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Pneumocystis carinii Pneumonia
Aka: Pneumocystis carinii Pneumonia, Pneumocystis jiroveci Pneumonia, Pneumocystis jiroveci, Pneumocystis carinii, Pneumocystis- See Also
- Epidemiology
- Pathophysiology
- Pneumocystis defies classification
- Both Protozoan and Fungal Characteristics
- Recently renamed as Pneumocystis jiroveci
- Ubiquitous organism
- Most humans and mammals exposed early in life
- Clinical infection may represent reactivation
- Pneumocystis defies classification
- Symptoms
- Symptoms usually develop over 1-2 weeks
- Typical Bacterial Pneumonia develops over 3-5 days
- Initial Symptoms (occur in 66%, often subtle)
- Pronounced Symptoms
- Sputum production
- Chest Pain
- Chills
- Symptoms usually develop over 1-2 weeks
- Labs
- White Blood Cell Count Normal
- Elevated WBC Count in typical Bacterial Pneumonia
- Sputum induction
- Efficacy
- Sensitivity 80-90% for Pneumocystis
- Negative Predictive Value only 50-60%
- Examination stains
- Methenamine silver
- Giemsa stains
- Efficacy
- White Blood Cell Count Normal
- Radiology: Chest XRay
- Diffuse bilateral Interstitial Infiltrates (80-95%)
- Seen in Tuberculosis
- Seen in Bacterial Pneumonia
- Focal infiltrates rarely seen with Pneumocystis
- Images
- Diffuse bilateral Interstitial Infiltrates (80-95%)
- Prognosis
- Treated appropriately: 60-90% survive
- Untreated: Uniformly fatal
- Management: General
- Treatment Duration for 14-21 days
- Management: Antibiotics
- First Line treatment
- Bactrim PO or IV (15 mg/kg of trimethoprim/day)
- Adverse reactions occur in 40-60% within 3 weeks
- Bactrim PO or IV (15 mg/kg of trimethoprim/day)
- Other agents (Bactrim intolerance)
- Pentamidine 4 mg/kg/day IV or IM
- Atovaquone 750 mg PO bid
- Dapsone and Trimethoprim
- Indicated for mild-moderate Pneumocystis
- Fewer dose limiting adverse reactions
- Primaquine and Clindamycin
- Indicated for intolerance for other regimens
- First Line treatment
- Management: Corticosteroids
- Efficacy
- Prevents alveolar inflammation and exudation
- Results from the killing of Pneumocystis organisms
- Reduces the risk of intubation and death by 50%
- Indications (based on Arterial Blood Gas)
- Arterial pO2 < 70 mmHg
- A-a Gradient > 35 mmHg on room air
- Dosing: Prednisone
- Start: 40 mg bid for 5 days
- Next: 40 mg qd for 5 days
- Taper: 20 mg qd for 10 days
- Efficacy
- Prevention: Pneumocystis prophylaxis Indications
- CD4 Count <200 cells
- HIV patients with respiratory symptoms
- References