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Pneumocystis jirovecii pneumonia - Pulmonary
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Pneumocystis jirovecii pneumonia - Pulmonary

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Contributors: Susan Voci MD, Sumanth Rajagopal MD, William Bonnez MD
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Synopsis

Pneumocystis jirovecii pneumonia : Fever, Dyspnea, Dry cough, HR increased, RR increased
Pneumocystis jirovecii, formerly known as Pneumocystis carinii, is the causative agent of Pneumocystis pneumonia (PCP), a disease almost exclusively seen in the setting of immunosuppression. It is most commonly seen in HIV-infected individuals with a CD4 cell count of < 200/mm3 and in patients on high-dose glucocorticoids or on immunosuppressive agents related to cancer chemotherapy or organ transplantation.

The distribution of the organism is worldwide, and most healthy children are exposed to it at an early age. However, disease manifestations are seen in the setting of immunosuppression. The risk of disease in the HIV-infected population rises dramatically at CD4 cell counts < 200/mm3, in the absence of appropriate prophylaxis. The presence of oral thrush and fevers are also independently associated with an increased risk, irrespective of the CD4 cell count.

Typical onset in HIV patients is insidious with a fever and dry cough and progressive shortness of breath. Chest pain and hemoptysis may rarely be present. The symptoms may be more acute in onset in non-HIV-infected patients. Infection is often asymptomatic in lung transplant recipients.

Physical examination usually reveals fever, tachycardia, and tachypnea. The breath sounds are often normal, but in up to one third of adults, rales are present. Impaired oxygenation (arterial blood gases) is a common finding, with varying degrees of hypoxemia and elevated alveolar-arterial oxygen gradient. Although nonspecific, serum LDH is often highly elevated and declines with successful therapy.

Codes

ICD10CM:
B59 – Pneumocystosis

SNOMEDCT:
79909001 – Pneumocystis carinii

Look For

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

Bacterial pneumonia – particularly in the presence of consolidations
Viral pneumonia – because of the diffuse interstitial pattern
Fungal pneumonia – because of the immunosuppressed status of the patient
Pulmonary tuberculosis – especially with the presence of cavities and calcifications

Best Tests

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Management Pearls

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Therapy

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Drug Reaction Data

Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.

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References

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Last Updated:03/28/2017
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Pneumocystis jirovecii pneumonia - Pulmonary
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A medical illustration showing key findings of Pneumocystis jirovecii pneumonia : Fever, Dyspnea, Dry cough, HR increased, RR increased
Imaging Studies image of Pneumocystis jirovecii pneumonia - imageId=2956223. Click to open in gallery. caption: 'Frontal chest x-ray with diffuse, bilateral ground glass opacities with progression to air space consolidation, worse in the lower lobes.'
Frontal chest x-ray with diffuse, bilateral ground glass opacities with progression to air space consolidation, worse in the lower lobes.

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