Pneumocystis jirovecii
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Pneumocystis jirovecii /
Revision as of 23:52, 14 August 2019 by Aidan (talk | contribs) (Aidan moved page Unusual fungi or fungal-like Pneumocystis jirovecii pneumonia (PJP) to Pneumocystis jirovecii pneumonia without leaving a redirect)
Pneumocystis jirovecii pneumonia (PJP)
Etiology
- Lower respiratory infection caused by Pneumocystis jirovecii
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
