Table Of Contents
Pneumocystis jirovecii Pneumonia (PCP)
Previously Pneumocystis carinii. A yeast-like, human-specific fungus that cannot be cultured in vivo.
- Symptoms
- Dyspnea
- Cough
- Chest pain
- Fever
- Constitutional symptoms
- Differentials
- Lymphoid interstitial pneumonitis (LIP): diffuse peribronchial and interstitial infiltrates composed of lymphocytes and plasma cells. May be asymptomatc or associated with dry cough, hypoxia, dyspnoea or wheezing on exertion, and clubbing. Parotid enlargment and generalized lymphadenopathy should be considered.
- Pulmonary tuberculosis
- Bronchiectasis
- Bacterial pneumonia
- Fungal pneumonia
- Investigations
- Sputum smear: best initial test. Silver staining with Gomori methenamine silver
- Bronchoalveolar Lavage: most accurate test. Silver staining with Gomori methenamine silver
- Chest X-ray:
- Diffuse bilateral symmetrical interstitial infiltrates starting at the hila and spreading out in a “butterfly” pattern
- Nodular lesions
- Pneumatoceles
- Streaky or lobar infiltrates
- CT-scan
- Patchy ground-glass attenuation
- Treatment
- Trimethroprim and Sulfamethoxazole (TMP/SMX), OR
- Clindamycin AND Primaquine OR
- Pentamidine
- Dapsone AND Trimethoprim (if allergic to SMX) OR,
- Dapsone AND Trimetrexate (if allergic to SMX, add Leucovorin)
- Atovaquone (if allergic to SMX)
- Adjunctive steroids (Prednisone)
- Trimethroprim and Sulfamethoxazole (TMP/SMX), OR
- Prophylaxis
- TMP/SMX OR,
- Dapsone or Atovaquone
