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Pneumocystis carinii Pneumonia

Richard B. Wilber, MD
JAMA. 1978;240(2):111. doi:10.1001/jama.1978.03290020033014.
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To the Editor.—  Recently, Rao et al (238:2301, 1977) reported an unusual and interesting case of Pneumocystis carinii pneumonia occurring in a previously healthy American-born infant without evidence of immune deficiency. I wish to comment on two aspects of this report.While the immune system of this patient was evaluated, little was said about the infant's nutritional status. In fact, it was stated that the globin level on admission was 8.5 g/dl. At the age of 7 months, the lower limit for the normal hemoglobin level is 10.5 g/dl.1,2 Ruling out other causes for anemia, hemoglobin values lower than 10.5 g/dl are presumptive evidence of inadequate nutrition with iron, if not undernutrition in general. Also, there is no mention in the report of the patient's weight for age-percentile rank, or of his serum albumin levels. Hughes et al3 showed undernutrition to be a host determinant for P carinii


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