VoI. XVIII. No. 1. 1982 - Abstract- Pneumocystis carinii The RoentgenologicaJ Study of Pneumocystic carinü Pneumonia In Young Choi , M.D. , Suk Huh , M.D. , Yong Chul Le e, M.D. Han Suk Kim , M.D. Department of Radiology, National Medicol Center , ' Seoul , Korea Keun Sohn, M.D . Department of Pediatrics, Nationa/ Medical Center , Seoul , Korea Pneumocystis carlnil pneumonia is caused by Preumocystls carini. It usually occurs in premature or debilltated infants. Recently sporadic cases of human dlsease in patients who have been on long term steroid therapy , cytotoxic drug therapy , drug were significantly Increased. We recently experienced 35 cases of Pneumocystis carinii pneumonia in infants of an institution for foreign adoption In three ep idemic period of Feb. 1979, Mar. 1980, and J an. 1981. The clinical review of 35 cases was made. Patients' age was between 1 to 4 months. Twenty one cases (60%) occured In 2 month old infants. Many patients were included in poor welght gain and development. The common symptoms were tachypnea, cyanosis, restlessness. cough , diarrhea in order of frequency. The roentgenological findings were classified into three groups: normal finding , pulmonary emphy- sema only , and various forms of pneumonic infiltration. The roentgenological findings were somewhat characteristic. The most common flnding (24 cases) showed streaky and mottled densities which began in both hili and were spreaded perlpherally. Thepneumonic infiltratlons were spared peripherallung, but progressed to total involvement. The prominence between alveolar and Interstitial infiltration was almostly equal when patients were admitted. Nineteen cases (54%) showed - 68 -
The RoentgenologicaJ Study of Pneumocystic carinü Pneumonia
In Young Choi, M.D. , Suk Huh, M.D. , Yong Chul Lee, M.D. Han Suk
Kim , M.D.
Department of Radiology, National Medicol Center,' Seoul,
Korea
Keun Ch Sohn, M.D.
Pneumocystis carlnil pneumonia is caused by Preumocystls carini. It
usually occurs in premature
or debilltated infants.
Recently sporadic cases of human dlsease in patients who have been
on long term steroid therapy, cytotoxic drug therapy ,
immunoppressive drug were significantly Increased.
We recently experienced 35 cases of Pneumocystis carinii pneumonia
in infants of an institution
for foreign adoption In three ep idemic period of Feb. 1979, Mar.
1980, and J an. 1981.
The clinical review of 35 cases was made.
Patients' age was between 1 to 4 months.
Twenty one cases (60%) occured In 2 month old infants.
Many patients were included in poor welght gain and
development.
The common symptoms were tachypnea, cyanosis, restlessness. cough,
diarrhea in order of frequency.
The roentgenological findings were classified into three groups:
normal finding, pulmonary emphy-
sema only , and various forms of pneumonic infiltration.
The roentgenological findings were somewhat characteristic.
The most common flnding (24 cases) showed streaky and mottled
densities which began in both hili
and were spreaded perlpherally.
The prominence between alveolar and Interstitial infiltration was
almostly equal when patients were
admitted.
- 68 -
~i'fr 1Æ
f o
.
(
i { }j
~J
!
• 13
.
Øi:
X
1) ~ 3) 41 51 6!
Trimethoprim
Sulfamethoxazole (Bact rim, Septrin)
f
m α{
X
35 X t1( iiE
n.
1979 2 ( 1 ) 1980 3 (2) 1981 1
(3 i'X) .
u
Pneumocysti s carinii
8 X j%
35 /H 0_ .
4
wrJ I
X jJE 3-"--4
5 IJ ?
.
T rimethoprim 20mg/ kg, S ulf amethoxa-
zole 1001 /kg 1 4 2
25 (60% )
7 (20%)
28 (80%) (Table 1.). 1 ~3
.
1M 4M Total 2M 3M
Male
Female
7
-%
6
15
1
.
t1(jJE H
. nasal flaring, I!t coryza,
U .
PO 0
.
14. 2% (5 ) 1
X 35
. (5
) (3 )
- 69-
5 3
'* tË
îï R
g 3 2, 3
3
. ij
27 j 24 { |
[
} R
(Fig. l. ) . a r- bronchogram .(Fig.
2)
l
F. 1. Admission roentgenogram showing biIateral streaky and
granular densities in both medial lungs. Sparing the periphera1
1urs.
3 wr;
8 'Ii~i
X {f[I!ij |!
‘ P
f (Fig. 3). :fif
f (Fig. 4). ~.~~ .~ ij
F. 3. Admission roentgenogram showing streaky den sities in both
media1 lung fields with homenous
increased desity in the right upper lung.
( Fig. 5)
nR O
Îf
(Table n .). x 3
.
F.2. Expired case: (Ieft) Admission roentgenograrn showÏI hazy and
streaky densities in both medial ng fields. (right) Fonow up
roentgenogram demonstrated extension of inf1ltration toward the
periphery of lung. AÏI bronchogram is well
- 70 -
volved extensively both entire lung fies.
F. S. Adrnission roentgenogram showing hazy desnity in right upper
lung and rnottled densities in both perilúlar regions.
Ernphysematous change in both lower lungs. Both diaphragrns are
flattened and depressed
Table 11. Findings on Chest P A Filrns
1. NorrnaI finding
2. Pneumonic infiltration
a. bilateral infiltration
3. Pulmonary emphyserna without pneumic in ftItration
- 71 -
N.
Ammich Inte r s titial plas ma cell pne
umoma
Jivorec Inte r stitial
plasma cell pneumonia Pneumocystis carinii
ZI 4) 10)
Chagas (1909) Pneumocys -
ti s carinii Iq f
A !WJ1
|
Saphrophyte
g {
‘ 11) 121
Pneumooystis carinii '*
# l 16) 11)
1:
Z
IF
t
'*11]
5 cases (1 4 .3%)
27 cases (77.1 %)
~~ 6 l Pneumocyst is carinii {
j l
$IJI 'J 1 IJfl { 1
);f: ~ll~ X
181 191
Gadju sel %
2 { 53 IJ
k
70% 1α 111
14) 21)
3 ι f
fiI
i 1
X j j
{ 3 11'
X
-
(l'J
O 9
}[ 24 (9IJ
19 (9IJ Bt
8 n g{ 14 f71j
13 (9IJ .
1 l :(911
*~
);f:(1'') lfË X
20)
X
{ 1 o-l r ] λ< -'ι - r
X Pneumocys ti s carinii 3 . exudative stage
lf R jj
Ú'J~ proteinaceous
exuda tion 8} pneumocystls
carinii t
, collopes stage
ßi1ïR
11í 0 Illli
1 j
l 11
2 i'X !
‘ 35
47%
l
. j{F. fj
.
(25- 100%)'~ 20
{R T rimetho -
prim sulfa methoxazole ’ ,'1
1 f 5%
151
}1
- - 72 - -
);f: i~ o /l i ff I~q;
I1
I ';JI 24
ff |i 14
| 13
.ìffi
mtî 19
.
i;l~l PZ M l
lIïlí }(
6i'ff x 1(1
#
.
New Engl j of Med. 297: 7387-7383, 7977.
2. Gerrard, J .W. Pneumocystis pneumonio. Ped
C/in Ame 5:327-335, 7958.
penumonio. Report of four coses. Aj R, 89: 7032-
7037, 7963.
5. Rowe, C. W. Pneumocystis carinii penumonia.
Radiology, 75:257-267, 7960.
The roentgen findings in pneumocystis carinii
pneumonia, radiology, 76:594-59κ 7963.
7. Wilber, R.B., Feldmen, 5. , Malone, W.J .. and Hughes, W.T.
Chemoprophylaxis for pneumocystis carinii
pneumonitis: Outcome of unstructured delivery.
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8. Harris, R. E., McCallister, J.A. , Allen, 5.A. and
Baehner, R. L. : Prevention of pneumocystis pneu
moniι Use of continuous sulfamethoxazole-trime-
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9. Pneumocystis carinii pneumonia.
7967.
10. Pneumocystis carinii
20 X i6"flffJ . § 3:95-99, 7962.
11. · Pn.
eumocystis Carinii 15 J Korea Ped
Asso 24 72ö-733, 1981
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770: 747-760, 7959.
14. Rifkind, D. , Faris, T.D. and Hill, R.B. : Pneum o
cystis carinii pneumonia: Studies on the diagnosis
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15. Perera, D., Wesrern, K.A. , Johnson, H.D., Johnson, W.W. and
5chulz, M. : Pneumocystis cariniii pneu
mohia in 0 hospital for children. jAMA, 724:
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16. Ruebush, T.K. , Weinstein, R.A., Baehner, R. L., 5ulzer, A.J.
and 5chultz , M.G. An outbreak of
pneumocystis pneumonia in children with acute
Iymphocytic leukemia. Ame J Dis Child. 732:743-
748, 7978.
feld , D. : Pneumocystis cariniipneumonia: A c/uster
of eleven cases. Annals Int Med. 82:772-77ζ 7975.
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cy stis carinii pneumonia: A clinicopathologic study
of twenty patients with neoplastic disease. Ame j
Med. 53:428-436, 7972.
19. Chauhary, 5., Hughes, W.T., Feldmen, 5. , 5anyall, 5.K. and
Cox, F. : Percutaneous tranthoracic needle
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907, 79 77.
of interstitiol plasma ce l/ pneumonia of premature
ond infants. Pediatrics, 79:543, 7957.
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gnosls and tretmenl. jAMA 274:7067-7073, 7970.
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D. Pneumocystis carinii infection:
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