. These studies show a poor prognosis for recovery from pneumocystis pneumonia in the pregnant women and the infrequency of maternal-infant transmission, if it occurs at all. Some evidence supports the contention that symptomatic P. carinii infection may occur in otherwise normal infants, children and elderly adults. However, these observations are based on a very limited number of cases. Pneumocystis pneumonia in non-AIDS patients differs clinically from that occurring in AIDS in that AIDS patients have longer duration of symptoms, lower respiratory rates, higher PaO₂ and higher frequency of adverse reactions to trimethoprim-sulphamethoxazole than do patients with non-AIDS pneumocystis pneumonia. The prompt, temporally-related improvement of an infant with pneumocystis pneumonia and respiratory failure to treatment with synthetic surfactant suggests the need for further study of this promising approach to therapy.