Michael H Augenbraun, MD, FACP Professor of Medicine and Preventive Medicine and Community Health, Director of 3rd Year Medical Clerkship, State University of New York Downstate College of Medicine; Hospital Epidemiologist and Director, Department of Epidemiology, University Hospital of Brooklyn; Medical Director of Sexually Transmitted Diseases Clinic, Director of Lumbar Puncture Clinic, Kings County Hospital Center
Michael H Augenbraun, MD, FACP is a member of the following medical societies: American College of Physicians , Infectious Diseases Society of America
Disclosure: Nothing to disclose.
Narrative: Pneumocystits jiroveci pneumonia (PCP), formerly know as Pneumocystis carinii pneumonia, is the most common opportunistic infection among people with human immunodeficiency virus (HIV), and mortality remains high at 10 to 20% during the initial infection.
This review examined the role of corticosteroids among HIV patients with PCP and hypoxemia defined as arterial oxygen partial pressure 35 mmHg on room air. The authors included six trials with 489 patients that randomized subjects to receive either corticosteroids or placebo as an addition to antimicrobials. The review reported outcomes for undeveloped nations with minimal access to antiretroviral therapy and for developed nations with access. Control group mortality rates were 25% and 10% in these two groups, respectively.
Note that despite the greater number of patients that will experience a harmful effect of steroids, the beneficial effect is of greater impact to most patients. Based on this value judgment we classified the therapy as beneficial overall (a green light).
Most of the studies gave intravenous methylprednisolone with a starting dose of either 40mg or 60mg every 6 hours, then tapered over 18 to 24 days. Two studies gave a burst of methylprednisolone for 10 days with no taper at either 40mg every 12 hours or based on weight (2mg/kg every 6 hours). Two studies gave oral prednisone at either 80mg per day for five days or 60mg per day for 7 days and then tapered to complete a course of 21 days.
Q. How is pneumonia diagnosed? Quite a few of my son's classmates have caught pneumonia. How can I know if my son caught it too? How is pneumonia diagnosed? A. When the doctor examines the patient and hears coarse breathing or crackling sounds when listening to a portion of the chest with a stethoscope, he can suspect Pneumonia. There may be wheezing, or the sounds of breathing may be faint in a particular area of the chest. A chest x-ray is usually ordered to confirm the diagnosis of pneumonia. There are more tests that can be done if the diagnosis has not been confirmed by the above tests.