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September 1990

Pneumocystis carinii PneumoniaThe Steroid Dilemma

Arch Intern Med. 1990;150(9):1793-1794. doi:10.1001/archinte.1990.00390200007001

Clinical illness caused by Pneumocystis carinii was first described in the early 1950s, although the organism was first demonstrated in human lung tissue in 1911.1 Prior to 1981, P carinii caused pneumonia sporadically, mainly in patients with impaired host defenses, ie, individuals with lymphoproliferative or hematologic malignancy or those receiving immunosuppressive therapy, including corticosteroids.2

See also p 1819.

In 1981, and subsequently, the epidemiology of P carinii changed with the recognition of the acquired immunodeficiency syndrome (AIDS). Pneumocystis carinii pneumonia (PCP) is the most common serious opportunistic infection in patients with AIDS. It occurs in at least 80% of patients with AIDS at some time during their illness.3,4 The mortality rate of patients hospitalized with AIDS and PCP approaches 45%.4,5 If respiratory failure occurs, mortality can approach 100%, especially when the patient requires intubation and mechanical ventilatory support.4,5

Faced with these facts, what can be

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