Pneumocystis jirovecii: Difference between revisions
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Pneumocystis jirovecii
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* Opportunistic fungal infection of the lower respiratory infection |
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= Pneumocystis jirovecii pneumonia (PJP) = |
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= Microbiology = |
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* Previously thought to be ''Pneumocystis carinii'', a close relative that causes disease in rats |
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* Lower respiratory infection caused by ''Pneumocystis jirovecii'' |
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= Epidemiology = |
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* HIV |
* HIV |
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* Immune-suppression, e.g. from steroids |
* Immune-suppression, e.g. from steroids |
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= Presentation = |
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* Shortness of breath on exertion |
* Shortness of breath on exertion |
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= Investigations = |
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* CXR |
* CXR |
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* CBC often normal |
* CBC often normal |
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= Diagnosis = |
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* Induced sputum or brochoalveolar lavage (normal sputum not sensitive enough) |
* Induced sputum or brochoalveolar lavage (normal sputum not sensitive enough) |
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* 6min walk test: will desaturate, even if well-oxygenated at rest |
* 6min walk test: will desaturate, even if well-oxygenated at rest |
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= Treatment = |
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* Septra 5-6mg/kg po BID for 3 weeks |
* Septra 5-6mg/kg po BID for 3 weeks |
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* Duration is 21 days (3 weeks) |
* Duration is 21 days (3 weeks) |
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== Prophylaxis == |
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* Usually instituted if the risk of PJP is greater than 3.5% per year |
* Usually instituted if the risk of PJP is greater than 3.5% per year |
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[[Category:Fungi]] |
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Revision as of 23:54, 14 August 2019
- Opportunistic fungal infection of the lower respiratory infection
Microbiology
- Previously thought to be Pneumocystis carinii, a close relative that causes disease in rats
Epidemiology
- HIV
- Immune-suppression, e.g. from steroids
Presentation
- Shortness of breath on exertion
Investigations
- CXR
- Typical: bilateral diffuse patchy disease
- Atypical:
- Normal (15%)
- Localized
- Pneumothorax
- Upper lobe, if on pentamidine
- LDH increased
- CBC often normal
Diagnosis
- Induced sputum or brochoalveolar lavage (normal sputum not sensitive enough)
- 6min walk test: will desaturate, even if well-oxygenated at rest
Treatment
- Septra 5-6mg/kg po BID for 3 weeks
- If pO2 <70mmHg or A-a gradient ≥35: prednisone
- Alternative: clindamycin-primaquine or IV pentamidine
- Duration is 21 days (3 weeks)
Prophylaxis
- Usually instituted if the risk of PJP is greater than 3.5% per year
References
- ^ Julien Senécal, Elizabeth Smyth, Olivier Del Corpo, Jimmy M. Hsu, Alexandre Amar-Zifkin, Amy Bergeron, Matthew P. Cheng, Guillaume Butler-Laporte, Emily G. McDonald, Todd C. Lee. Non-invasive diagnosis of Pneumocystis jirovecii pneumonia: a systematic review and meta-analysis. Clinical Microbiology and Infection. 2022;28(1):23-30. doi:10.1016/j.cmi.2021.08.017.
- ^ Po-Yi Chen, Chong-Jen Yu, Jung-Yien Chien, Po-Ren Hsueh. Anidulafungin as an alternative treatment for Pneumocystis jirovecii pneumonia in patients who could not tolerate Trimethoprim/sulfamethoxazole. International Journal of Antimicrobial Agents. 2019. doi:10.1016/j.ijantimicag.2019.10.001.
- ^ L. Cooley, C. Dendle, J. Wolf, B. W. Teh, S. C. Chen, C. Boutlis, K. A. Thursky. Consensus guidelines for diagnosis, prophylaxis and management ofPneumocystis jiroveciipneumonia in patients with haematological and solid malignancies, 2014. Internal Medicine Journal. 2014;44(12b):1350-1363. doi:10.1111/imj.12599.
- ^ N. Goto, S. Oka. Pneumocystis jirovecii pneumonia in kidney transplantation. Transplant Infectious Disease. 2011;13(6):551-558. doi:10.1111/j.1399-3062.2011.00691.x.
