Showing papers in "Pediatric Infectious Disease Journal in 2000"
TL;DR: The Wyeth Lederle as discussed by the authors determined the efficacy, safety and immunogenicity of the CRM197 pneumococcal conjugate vaccine against invasive disease caused by vaccine serotypes and to determine the effectiveness of this vaccine against clinical episodes of otitis media.
Abstract: Objective.To determine the efficacy, safety and immunogenicity of the heptavalent CRM197 pneumococcal conjugate vaccine against invasive disease caused by vaccine serotypes and to determine the effectiveness of this vaccine against clinical episodes of otitis media.Methods.The Wyeth Lederle
2,204 citations
TL;DR: The possible causative agent of childhood community‐acquired pneumonia can be detected in most cases and with effective immunization for S. pneumoniae and respiratory syncytial virus infections, more than one‐half of the pneumonia cases in this study could have been prevented.
Abstract: Background.Childhood community-acquired pneumonia is a common illness, but there have been relatively few comprehensive studies of the viral and bacterial etiology in developed countries. The aim of the present investigation was to determine the etiology of community-acquired pneumonia in ho
610 citations
TL;DR: The incidence of candidemia might be decreased by the judicious use of treatments identified as risk factors and avoiding H2 blockers, according to a prospective cohort study performed in six NICU patients from 1993 to 1995.
Abstract: Background.Candidaspecies are important nosocomial pathogens in neonatal intensive care unit (NICU) patients.Methods.A prospective cohort study was performed in six geographically diverse NICUs from 1993 to 1995 to determine the incidence of and risk factors for candidemia, including the rol
557 citations
TL;DR: Some of the identified risk factors for meningococcal disease are modifiable and measures to reduce overcrowding could have a marked effect on reducing the incidence of this disease in Auckland children.
Abstract: Background.New Zealand is in its ninth year of a serogroup B meningococcal disease epidemic with annual rates of up to 16.9 cases per 100 000. The highest incidence is in Maori and Pacific Island children in the Auckland region. We conducted a case-control study to identify potentially modifiable ri
278 citations
TL;DR: The results indicate that the measurement of serum PCT, CRP and IL‐6 has little value in the differentiation of bacterial and viral pneumonia in children, however, in some patients with very high serum P CT,CRP or IL‐ 6 values, bacterial pneumonia is probable.
Abstract: Objective.Serum procalcitonin (PCT), C-reactive protein (CRP) and interleukin-6 (IL-6) concentrations were measured in 126 children hospitalized for community-acquired, radiologically confirmed pneumonia to assess whether these host response values could be used to distinguish bacterial from
241 citations
TL;DR: Zanamivir was effective in shortening the duration and severity of influenza symptoms and was well-tolerated among children 5 to 12 years of age.
Abstract: Background Influenza infection rates are higher in children than in other age groups. This study evaluated the efficacy, safety and tolerability of a 5-day course of twice daily inhaled zanamivir, 10 mg, compared with placebo in the treatment of symptomatic influenza A and B viral infections among children 5 to 12 years of age. Methods This double blind, randomized, placebo-controlled, parallel group, multicenter study conducted in the Northern Hemisphere during the 1998 and 1999 influenza season enrolled 471 patients with influenza-like symptoms for Findings A total of 346 (73%) patients were influenza-positive by culture, serology or polymerase chain reaction (65% influenza A, 35% influenza B). Zanamivir reduced the median time to symptom alleviation by 1.25 days compared with placebo among patients with confirmed influenza infection (P Conclusions Zanamivir was effective in shortening the duration and severity of influenza symptoms and was well-tolerated among children 5 to 12 years of age.
231 citations
TL;DR: Questions are asked and at the end of the article are questions (with the answers provided) for your consideration.
Abstract: CHIEF EDITORS’ NOTE: Each year we publish four review articles for which a total of 4 AMA Category 2 hours can be credited as part of a physician’s unsupervised learning activities. At the end of the article are questions (with the answers provided) for your consideration. All record keeping for these credit hours is the responsibility of the physician. Do not send the answers to the journal office. Support for the CME Review Articles is provided by an educational grant from Roche Laboratories, Nutley, NJ.
210 citations
TL;DR: Control and prevention of rotavirus infection are difficult because of the lack of a licensed vaccine, the absence of any effective treatment other than palliative measures and the presence of asymptomatic children shedding virus.
Abstract: Rotavirus is the most common gastrointestinal pathogen present in day-care settings. Control and prevention of rotavirus infection are difficult because of the lack of a licensed vaccine, the absence of any effective treatment other than palliative measures and the presence of asymptomatic children shedding virus. Rotavirus is transmitted by fecal-oral contact and possibly by contaminated surfaces and hands and respiratory spread. Other gastrointestinal pathogens are also transmitted primarily by the fecal oral route, although contaminated surfaces, hands or food may also serve to transmit infection in some cases. Control and prevention measures for all enteric pathogens include isolating infected children from others, thoroughly cleaning and disinfecting environmental surfaces with effective agents and strictly following handwashing procedures before and after contact with infected persons and/or potentially contaminated surfaces.
201 citations
TL;DR: Comprehensive analysis of the reported adverse reactions established that serious events causally related to MMR vaccine are rare and greatly outweighed by the risks of natural MMR diseases.
Abstract: Background.Several disorders have been attributed to measles-mumps-rubella (MMR) vaccination during the past decade. The aim of this prospective follow-up study was to identify serious adverse events causally related to MMR vaccination.Methods.When the MMR vaccination program was launched in Finland
194 citations
TL;DR: In this paper, the authors evaluated the variation in NBSI incidence among six NICUs and found that NBSIs occur frequently in neonatal intensive care units and are associated with substantial morbidity and mortality.
Abstract: Background.Nosocomial bloodstream infections (NBSIs) occur frequently in neonatal intensive care units (NICUs) and are associated with substantial morbidity and mortality. Little has been published regarding variation in NBSI among institutions.Objective.To determine NBSI incidence among six NICUs a
194 citations
TL;DR: Bacteremia is common in hospitalized Malawian children and has a high mortality and there are high rates of resistance to some of the commonly used antibacterial agents.
Abstract: Background.There are no published data for the incidence or etiology of childhood bacteremia in Malawi. We describe the clinical and microbiologic features of children admitted to hospital from whom blood cultures yielded bacterial pathogens.Methods.Any neonate or child admitted to the pedia
TL;DR: Caregivers felt that the most helpful interventions would be modifications to improve the convenience and palatability of medications and increased access to medical advice.
Abstract: Background. Rigorous adherence to antiretroviral medication regimens is necessary to achieve and maintain undetectable viral levels. This study describes adherence in a population of children with HIV infection. Methods. Caregivers of HIV-infected children were interviewed about their experiences with administration of medications for treatment of HIV, opinions regarding medication-related issues and the potential usefulness of interventions to improve adherence. Results. In the 90 caregiver interviews completed, 78% of the children were taking 3 or more medications, 17% missed a dose in the previous 24 h and 43% missed at least 1 dose in the previous week. Children whose caregivers reported no missed doses in the previous week (adherent) were more likely to have an HIV viral load <400 copies/ml (50% vs. 24%, P = 0.04). Nonadherent caregivers (who reported 1 or more missed doses in the previous week) were more likely than adherent caregivers to agree with a statement that full adherence is impossible (44% vs. 12%, P = 0.001) and express the need for more help with medication administration (26% vs. 6%, P = 0.02). They were less likely to have informed the school or day-care site about the child's HIV infection (42% vs. 67%, P = 0.05) and more concerned about the child's teachers and friends finding out (54% vs. 31%, P = 0.05). Of 10 potential interventions 6 were rated by a majority of respondents as very helpful: better tasting medications (81%); longer dosing intervals (72%); medications that did not require refrigeration (63%); access to 24-h telephone advice (62%); a follow-up call from a health care provider (57%); and a pill organizer (56%). Conclusions. Caregivers' perceptions that adherence is too difficult or concerns about loss of privacy may affect their ability to adhere to complicated medication regimens. Caregivers felt that the most helpful interventions would be modifications to improve the convenience and palatability of medications and increased access to medical advice.
TL;DR: It is indicated that amoxicillin/clavulanate has superior bacteriologic and clinical efficacy compared with azithromycin in children with AOM and signs and symptoms were more likely to resolve completely or improve in all culture‐positive patients.
Abstract: Objectives.To compare the bacteriologic and clinical efficacy of amoxicillin/clavulanate and azithromycin in patients with acute otitis media (AOM), particularly the ability to eradicate the predominant AOM pathogens from middle ear fluid as assessed by mandatory second tympanocentesis.Metho
TL;DR: Despite many years of study, the precise routes rhinovirus takes to inflict the misery of the common cold on a susceptible population remain controversial.
Abstract: Respiratory viruses in the home exploit multiple modes of transmission. RSV is transmitted primarily by contact with ill children and contaminated objects in the environment. Influenza appears to be spread mainly by airborne droplet nuclei. Despite many years of study, from the plains of Salisbury, to the hills of Virginia, to the collegiate environment of Madison, WI, the precise routes rhinovirus takes to inflict the misery of the common cold on a susceptible population remain controversial.
TL;DR: “I believe that as soon as haemoculture takes its lawful place in the routine diagnosis, not only of enteric tropical fevers, but also of quinine-resistant fevers of short duration, and that heterogeneous rubbish heap known as P.U.O., paratyphoid C will come to the fore as a frequent and widespread disease, calling for the same general preventive measures currently required for the other better known fevers.
Abstract: “I believe that as soon as haemoculture takes its lawful place in the routine diagnosis, not only of enteric tropical fevers, but also of quinine-resistant fevers of short duration, and that heterogeneous rubbish heap known as P.U.O., paratyphoid C will come to the fore as a frequent and widespread disease, calling for the same general preventive measures currently required for the other better known fevers of the enteric-parenteric group.”
TL;DR: Pulsed field gel electrophoresis of the 10 community-acquired MRSA isolates revealed 8 distinct patterns; these data suggest that multiple clones were circulating at UCCH, suggesting that MRSA are no longer confined to children with established risk factors.
Abstract: Background.The prevalence of community-acquired methicillin-resistant Staphylococcus aureus (MRSA) infections increased at the University of Chicago Children’s Hospital (UCCH) from 10 per 100 000 admissions from 1988 to 1990 to 259 per 100 000 admissions from 1993 to 1995. Because this increase may
TL;DR: In children with invasive pneumococcal disease caused by the pediatric serogroups, HIV-infected children have more antibiotic-resistant isolates and have a different clinical presentation than do HIV-un Infected children.
Abstract: Background HIV-infected children are at increased risk of developing invasive Streptococcus pneumoniae disease. Objective. To determine the impact of the HIV epidemic on the epidemiology of invasive pneumococcal disease in hospitalized African children. Methods. Children <12 years of age with invasive pneumococcal disease were enrolled between March, 1997, and February, 1999. Results. The seroprevalence of HIV was 64.9% (146 of 225). In children with pneumococcal isolates from serogroups 6, 9, 14, 19 or 23 (pediatric serogroups), pneumonia and pneumonia with concurrent meningitis was more common in HIV-infected children (P = 0.03 and P = 0.003, respectively), whereas septic shock occurred more often in HIV-uninfected children (P = 0.0003). The overall burden of severe invasive pneumococcal disease was 41.7 (95% confidence interval, 26.5 to 65.6) fold increased in HIV-infected compared with HIV-uninfected children. Reduced susceptibility to penicillin (45.9% us. 27.9%, P = 0.009), trimethoprim-sulfamethoxazole (44.5% vs. 19.0%, P = 0.0002) and multiple drug resistance was more common in HIV-infected than in HIV-uninfected children (24.0% vs. 6.4%, P = 0.01), respectively. The increased burden of disease and reduced antibiotic susceptibility of pneumococcal isolates in HIV-infected children was because of a heightened susceptibility to disease caused by pediatric serogroups in these children than in HIV-uninfected children (P = 0.01). Although the case fatality rates did not differ between HIV-infected and -uninfected children, mortality in HIV-infected children with advanced AIDS (Stage C, 22 of 61; 36.1%) was greater than that in children with moderate AIDS (Stage B, 12 of 85; 14.1%, P = 0.002). Conclusions. In children with invasive pneumococcal disease caused by the pediatric serogroups, HIV-infected children have more antibiotic-resistant isolates and have a different clinical presentation than do HIV-uninfected children.
TL;DR: Systemic Candida infection is associated with increased short and long term morbidity in extremely low birth weight infants andCandida infection of the central nervous system has a significant impact on long term neurodevelopmental outcome.
Abstract: Objective.To describe mortality, morbidity at discharge and neurodevelopmental outcome at 2 years corrected age in extremely low birth weight infants with systemicCandidainfection during intensive care stay.Method.We identified all extremely low birth weight (birth weight <1000 g) infants di
TL;DR: Preliminary evidence from large scale field trials indicates that pneumococcal conjugate vaccines are effective in reducing invasive pneumococCal disease as well as acute otitis media and pneumonia in children and represents a significant advance in the prevention of childhood infectious diseases.
Abstract: Background.Each yearStreptococcus pneumoniaecauses ˜1.2 million deaths worldwide from pneumonia. In the United StatesS. pneumoniaeis estimated to cause 500 000 cases of pneumonia and 7 million episodes of acute otitis media annually.Conjugate vaccines.The current pneumococcal polysaccharide
TL;DR: The detection of influenza A by EIA has a positive impact on medical management by decreasing antibiotic use in pediatric patients evaluated in an ED, by decreasing the duration of antibiotics use in hospitalized patients and by encouraging antiviral therapy.
Abstract: Background.Few studies have examined the impact of rapid viral diagnostic tests on patient management.Objective.To assess the effect of rapid diagnosis of influenza A infections on patient management.Methods.The medical records of children with respiratory infections who were evaluated at a
TL;DR: This large descriptive study has enabled us to define the influence of specific risk factors that increase the risk of rehospitalization for RSV infection in preterm infants and define the appropriate role of available prophylactic interventions and establish treatment guidelines.
Abstract: Objective. To collect data on hospitalization for respiratory syncytial virus (RSV) infections and presumptive risk factors for rehospitalization among premature infants in Spain. Design. Observational, prospective, longitudinal, multicenter study. Setting. Fourteen Spanish neonatal units with an annual birth cohort of 57 000 infants. Patients. All children (n = 680) born s32 weeks of gestational age between April 1, 1998, and March 31, 1999, and discharged from the hospital before March 31, 1999, were included in the study. A total of 96 were excluded because of administration of prophylactic treatment (n = 55) or were lost to follow-up (n = 41). Five children died during the study period, but death was related to RSV in only 1 case. Methods and main outcome measures. Neonatal and demographic data were recorded at the initial visit. Infants were prospectively followed at monthly intervals up to March 31, 1999. In patients rehospitalized for respiratory disorders, further data about RSV status and morbidity were collected. A comparison was made between children rehospitalized for RSV infection and those who were not. The influence of factors on the probability of rehospitalization for RSV infection was assessed by logistic regression analysis. Results. Of the 584 evaluable patients 118 (20.2%) were rehospitalized for respiratory disease during the study period. The causative pathogen was identified in 89 (75.4%) hospital admissions. Of these 59 (66.3%) were a result of RSV infection in 53 children; 6 were reinfections. In a logistic regression model significant independent prognostic variables included: lower risk of RSV hospitalization with increase gestational age [odds ratio (OR), 0.85; 95% confidence interval (CI), 0.72 to 0.99; P < 0.047]; higher risk with chronic lung disease (OR = 3.1; 95% CI 1.22 to 7.91; P < 0.016); and living with school age siblings (OR = 1.86; 95% CI 1.01 to 3.4; P < 0.048). Conclusion. This large descriptive study has enabled us to define the influence of specific risk factors that increase the risk of rehospitalization for RSV infection in preterm infants. Such studies help to define the appropriate role of available prophylactic interventions and establish treatment guidelines.
TL;DR: Prudent use of both antibiotics and antibacterials must be championed to achieve and maintain the balanced microbial environment in which the authors have entered and evolved.
Abstract: More and more we are moving patients from hospitals to homes for continued treatment. Vancomycin and triclosan were used for 30 years before any resistance emerged, because their applications were strictly limited. Today, after greatly increased use, resistance to both antibiotics and antibacterials has appeared. Of importance there are genetic links between resistance to antibiotics and to antibacterials. Health professionals and the public need to be educated about the rational use of drugs that affect the microbial world. The Alliance for the Prudent Use of Antibiotics, an international organization established in 1981 with members in more than 100 countries, has adopted education as its prime mission. Via its web site (www.apua.org) and linked information on reservoirs of antibiotic resistance (ROAR) among nonpathogenic bacteria, it reaches both providers and consumers. The message is simple: bacteria are needed for our survival. The vast majority of bacteria perform important functions that are crucial for our lives. Prudent use of both antibiotics and antibacterials must be championed to achieve and maintain the balanced microbial environment in which we have entered and evolved.
TL;DR: The results suggest that the initially seropositive infants were primed despite maternal antibody interference and the hepatitis A vaccine was well-tolerated in this population of young infants.
Abstract: Background.Maternal antibodies interfere with hepatitis A vaccination in young infants. We examined the response to a high dose hepatitis A vaccine administered concomitantly with a combination of diphtheria-tetanus toxoids-acellular pertussis-inactivated poliovirus vaccine/ Haemophilus influenzae t
TL;DR: Nasal RSV quantity correlates with disease severity in hospitalized infants with recently identified RSV infection.
Abstract: Objective.To evaluate the relationship between nasal quantity of respiratory syncytial virus (RSV) and disease severity in hospitalized infants without underlying cardiopulmonary disease or immunodeficiency.Methods.Nasal aspirates were obtained from hospitalized infants <24 months of age wit
TL;DR: Children with sternal wound infection had lower age, higher American Society of Anesthesiologist score, longer preoperative stay, longer period of ventilation and inotropic support, longer intensive care unit and total postoperative hospital stays and increased leukocyte band cell counts preoperatively and on Postoperative Day 1 than those without sternal infection.
Abstract: BackgroundThis study was undertaken to determine the incidence, pathogens and risk factors associated with development of sternal wound and other infections in children undergoing cardiac surgeryMethodsRetrospective chart review was performed for all cardiac surgeries performed on children <18 ye
TL;DR: Challenges in etiologic diagnosis and treatment of childhood community-acquired pneumonia are described and efforts to identify new intervention strategies, diagnostic tools, therapies and vaccines will be helpful in managing this disease.
Abstract: Background. This paper describes challenges in etiologic diagnosis and treatment of childhood community-acquired pneumonia and the means of addressing some of them. Microbiologic diagnosis. From about one-third to two-thirds of cases of pneumonia can be attributed to a specific etiology depending on which culture, antigen detection and specialized serologic techniques, some of which are unavailable to clinicians, are used. Results of studies in which microbiologic causes have been sought confirm the importance of Streptococcus pneumoniae as the primary bacterial cause of pneumonia in infants and children. Viral etiologies become less prevalent and mycoplasmal and chlamydial infections become more prevalent with increasing age. Empiric treatment. Because definitive information about causative pathogens is seldom available, treatment of pneumonia is most often empiric. Antibiotic therapy can be withheld in mildly ill, ambulatory patients in whom viral infection is likely. Most guidelines suggest initial treatment with orally administered amoxicillin or amoxicillin/clavulanate or with intravenous cefuroxime when patients require hospitalization. In May, 2000, the Centers for Disease Control-convened Drug-Resistant S. pneumoniae Therapeutic Working Group identified oral beta-lactams including cefuroxime axetil, amoxicillin and amoxicillin/clavulanate as appropriate options for first line therapy of community-acquired pneumonia in ambulatory adults and children. Conclusions. New diagnostic techniques such as pneumococcal serologies and polymerase chain reaction testing have improved the ability to determine the microbiologic etiology of childhood pneumonia. Because these tests are not generally available, empiric treatment is necessary. Efforts to identify new intervention strategies, diagnostic tools, therapies and vaccines will be helpful in managing this disease.
TL;DR: Streptococcus pneumoniae is recognized as an important cause of pediatric pneumonia regardless of age in both the inpatient and outpatient setting, and conjugate pneumococcal vaccines prove effective at eradicating carriage of pneumococci in the nasopharynx, immunization may be an important tool against the spread of pneumonia.
Abstract: Background.Lower respiratory tract infections are a common cause of morbidity among children. Among these infections pneumonia is the most serious illness and can be difficult to diagnose. The etiology of pneumonia is still partly unknown, primarily because of difficulty in obtaining adequat
TL;DR: The need for accurate diagnostic tests in newborn sepsis is reviewed and the current clinical role of cytokines in the diagnosis of newborn septicaemia is evaluated.
Abstract: OBJECTIVES 1. Review the need for accurate diagnostic tests in newborn sepsis. 2. Examine the role of cytokines as potential markers for sepsis. 3. Assess the methodology of published studies that have reported on the role of cytokines in the diagnosis of newborn sepsis. 4. Describe the accuracy of reported studies. 5. Evaluate the current clinical role of cytokines in the diagnosis of newborn sepsis.
TL;DR: Children congenitally infected with CMV are chronically infected for years, but the duration of CMV urinary excretion is not associated with abnormalities of growth, or neurodevelopmental deficits, however, SNHL and progressive SNHL were associated with a shorter duration ofCMV excretion.
Abstract: Background. Cytomegalovirus (CMV) is the most frequent cause of congenital infection, and both symptomatic and asymptomatic infants may have long term sequelae. Children with congenital CMV infection are chronically infected and excrete CMV in the urine for prolonged periods. However, the effect of prolonged viral replication on the long term outcome of these children is unknown. Objective. To determine whether duration of CMV excretion is associated with outcome at 6 years of life in symptomatic and asymptomatic congenitally infected children. Methods. Longitudinal cohort study. Children congenitally infected with CMV were identified at birth and followed prospectively in a study of long term effects of congenital CMV infection. The relationship between duration of CMV urinary excretion and growth, neurodevelopment and presence and progression of sensorineural hearing loss (SNHL) at 6 years of age was determined. Results. There was no significant difference in the duration of viral urinary excretion between children born with asymptomatic (median, 4.55 years) and symptomatic (median, 2.97 years) congenital CMV infection (P= 0.11). Furthermore there was no association between long term growth or cognitive outcome and duration of viral excretion. However, a significantly greater proportion of children who excreted CMV for 4 years (P= 0.019,P= 0.009, respectively). Conclusions. Children congenitally infected with CMV are chronically infected for years, but the duration of CMV urinary excretion is not associated with abnormalities of growth, or neurodevelopmental deficits. However, SNHL and progressive SNHL were associated with a shorter duration of CMV excretion.
TL;DR: Induced sputum is effective for obtaining lower respiratory tract secretions for diagnosis of PCP but an NPA is not useful and is associated with a high mortality in HIV‐infected children in South Africa.
Abstract: Background. Pneumocystis carinii pneumonia (PCP) has been regarded as uncommon in HIV-infected patients in Africa, but diagnostic difficulties and geographic variability may partly account for this. There is little information on the incidence of PCP in HIV-infected children in Africa. Aim. To investigate (1) the incidence and associated features of PCP in African HIV-infected children and (2) the usefulness of sputum induction and nasopharyngeal aspirates (NPAs) for diagnosis of PCP. Methods. HIV-infected children hospitalized with pneumonia were prospectively enrolled in a 1-year study in South Africa. History, examination, chest radiology and blood tests (including HIV testing) were performed. Sputum induction (5% NaCl nebulization) or nondirected bronchoalveolar lavage in intubated patients was performed for P. carinii identification using immunofluorescence and silver stain; immunofluorescence was also done on nasopharyngeal aspirates (NPAs). Results. Of 151 HIV-infected children [47% female; median age, 9 (range, 3 to 23) months], 87 had been previously diagnosed with HIV whereas 64 (42.4%) were found to be HIV-positive at the time of admission. PCP occurred in 15 children (9.9%; 95% confidence interval, 5.9 to 15.5) and was the AIDS-defining infection in 13 of 64 (20.3%; 95% confidence interval, 11.8 to 31.5). Only 1 of 59 children receiving prophylaxis (1.7%) developed PCP compared with 14 of 92 (15.2%) not taking prophylaxis [relative risk, 0.11 (0.02 to 0.82), P = 0.007]. PCP-infected children were younger [3 (range, 3 to 4) vs. 10 (range, 4 to 24) months, P < 0.001] and presented with more severe pulmonary disease as indicated by a higher respiratory rate [63 (range, 60 to 73) vs. 50, (range, 40 to 60) P < 0.001], heart rate [160 (range, 136-180) vs. 140 (range, 120-152) P = 0.025] and a greater incidence of cyanosis (53% vs. 26%, P = 0.025). Clinical signs of HIV infection, occurring in 96% of children, were equally prevalent in both groups. High serum lactate dehydrogenase was the only laboratory investigation that distinguished PCP-infected from uninfected children [626 (range, 450 to 1098) vs. 307 (range, 243 to 465) units/l], P < 0.001. No radiologic features were found to be diagnostic of PCP. P. carinii was identified in 9 sputa and 6 bronchoalveolar lavage specimens, but all corresponding NPAs were negative. Seven of 15 (47%) children with PCP died while hospitalized compared with 24 of 136 (18%) without PCP [relative risk, 1.21 (range, 0.99 to 1.47), P = 0.008]. Conclusion. PCP is an important pathogen in HIV-infected infants in South Africa and is associated with a high mortality. Induced sputum is effective for obtaining lower respiratory tract secretions for diagnosis of PCP but an NPA is not useful.