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Pneumocystis Jeroveci Pneumonia
- 1. HIV and Pneumonia Mariam Alosfoor 213117271 Tutor: Dr. Shahzeen
- 2. Questions Would you consider his chest condition to be potentially infectious to others? Should you isolate the patient in the mean time until his condition proven to be non-infectious? Outline treatment plan for the patient
- 3. Case Positive Symptoms Fever Dyspnea Fatigue Qat use Smoking Unprotected sex Chest pain Pain and difficulty swallowing Non-productive cough Oral thrush Weight loss Sinus tachycardia SaO2 91% Negative Symptoms No alcohol No blood transfusions No asthma No illicit drug abuse No respiratory tract infections No urethral discharges No diarrhea No headache No enlarged lymph nodes Chest sound clear No abnormal heart sounds No skin abnormalities
- 4. Diagnosis Opportunistic infection by Pneumocystis Jiroveci formerly P. carinii
- 5. Pneumocystis Jirovesi Commonly found in lungs of healthy people Most common cause of pneumonia in HIV patients CD4 < 200 Classified as Fungal pneumonia Does not respond to antifungal treatment
- 6. Infectious or Not Infectious? Opportunistic infection! Standard precaution Avoid placement in the same room with an immunocompromised patient.
- 7. Treatment Plan • TMP-SMX (trimethoprim-sulfamethoxazole): IV, 3 times a day • 21 Days • Pentamidine or TMP-dapsone: IV, 3 times a day • 21 Days • Corticosteroids • In severe hypoxia
- 8. Treatment Plan High rate of adverse reactions with TMP-SMX treatment Adverse effects with TMP-SMX are dose related. clinical visit with laboratory evaluation one week after discharge from the hospital. patient with an adverse reaction may still be able to tolerate lower dose used for PJP prophylaxis.
- 9. Treatment Plan Intravenous therapy for PCP is required in any of the following situations: Respiratory status: Wide A-a gradient Poor oxygenation Respiratory failure When oral treatment cannot be administered because of clinical status or gastrointestinal issues In patients who require Pentamidine (usually because of multiple drug intolerances) c Suggested by: above 45 mmHg partial pressure of arterial oxygen < 60 mmHg suggested by a high respiratory rate or a PaCO2 that is normal or higher than normal in a patient with hypoxia
- 10. Inpatient Vs. Outpatient Indications for hospitalization: Disease severe enough to warrant treatment with corticosteroids Initial treatment with intravenous Pentamidine, Patients for whom compliance with therapy or laboratory monitoring is likely to be difficult
- 11. Summary Most Common opportunistic infection in HIV patients is PJP Treatment is initiated as early as possible First Line therapy is TMP-SMX Use corticosteroids in severe cases Keep patient away from other immunocompromised patients
Editor's Notes
- Patients with PCP may worsen clinically, with an increase in the alveolar-arterial oxygen gradient, two to three days after starting anti-Pneumocystis therapy, presumably because of increased inflammation in the lungs as organisms are killed. This worsening can often be prevented or blunted with corticosteroids that are administered at the initiation of therapy
- 1. regardless of whether intravenous or oral anti-Pneumocystis therapy is used 2. because of the potential side effects of therapy (in particular, hypoglycemia and hypotension)