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An Outbreak of Pneumocystis Pneumonia in Children With Acute Lymphocytic Leukemia

An Outbreak of Pneumocystis Pneumonia in Children With Acute Lymphocytic Leukemia Abstract • Between Jan 1 and Oct 31, 1975, a cluster of ten cases of pneumocystis pneumonia occurred in children with acute lymphocytic leukemia (ALL) at the James Whitcomb Riley Hospital for Children in Indianapolis. The risk of infection appeared to be related to the intensity of chemotherapy. Furthermore, illness developed in nine of the ten patients between 30 and 100 days after initiation of therapy, suggesting a period of heightened susceptibility to infection. An indirect immunofluorescent test was used to detect antipneumocystis antibodies in serum samples collected from patients with pneumocystis pneumonia and their contacts. Members of the Riley Hospital staff who had close contact with infected children had a higher prevalence of elevated antibody titers (7/12) than other staff members (2/22; P =.004) or parents of infected patients (0/8; P =.01). This suggests that transmission of pneumocystis may occur within the hospital environment. (Am J Dis Child 132:143-148, 1978) References 1. Gajdusek DC: Pneumocystis carinii—etiologic agent of interstitial plasma cell pneumonia of premature and young infants . Pediatrics 19:543-565, 1957. 2. Post C, Dutz W, Nasarian I: Endemic Pneumocystis carinii pneumonia in South Iran . Arch Dis Child 39:35-40, 1964.Crossref 3. Lim SK, Moon CS: Studies on Pneumocystis carinii pneumonia: II. Epidemiologic and clinical studies of 80 cases . Jonghap Med 6:77-86, 1960. 4. Perera DR, Western KA, Johnson HD, et al: Pneumocystis carinii pneumonia in a hospital for children . JAMA 214:1074-1078, 1970.Crossref 5. Singer C, Armstrong D, Rosen PP, et al: Pneumocystis carinii pneumonia: A cluster of 11 cases . Ann Intern Med 82:772-777, 1975.Crossref 6. Norman L, Kagen IG: Some observations on the serology of Pneumocystis carinii infections in the United States . Infect Immun 8:317-321, 1973. 7. Pifer LL, Hughes WT: Cultivation of Pneumocystis carinii in vitro . Pediatr Res 9:344, 1975. 8. Watanabe JM, Chinchinian H, Weitz C, et al: Pneumocystis carinii pneumonia in a family . JAMA 193:685-686, 1965.Crossref 9. Brazinsky JH, Phillips JE: Pneumocystis pneumonia transmission between patients with lymphoma . JAMA 209:1527, 1969.Crossref 10. Frenkel JK, Good JT, Schultz JA: Latent pneumocystis infection of rats, relapse, and chemotherapy . Lab Invest 15:1559-1577, 1966. 11. Sheldon WH: Experimental pulmonary Pneumocystis carinii infection in rabbits . J Exp Med 110:147-160, 1959.Crossref 12. Hughes WT, Price RA, Sisko F, et al: Protein-calorie malnutrition: A host determinant for Pneumocystis carinii infection . Am J Dis Child 128:44-52, 1974.Crossref 13. Esterly JA: Pneumocystis carinii in lungs of adults at autopsy . Am Rev Resp Dis 97:935-937, 1968. 14. Hamlin WB: Pneumocystis carinii . JAMA 204:173-174, 1968.Crossref 15. Hughes WT, Feldman S, Aur RJA, et al: Intensity of immunosuppressive therapy and the incidence of Pneumocystis carinii pneumonitis . Cancer 36:2004-2009, 1975.Crossref 16. Leventhal BG, Cohen P, Triem SC: Effect of chemotherapy on the immune response in acute leukemia: A review . Isr J Med Sci 10:866-887, 1974. 17. Hughes WT: Treatment of Pneumocystis carinii pneumonitis . N Engl J Med 295:726-727, 1976.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png American Journal of Diseases of Children American Medical Association

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Publisher
American Medical Association
Copyright
Copyright © 1978 American Medical Association. All Rights Reserved.
ISSN
0002-922X
DOI
10.1001/archpedi.1978.02120270041009
Publisher site
See Article on Publisher Site

Abstract

Abstract • Between Jan 1 and Oct 31, 1975, a cluster of ten cases of pneumocystis pneumonia occurred in children with acute lymphocytic leukemia (ALL) at the James Whitcomb Riley Hospital for Children in Indianapolis. The risk of infection appeared to be related to the intensity of chemotherapy. Furthermore, illness developed in nine of the ten patients between 30 and 100 days after initiation of therapy, suggesting a period of heightened susceptibility to infection. An indirect immunofluorescent test was used to detect antipneumocystis antibodies in serum samples collected from patients with pneumocystis pneumonia and their contacts. Members of the Riley Hospital staff who had close contact with infected children had a higher prevalence of elevated antibody titers (7/12) than other staff members (2/22; P =.004) or parents of infected patients (0/8; P =.01). This suggests that transmission of pneumocystis may occur within the hospital environment. (Am J Dis Child 132:143-148, 1978) References 1. Gajdusek DC: Pneumocystis carinii—etiologic agent of interstitial plasma cell pneumonia of premature and young infants . Pediatrics 19:543-565, 1957. 2. Post C, Dutz W, Nasarian I: Endemic Pneumocystis carinii pneumonia in South Iran . Arch Dis Child 39:35-40, 1964.Crossref 3. Lim SK, Moon CS: Studies on Pneumocystis carinii pneumonia: II. Epidemiologic and clinical studies of 80 cases . Jonghap Med 6:77-86, 1960. 4. Perera DR, Western KA, Johnson HD, et al: Pneumocystis carinii pneumonia in a hospital for children . JAMA 214:1074-1078, 1970.Crossref 5. Singer C, Armstrong D, Rosen PP, et al: Pneumocystis carinii pneumonia: A cluster of 11 cases . Ann Intern Med 82:772-777, 1975.Crossref 6. Norman L, Kagen IG: Some observations on the serology of Pneumocystis carinii infections in the United States . Infect Immun 8:317-321, 1973. 7. Pifer LL, Hughes WT: Cultivation of Pneumocystis carinii in vitro . Pediatr Res 9:344, 1975. 8. Watanabe JM, Chinchinian H, Weitz C, et al: Pneumocystis carinii pneumonia in a family . JAMA 193:685-686, 1965.Crossref 9. Brazinsky JH, Phillips JE: Pneumocystis pneumonia transmission between patients with lymphoma . JAMA 209:1527, 1969.Crossref 10. Frenkel JK, Good JT, Schultz JA: Latent pneumocystis infection of rats, relapse, and chemotherapy . Lab Invest 15:1559-1577, 1966. 11. Sheldon WH: Experimental pulmonary Pneumocystis carinii infection in rabbits . J Exp Med 110:147-160, 1959.Crossref 12. Hughes WT, Price RA, Sisko F, et al: Protein-calorie malnutrition: A host determinant for Pneumocystis carinii infection . Am J Dis Child 128:44-52, 1974.Crossref 13. Esterly JA: Pneumocystis carinii in lungs of adults at autopsy . Am Rev Resp Dis 97:935-937, 1968. 14. Hamlin WB: Pneumocystis carinii . JAMA 204:173-174, 1968.Crossref 15. Hughes WT, Feldman S, Aur RJA, et al: Intensity of immunosuppressive therapy and the incidence of Pneumocystis carinii pneumonitis . Cancer 36:2004-2009, 1975.Crossref 16. Leventhal BG, Cohen P, Triem SC: Effect of chemotherapy on the immune response in acute leukemia: A review . Isr J Med Sci 10:866-887, 1974. 17. Hughes WT: Treatment of Pneumocystis carinii pneumonitis . N Engl J Med 295:726-727, 1976.Crossref

Journal

American Journal of Diseases of ChildrenAmerican Medical Association

Published: Feb 1, 1978

References