Pneumocystis Pneumonia

Pneumocystis Pneumonia

- Caused by fungal organism called Pneumocystis jiroveci. Previously known as Pneumocystis carinii (PCP).
- Causes a pneumonia in the immunosuppressed, typically HIV with CD4 <200 therefore may require prophylaxis. Also seen in lymphoproliferative disorders, organ transplants and chemotherapy patients.

- Insidious onset, increasing dyspnoea, dry cough and fever. Patient may have bilateral fine crepitations and signs of hypoxia. 

- CXR - can be normal, or classically showing bilateral perihilar interstitial shadowing. The CXR above also shows cavitating lesions. 

- CT - ground glass appearance. This CT shows multiple cavitations. 

- Diagnosis - direct visualisation on microscopy specimen from bronchoalveolar lavage or biopsy. 

- Management - ASAP give high dose IV co-trimoxazole or IV penamidine. Steroids useful in severe hypoxia. Supportive therapy with oxygen. May require CPAP or mechanical ventilation.

Related Questions Respiratory Pathology

L: Lungs - Atypical pneumonia.
Relatively nonproductive cough
Dyspnea
Pleuritic or non pleuritic chest pain
Confluent or patchy infiltrates on x-ray
Random fact: Interstitial infiltrates aren’t seen often like in other atypical pneumonias.

E: Encephalon - Neurologic abnormalities.
Headache
Confusion or changes in mental status
Encephalopathy

G: Gastrointestinal symptoms.
Abdominal pain
Nausea
Vomiting
Watery diarrhea

ION: Na ion decreases.
Hyponatremia (serum sodium level of 131 meq/L)

- Caused by fungal organism called Pneumocystis jiroveci. Previously known as Pneumocystis carinii (PCP).
- Causes a pneumonia in the immunosuppressed, typically HIV with CD4 <200 therefore may require prophylaxis. Also seen in lymphoproliferative disorders, organ transplants and chemotherapy patients.

- Insidious onset, increasing dyspnoea, dry cough and fever. Patient may have bilateral fine crepitations and signs of hypoxia. 

- CXR - can be normal, or classically showing bilateral perihilar interstitial shadowing. The CXR above also shows cavitating lesions. 

- CT - ground glass appearance. This CT shows multiple cavitations. 

- Diagnosis - direct visualisation on microscopy specimen from bronchoalveolar lavage or biopsy. 

- Management - ASAP give high dose IV co-trimoxazole or IV penamidine. Steroids useful in severe hypoxia. Supportive therapy with oxygen. May require CPAP or mechanical ventilation.