Pneumocystis jirovecii

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Pneumocystis jirovecii /

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