Pneumocystis pneumonia in children in Calabar, Nigeria

Pneumocystis pneumonia (PJP), initially thought to be rare in this part of the world, has over the years, been diagnosed and treated in our center. PJP should be considered in a young child 3 to 6 months of age with very severe pneumonia, known or suspected to be HIV infected. It should be suspected when severity of illness is out of proportion with the chest findings and chest x-ray is normal or shows minimal or bilateral interstitial infiltrates. Treatment is oral or intravenous high dose cotrimoxazole given 6-8 hourly for 3 weeks and the addition of prednisolone. The objective of this report is to describe the presentation, challenges of diagnosing and management of PJP in children in a developing country. Report of 3 cases aged 3, 4 and 41/2 months, exposed to the HIV. All developed severe pneumonia characteristic of PJP and all responded to treatment with high dose cotrimoxazole and Prednisolone. A high index of suspicion is needed to diagnose PJP in a resource poor setting like ours. It is common in HIV positive children but can also occur in HIV negative individuals as shown by these case reports. A presumptive diagnosis can be made in a young child, usually below 6 months of age, very ill with severe pneumonia and minimal chest findings who responds to cotrimoxazole. Addition of prednisolone has been found to improve the outcome. Antibiotics should continue to cover for co-existing bacterial pneumonia.