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Query: UMLS:C0032285 (pneumonia)
 54,520 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Eighteen children with pneumocystis carinii pneumonia diagnosed over a period of 16 years at a children's hospital are reviewed. All had an underlying disease, either congenital immunodeficiency or a malignancy. 15 patients were treated, 10 with pentamidine isethionate alone, 2 with both pentamidine and co-trimoxazole, and 3 with co-trimoxazole alone. 12 of the treated group recovered and the 3 untreated patients died. The 3 deaths after treatment occurred in children receiving pentamidine alone, and in whom secondary factors contributed. The side effects of treatment with pentamidine were high, and included local reactions, hypoglycaemia, and uraemia. However, our results confirm that pentamidine is an effective treatment for pneumocystis carinii pneumonia in childhood. Co-trimoxazole may be an effective and relatively nontoxic alternative treatment.
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PMID:Treatment of pneumocystis carinii pneumonia in children. 30 Oct 10

Diarrhea, pneumonia, and malnutrition account for most of mortality and morbidity in children in developing countries. The Expanded Program of Immunization (EPI) is making progress with more than 50% of children under the age of 1 year receiving vaccination against the 6 EPI-listed diseases. The eradication of poliomyelitis by 2000 is realistic, so that the world could be smallpox- and polio-free by the 21st century. In July-August 1988 a cholera epidemic erupted in Delhi, India in which several hundreds died. The combined whole cell and toxin-B subunit oral vaccine against cholera has shown a decrease in protection from around 75-80% at the end of 6 months to around 60% at the end of 2 years. Typhoid fever affecting close to 8 million people in Asia has been treated with the improved formulation of TY21A vaccine and with the Vi polysaccharide capsular surface antigen in encouraging trials in Nepal. Co-trimoxazole has reduced child mortality caused by acute lower respiratory tract infections at the community level. 3 oral antirabies vaccines have been found safe, and oral baits have been effective. Chloroquine-resistant Plasmodium falciparum malaria is a major problem in may Asian countries involving sulfadoxine-pyrimethamine combinations as well. Lymphatic filariasis is expressed clinically as elephantiasis. More than 90 million people are believed to be infected. Ivermectin in a single dose as low as 25 mcg/kg of body weight was shown to be microfilaricidal in lymphatic filariasis. Allopurinol riboside is effective against visceral leishmaniasis or kala-azar. Leprosy and tuberculosis continue to be major health problems in Asia. There have been encouraging advances in immunization against cancers of the tropics, such as hepatitis B and primary carcinoma of the liver, the human papilloma virus and cancer of the uterine cervix, the Epstein-Barr virus and Burkitt's lymphoma, and nasopharyngeal carcinoma.
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PMID:Perspectives on research and diseases of the Tropics: an Asian view. 269 93

134 Gambian children under 5 years of age with severe pneumonia (as defined by the World Health Organisation classification of acute respiratory infections) were given either oral co-trimoxazole for 5 days, or a single intramuscular dose of fortified procaine penicillin and 5 days of oral ampicillin. At 2 weeks, there was no significant difference in outcome between the two groups. Co-trimoxazole is much less expensive than ampicillin or procaine penicillin, requires only twice-daily administration, and can be given by health-care staff with little training. The results support the use of co-trimoxazole as the antibiotic of first choice in outpatient management of young children with pneumonia in developing countries.
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PMID:Trial of co-trimoxazole versus procaine penicillin with ampicillin in treatment of community-acquired pneumonia in young Gambian children. 256 98

This is a case report on a 70-year-old male patient. During chemotherapy treatment after a bladder tumor operation, the patient had a complication of pneumonia which did not respond to various antibiotics. From clinical observations and chest X-ray, it was diagnosed as pneumocystis carinii (PC) pneumonia and was cured by medication of Co-trimoxazole.
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PMID:[A case of pneumocystis carinii pneumonia after chemotherapy of bladder tumor]. 387 33

Report of a now 2 8/12-year-old girl, who presented at the age of 8 months with chronic progressive pneumonia, mucocutaneous candidiasis, diarrhea, failure to thrive and a non-progressive paraplegia. The child's mother presented AIDS with pneumocystis carinii pneumonia and progressive general paralysis one year after the beginning of the child's disease and died within a few months. Additional findings in the child include lymphopenia, hyperimmunoglobulinemia, cutaneous anergy and an abnormal T helper/T suppressor cell ratio. HTLV-III antibodies were positive (ELISA and Western blot virus strip RIA). Prophylactic treatment with Co-trimoxazole relieved pulmonary infections but failure to thrive remained unchanged in spite of a continuous nutritional support. A vertical mode of transmission of AIDS from mother to child seems very probable.
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PMID:[Acquired immunodeficiency syndrome in a child of Swiss origin whose mother died from AIDS]. 387 45

The acquired immune deficiency syndrome (AIDS) represents a new epidemic of major proportions. Risk factors include homosexuality, intravenous drug abuse, Haitian descent, and multiple transfusion in the presence of hemophilia A. The etiology of AIDS remains unknown, but there is increasing evidence implicating a transmissible infectious agent and/or multiple antigenic exposures inducing a loss of immunoregulation. In a high-risk patient, the features of weight loss, generalized lymphadenopathy, and fever should arouse suspicion of AIDS. Diagnostic confirmation includes demonstration of reduced numbers of T lymphocytes with reversal of helper-suppressor T-lymphocyte ratio, presence of unusual opportunistic infections, and a progressive downhill course. The most common infection in AIDS is Pneumocystis carinii pneumonia. Treatment failures with trimethoprim-sulfamethoxazole (Bactrim, Septra) are common; pentamidine isethionate (Lomidine) may be more effective in eradicating the infection. In spite of initial improvement, recurrences of P carinii pneumonia and other opportunistic infections are common. In addition, other protozoan, viral, fungal, and atypical mycobacterial infections are frequent in patients with AIDS. Finally, rare neoplasms such as Kaposi's sarcoma and B-cell lymphoma, including primary lymphoma of the brain, are also being recognized as complications. At present there is no specific therapy for AIDS, and the disease is usually fatal. Continued research will hopefully result in immunomodulation techniques and specific vaccines to combat this serious epidemic.
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PMID:Acquired immune deficiency syndrome. A deadly new disease. 660 12

Co-trimoxazole presently remains the first choice for prophylaxis and treatment of Pneumocystis carinii infections. The high incidence of adverse reactions experienced by patients taking co-trimoxazole has led to a number of trials comparing it with other antipneumocystis agents. Adjuvant therapy with corticosteroids may benefit patients with severe P. carinii pneumonia. This paper reviews the standard treatments for P. carinii pneumonia, some of the newer agents such as atovaquone, recently licensed in the U.K., and a variety of novel agents being assessed for treatment and prophylaxis. Current recommendations may change over the new few years.
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PMID:Therapeutic progress. IV: Treatment and prophylaxis of Pneumocystis carinii infection. 759 74

Co-trimoxazole is still widely used for indications where trimethoprim alone is equally effective. The pharmacological rationale of the combination of trimethoprim and sulphamethoxazole involves synergistic action of the two drugs. This is true only from a laboratory point of view; several considerations have led to the conclusion that the synergism between the two components is of only in vivo marginal importance in determining the clinical efficacy of co-trimoxazole. This is due to a greater tissue affinity of trimethoprim compared to that of sulphamethoxazole and, therefore, to the different tissue concentration ratios obtained in vitro and in vivo. Another claim sustaining the combination is the prevention of developing resistance to trimethoprim; however, there is no substantial clinical evidence to support this claim. It does seem likely that trimethoprim has protected against the emergence of that sulphonamide resistance. This slight benefit is outweighed by the disadvantages of the combination, mainly consisting of the occurrence of adverse events due to the sulphonamide moiety. Consequently, the incidence and severity of the adverse events seen with co-trimoxazole should be reduced by using trimethoprim alone. There are only a few cases where co-trimoxazole is better than trimethoprim: toxoplasmosis, brucellosis, nocardiosis, chancroid and pneumonia due to Pneumocystis carinii. For the other and many common infections, scientific rationale, economic and clinical reasons dictate that trimethoprim is superior to co-trimoxazole.
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PMID:Combinations of sulphonamides with diaminopyrimidines: how, when and why? 766 20

A model for the in vivo evaluation of antipneumocystis drugs has been developed in SCID mice infected intratracheally with cryopreserved mouse-derived Pneumocystis carinii. The development of a highly reproducible fatal P. carinii pneumonia occurred within 10 weeks (mean survival time +/- SEM = 72.2 +/- 1.2 days). Continuous administration of dexamethasone (2 mg/liter in the drinking water) exacerbated the rate of onset of severe P. carinii pneumonia (mean survival time +/- SEM = 63 +/- 1.3 days) in SCID mice. The number of cysts per g of lung homogenate (homogenate counts) were maximal with an inoculum of 20,000 cysts at 6 weeks post infection. Homogenate counts correlated with infection scores (graded assessments of immunofluorescent cysts on lung impression smears) suggesting that infection scoring accurately and rapidly reflects the severity of P. carinii pneumonia in SCID mice. These studies led to the development of a drug screening protocol in which Pneumocystis-free female SCID mice (20-25 g) were started on dexamethasone 7 days prior to IT inoculation with a single dose of 20,000 cysts. Drugs were evaluated either for: a) prophylaxis (continuously from day 1 post infection) or b) treatment (from day 21 post infection) until day 42 post infection, when all mice were killed and infection scores determined. Co-trimoxazole (at 250 mg sulfamethoxazole + 50 mg trimethoprim/kg/day) given in the drinking water was found to be highly effective in both the prophylaxis and treatment of mouse P. carinii pneumonia.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Artificial infections of Pneumocystis carinii in the SCID mouse and their use in the in vivo evaluation of antipneumocystis drugs. 786 80

Co-trimoxazole is still widely used for indications where trimethoprim alone is equally effective. Microbiological and pharmacokinetic considerations reveal that trimethoprim alone provides adequate anti-microbial activity for treatment of conditions for which co-trimoxazole is often given. Synergy may be shown in vitro, but in clinical practice is an unusual occurrence. There is no evidence from clinical studies that the sulphonamide moiety fo co-trimoxazole prevents the development of resistance to trimethoprim. The adverse event profile of co-trimoxazole is a summation of that of sulphonamide and of trimethoprim. Thus, using trimethoprim alone should reduce both the incidence and potential severity of adverse events seen when co-trimoxazole is used. Clinical trials have shown trimethoprim to be as effective as co-trimoxazole in many of the common bacterial infections of the urinary and respiratory tracts. However, there are a few specific varieties of infection for which co-trimoxazole can be shown to be superior to trimethoprim: these include toxoplasmosis, brucellosis, nocardiosis, chancroid and pneumonia caused by Pneumocystis carinii. For many common infections, scientific, rational, economic and clinical reasons dictate that trimethoprim is preferable to co-trimoxazole.
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PMID:Limitations of and indications for the use of co-trimoxazole. 807 75


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