Common respiratory infections that affect HIV positive patients especially, pneumocystis jiroveci pneumonia

1. CASE B: HIV AND LUNG
INFECTION
Presented by:
Arwa Al-Onayzan.
ID: 215007943.

2. OUR CASE
 A 30 yo men complain of fever and dyspnea on exertion 3 weeks
ago.
 He is from Yemen, he had tried ‘qat'. He had lived loose life-style.
 He is a party smoker since age of 16.
 He admitted having unprotected sex with multiple partners.
 He had lost some body weight.
 He had Dysphagia.
 There was one whitish spot on the palate suspected to be oral
thrush.

3. CON…
 No known exposure to TB or Asthma or respiratory tract infections.
 No urethral discharge, no headache and no diarrhea.
 Chest pain accompanied with slight non-productive cough.
 On examination, he was dyspnoic with respiratory rate 36/ min (
increase ),
 Auscultation >> normal.
 Regular tachycardia.
 No skin abnormalities especially bluish indurated lesions.
 On pulsoxymetry, oxygen saturation was only 91% (Low )

4. LEARNING OBJECTIVES
 Which diagnosis do you consider?
 Which initial laboratory tests do you recommend or
order, and why? Do you expect any abnormalities in
the standard blood indices and blood chemistry tests?
Do you expect any benefit from additional tests to
evaluate his chest complaints?

5. WHICH DIAGNOSIS DO YOU
CONSIDER?

6. FROM THE CASE
Men complain of fever and dyspnea on
exertion 3 weeks ago. He used ‘qat'.
He having unprotected sex with multiple
partners.
He have one whitish spot on the palate
suspected to be oral thrush.
This Patient most likely to have? Pulmonary
complication due to HIV

7. PULMONARY INFECTION
ASSOCIATED WITH HIV
Bacterial
pneumonia
Pneumocystis
pneumonia
(PCP)
TB Candidiasis
Organis
m
Streptococcus
pneumonia,
Haemophilus
species,
Pseudomonas,
etc.
Pneumocystis
jirovecii.
Mycobacterium
tuberculosis.
Candida
albicans.
Sign
and
sympto
Cough with
purulent
sputum, fever,
Non
productive
cough,
Cough, fever,
night sweating,
weight loss,
Creamy white
lesion in
tongue, loss of

8. PNEUMOCYSTIS PNEUMONIA (PCP)
 Is a serious infection that causes inflammation and fluid buildup
in the lungs.
 It is caused by a fungus called Pneumocystis jiroveci.
 Pneumocystis organisms are commonly found in the lungs of
healthy individuals.
 It causes pneumonia in people with weakened immune systems.

9. Fever (80 %- 100 %)
Exertional dyspnea
(95%)
Nonproductive
cough (95 percent)
Heart palpitations
CLINICAL FEATURE OF PCP

10. weight loss Fatigue i.g.
climbing stairs.
chest pain or
discomfort
Hemoptysis
CLINICAL FEATURE OF PCP

11. WHICH INITIAL LABORATORY TESTS DO YOU
RECOMMEND OR ORDER, AND WHY? DO YOU
EXPECT ANY ABNORMALITIES IN THE
STANDARD BLOOD INDICES AND BLOOD
CHEMISTRY TESTS? DO YOU EXPECT ANY
BENEFIT FROM ADDITIONAL TESTS TO
EVALUATE HIS CHEST COMPLAINTS?

12.  CBC:
 RBC'S, Hb, and hematocrit : Anemia
 Platelets : Thrombocytopenia
 WBC Count :
 Few neutrophils in PCP patient with HIV.
 WBC reflect the degree of immunosuppression rather than the
presence of PCP.
 Blood chemistry tests:
 Electrolyte tests, Liver function tests (LFTs) and RFT are normal or not
INVESTIGATIONS:

13.  Low CD4 counts :
The incidence of PCP in HIV-infected patients
increases as the CD4 count decreases , with
most cases occurring when the CD4 count
drops below 200 cells/microL .
 Arterial blood gas (ABG):
- Hypoxia and hypocapnea due to
hyperventilation.
- Oxygen desaturation can occur with
exercise and is highly suggestive of a
INVESTIGATIONS: BLOOD TEST

14.  A lactic dehydrogenase (LDH):
 It usually elevated (>220 U/L) in patients with PCP.
 it has high sensitivity (78%-100%), but it has low
specificity.
 The use of serum (1→3) beta-D-glucan levels:
 (high in PCP) is being investigated as a diagnostic test.
INVESTIGATIONS: BLOOD TEST

15.  Chest radiographs should be included in
the initial evaluation for PCP.
 Chest radiography should be obtained in
any immunocompromised patient with
fever and/or respiratory signs or
symptoms.
 Findings:
 May be normal in patients with early mild
disease.
 Diffuse bilateral infiltrates extending from
INVESTIGATIONS: CHEST X-RAY

16. CT scan :
 patchy or nodular ground-glass
attenuation.
Gallium 67 scanning :
 Is a type of nuclear medicine study that
uses a gallium-67 to obtain images of
body.
 Is used to screen for PCP in suspected
individuals with a normal X-ray but HRCT
INVESTIGATIONS

17. CONFIRMATION OF DIAGNOSIS
 Histological identification of the causative organism in
sputum or bronchioalveolar lavage.
 Staining with toluidine blue, silver stain, periodic-acid
schiff stain, or an immunofluorescence assay will show the
characteristic cysts.
Silver
Stain

18. SUMMARY
 Pneumocystis jiroveci pneumonia is a fungal infection of
the lungs causes inflammation and fluid buildup in the
lungs.
 Symptoms of PCP include the following:
 Progressive exertional dyspnea, fever, nonproductive
cough, chest discomfort, weight loss, and chills.
 Investigations of PCP are: Blood test, Chest X ray, CT,
and histopathologic conformation.

19. ANY QUESTIONS?!

20. REFERENCE
 Author: Nicholas John Bennett, Pneumocystis jirovecii
Pneumonia Overview of PCP, Dec 26, 2013,
medscape.com.
http://emedicine.medscape.com/article/225976-
overview#aw2aab6b2
 Merk Manual (p 1935- 1936)