hospitalized for close observation and further evaluation as needed In general, patients with PCP not respond rapidly to antibiotic therapy Patients intolerant of TMP-SMZ can be treated with systemic (not aerosolized) pentamidine (4 mg/kg/day as a single daily dose) or atovaquone, but these should be considered second-line agents Corticosteroid therapy in children with severe PCP improves survival and is generally recommended for patients with PaO2 less than 70 mm Hg or an alveolar–arterial gradient of greater than 35 mm Hg Standard precautions are indicated LIP is a lymphoid hyperplastic condition associated with both HIV and EBV infections LIP results in a slowly progressive hypoxemic condition in children outside infancy The most common symptoms are chronic cough, mild tachypnea, generalized adenopathy, marked hypoxemia, and digital clubbing Chest radiography reveals an interstitial nodular pattern, and bronchiectasis can be seen on high-resolution CT of the chest The diagnosis is confirmed via biopsy Fever is an unusual manifestation of LIP and should prompt evaluation for secondary pyogenic bacterial infections Therapy may be with antiretroviral therapy; in acute respiratory compromise, empiric corticosteroid therapy may be warranted If the PaO2 is less than 65 mm Hg, LIP is treated with to mg/kg/day of prednisone (maximum: 60 mg/day) for to weeks and subsequently tapered to maintain the PaO2 above 70 mm Hg If the patient is febrile, tuberculosis or MAI must be ruled out before beginning steroid therapy Management: Whenever a child with HIV infection presents with high-grade fever (temperature higher than 39°C or 102.2°F), a complete blood cell count (CBC) with differential and blood culture is recommended If the child is still in diapers, a urine sample should be obtained for analysis and culture Older children who are toilet trained usually complain of dysuria or frequency if they have a UTI If the child has any respiratory signs or symptoms, including isolated tachypnea, or if the CBC has an elevated leukocyte count with a shift to left, regardless of the presence of respiratory signs, pulse oximetry and a chest radiograph should be ordered The WBC count is best evaluated in relation to baseline counts because many HIV-infected children have some degree of leukopenia If it is known that the child is not leukopenic or the baseline is not available, a WBC count of 15,000/mm3 or more should be considered suggestive of bacterial infection If the child appears well and the evaluation has not revealed a source for the fever that requires hospitalization, the child may be sent home (if the child’s caregiver can be easily contacted and has the means to return if necessary) with instructions to return if symptoms worsen or if the patient