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Main risk factors are AIDS, transplantation, corticosteroid and antineoplastic therapy. About 20% of AIDS patients will develop P.carinii pneumonia despite prophylaxis, if CD4 count is >100 mm3.

Diagnosis is made from bronchoalveolar fluid, induced sputum or lung biopsy - smears are stained with special stains, and the presence of cysts and trophozoits is diagnostic. P.carinii has not yet been isolated.