You Can Prevent Pneumocystis carinii Pneumonia in Children
A Guide for Care Givers of Children with HIV Infection
What is PCP?
Pneumocystis carinii [NEW-mo-SIS-tis CA-RIN-nee-eye] pneumonia, or "PCP," is a severe pneumonia in children with HIV infection. This serious infection of the lungs is caused by an organism called Pneumocystis carinii. Most people who are infected with this organism don't get pneumonia because their immune systems are working normally. Children and adults whose immune systems are badly damaged by human immunodeficiency virus (HIV) (the virus that causes AIDS), by cancer, or by other conditions can get PCP. PCP is called an opportunistic infection because a person may get the infection when their weakened immune system gives it the opportunity to develop. About one out of eight HIV-infected babies get PCP before their first birthday unless they take preventive medicine. PCP is most common in HIV-infected babies 2- 6 months old.
What are the symptoms of PCP?
Children with PCP usually have fever, cough, and difficulty breathing because of the infection in the lungs. Children may die of PCP, especially if the infection is not diagnosed and treated quickly. The disease can be diagnosed by laboratory tests of body fluid from the lungs.
Can a child catch PCP from other people?
The PCP organism might be spread from one person to another. Or it might be found in the environment such as in air or dust. Most scientists believe that it is most likely spread in the air. In any case, children with normal immune systems do not get PCP. Children with HIV infection should get medical care to prevent PCP and other diseases.
Can PCP be prevented?
Yes. The best drug for preventing PCP (as well as other HIV-related opportunistic infections, such as toxoplasmosis and severe bacterial infections) is trimethoprim-sulfamethoxazole (try- METH-o-prim - sul-fa-meth-OX-uh-zole), or TMP-SMX. Even though PCP is preventable, it is still the most common opportunistic infection among children with HIV.
What is TMP-SMX?
TMP-SMX is a combination of two antibiotic medicines. It is prescribed under many different brand names such as Bactrim, Septra, Co-trimoxazole,* and others. For PCP, TMP-SMX is used to prevent infection before it starts. Babies take TMP-SMX in syrup form; older children and adults may take it in tablet form. +
Who should be given treatment to prevent PCP?
All babies born to mothers with HIV infection should receive TMP-SMX beginning at 4-6 weeks of age. TMP-SMX should be taken this early to prevent infection before it starts. This is because PCP is especially common in young babies who can die from PCP even before their doctors know they have HIV infection. If a baby is later found not to be infected with HIV, the TMP-SMX treatment should be stopped. If the baby is or may be infected with HIV, TMP-SMX should be continued for the first year of life. The baby's doctor should be able to determine the amount of medication and the need for follow-up treatment after the first year.
Why do we wait 4-6 weeks before starting PCP prevention treatment for newborns of HIV-infected women?
Although young babies do get PCP, the disease is not common before 8 weeks of age. Also, TMP-SMX is not recommended in the first month of life because it can cause jaundice (liver damage and yellow skin coloring) in newborns. For newborn babies who are taking zidovudine [zy- DAH-vue-deen] to reduce their chance for HIV infection, TMP- SMX should be started after the zidovudine is stopped. TMP-SMX is generally safe for children older than 4 weeks of age. Premature babies should be followed more closely by their doctors or nurses.
What kind of medical follow-up do babies at risk for PCP need?
The medical follow-up treatment is usually determined by the counts of CD4+ lymphocyte cells (the white cells or T-helper cells that help the body fight off infections) which show if the immune system is strong enough to prevent PCP without medications. Therefore, it is important for children with HIV infection to continue to see their doctor so that their CD4+ cells and overall health can be watched carefully.
Can children with HIV infection get side effects from TMP-SMX? Are there other medicines to use?
Yes. Reactions from TMP-SMX can make some children have a rash or feel sick. If the drug reaction is not life-threatening, TMP-SMX should be continued because it works so much better than any other medicine to prevent PCP. However, other drugs are available if a child with HIV infection cannot take TMP-SMX. You should check with your doctor about the possibility of other treatments.
Can a child with HIV infection get PCP more than once?
Yes. Because PCP affects children with weakened immune systems, those who have had it once may get it again. TMP- SMX is also effective in preventing second infections with PCP. Therefore, treatment should be used even after a child has had PCP to prevent another bout of the disease. +
Is there anything a pregnant woman with HIV infection can do to prevent PCP in her child?
Yes. Early and continued care for women with HIV infection and their babies is key to disease prevention. Pregnant women with HIV infection who have weakened immune systems (low CD4 counts) should take preventive medicine to prevent PCP. However, even though this therapy prevents them from getting PCP, there is no evidence that such treatment will reduce the chance that their babies will get PCP. The best way to prevent PCP in children is to prevent HIV infection in children. Zidovudine is a medicine that an HIV- infected pregnant woman can take to reduce the chance that her child will get HIV infection. HIV-infected pregnant women should discuss this treatment with their doctors.
What research is being done to find out more about preventing PCP in children?
We already know that children with HIV are at high risk for PCP. PCP is still the most common opportunistic infection in HIV-infected people despite available treatments. One important goal for scientists is to find out why some people do not receive appropriate treatment to prevent infection with this deadly illness.
+ It is important to take all medicines prescribed by your doctor.
* Use of trade names and commercial sources is for identification only and does not imply endorsement by the Public Health Service or the U.S. Department of Health and Human Services.
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This article was provided by U.S. Centers for Disease Control and Prevention. Visit the CDC's website to find out more about their activities, publications and services.