Pneumocystis carinii pneumonia (PCP) at Ga-Rankuwa Hospital

Abstract

Pneumocystis carinii is recognized as one of the leading causes of death in AIDS patients in developed countries but its role in this regard in developing countries appears to be less prominent. Sub-Saharan African countries, in spite of their high HIV prevalence, have hardly recorded any cases. We report the first microbiologically proven case of PCP in an adult patient at Ga-Rankuwa Hospital. A 37 year old African woman was referred to Ga-Rankuwa Hospital from the local clinic for chest infection with a non productive cough that had not responded to conventional treatment. On admission, she was febrile, emaciated and in respiratory distress with oral thrush. Chest radiography showed diffuse bilateral infiltrations and a preliminary diagnosis of atypical pneumonia and tuberculosis was made. The patient was begun on penicillin, gentamicin, contrimoxazole and anti-tuberculosis therapy. Laboratory investigations revealed a low haemoglobin, positive HIV test (after counselling) and Pneumocystis carinii trophozoites and cytes in the bronchoalveolar larvage specimen. In spite of appropriate treatment the patient died within three days. One wonders whether the outcome for this middle aged woman with advanced HIV infection would have been different had appropriate cotrimoxazole therapy been administered at the primary health care centre. It must be noted that PCP may no longer be a rare disease in sub-Saharan countries and intensive investigations should be carried out to avoid losing patients with treatable infectious diseases.