Hello kathy....here are a couple of studies linking P C P and  Prednisone
use ......your view is not correct....   Mahalo   Michael

     Heart Lung. 2002 Jan-Feb;31(1):50-2. Related Articles, Links

Pneumocystis carinii pneumonia presenting as a fever of unknown origin in a
patient without AIDS.

Jani K, Mehta NJ.

State University of New York Health Science Center, Division of Pulmonary
and Critical Care Medicine, Brooklyn, USA.

Pneumocystis Carinii pneumonia (PCP) remains an opportunistic infection that
causes substantial morbidity and mortality in patients who have impaired
immune function. PCP in patients who do not have AIDS usually manifests in a
more fulminant manner than in patients with AIDS. In recent years, PCP has
been reported increasingly in patients with connective tissue disorders. The
role of corticosteroids in inducing PCP is well established in humans and
animals, though information is currently lacking about the exact mechanism
of induction, frequency, dosage, and duration of corticosteroid therapy that
predisposes the development of PCP across a variety of patient groups. Until
earlier diagnosis and a better understanding of who is at risk are readily
available, health care providers need to consider the diagnosis of PCP early
in the clinical course of any patient who receives systemic steroid therapy.
We report a case of PCP in a patient who took oral steroid treatment for 2
months for suspected connective tissue disorder. The patient presented with
a fever of unknown origin. The case is unusual because the patient's serial
chest x-ray and gallium scan yielded normal findings and no suggestive
respiratory signs or symptoms were found. The only suggestive finding was a
consistently elevated serum lactate dehydrogenase level. The diagnosis was
established by the identification of Pneumocystic carinii in bronchoalveolar
lavage fluid.

Publication Types:
 a.. Case Reports

PMID: 11805750 [PubMed - indexed for MEDLINE]

     Infection. 2000 Jul-Aug;28(4):227-30. Related Articles, Links

Pneumocystis carinii pneumonia as a complication of immunosuppressive
therapy.

Gluck T, Geerdes-Fenge HF, Straub RH, Raffenberg M, Lang B, Lode H,
Scholmerich J.

Dept. of Internal Medicine I, University Medical Center, University of
Regensburg, Germany. thomas.glueck@Klinik.uni-regensburg.de

BACKGROUND: Patients receiving immunosuppressive therapy with
corticosteroids and cytotoxic agents may develop opportunistic infections
such as Pneumocystis carinii pneumonia (PCP). This indicates a severe T-cell
defect, but so far there are no established criteria for identifying
patients at risk. PATIENTS AND METHODS: CD4+ and CD8+ T-lymphocyte counts
were determined by flow cytometry in seven HIV-negative patients who
developed PCP as a complication of immunosuppressive treatment. RESULTS:
CD4+ T-lymphocyte counts (T-helper phenotype) were less than 200/microl in
all seven patients (mean 90.6/microl). The markedly reduced CD4 counts
measured in these patients are similar to those observed in organ transplant
recipients who developed PCP during immunosuppressive therapy for prevention
of graft rejection and in HIV-positive patients with PCP as an AIDS-defining
illness. CONCLUSION: Measuring CD4+ T-lymphocyte counts may be helpful in
determining the risk of PCP not only in HIV-positive patients, but also in
patients receiving immunosuppressive therapy. The risk of acquiring PCP
seems to increase when CD4+ lymphocyte counts drop below 200/microl,
regardless of the underlying disease.

Publication Types:
 a.. Case Reports

PMID: 10961529 [PubMed - indexed for MEDLINE]

Rheumatology (Oxford). 2004 Apr;43(4):479-85. Epub 2004 Feb 3.  RESULTS:
Detection of P. carinii DNA by PCR was significantly more sensitive than
cytology; 54.5% patients were positive by PCR and only 4.5% by cytology. The
prevalence of PCP was higher than previously considered and was especially
high in patients receiving > 30 mg/day prednisolone with or without other
immunosuppressants.

CONCLUSIONS: PCP may complicate a variety of immunocompromised states
especially autoimmune diseases and hematologic malignancy. Patients who
receive corticosteroids and/or cytotoxic drugs should receive primary PCP
prophylaxis. The mortality rate is high especially in severe cases that need
mechanical ventilation. Intensive care and close monitoring are needed for
these patients.

PMID: 12948254 [PubMed - indexed for MEDLINE]

CONCLUSION: Although these results do not suggest that premorbid
administration of corticosteroids is the only factor that contributes to the
development of P. carinii pneumonia in these patients, they show that, in
this large consecutive series, systemic corticosteroid therapy, even in
moderate doses, was administered to most patients during the month preceding
the onset of P. carinii pneumonia. Consideration should be given to
instituting P. carinii prophylaxis (when not contra-indicated) in patients
for whom prolonged systemic corticosteroid therapy is prescribed.  PMID:
8538233 [PubMed - indexed for MEDLINE]

Pneumocystis carinii pneumonia in patients with ulcerative colitis treated
with corticosteroids.

Bernstein CN, Kolodny M, Block E, Shanahan F.

Department of Medicine, University of California, Los Angeles.

Today, Pneumocystis carinii pneumonia (PCP) is typically associated with
AIDS. However, in the pre-AIDS era, PCP was known to be associated with
various immunodeficiency states, malignancies, and immunosuppressive
therapy, particularly the use of corticosteroids. PCP has been reported to
occur during immuno-suppressive therapy of some chronic inflammatory states,
but it has never been reported in patients with inflammatory bowel disease.
We report two patients with ulcerative colitis who developed PCP during
high-dose corticosteroid therapy, and review the literature regarding
non-AIDS PCP. PCP should thus be added to the list of bronchopulmonary
complications in inflammatory bowel disease. This report should give
gastroenterologists further impetus to limit immunosuppressive therapy to
its minimal effective dose.

Publication Types:
 a.. Case Reports