A 30-year-old man presented with a 3-week history of fever and dyspnea on exertion. He was a former smoker and had unprotected sex with multiple partners. On examination, he had a respiratory rate of 36, fast but regular heart rate, and oxygen saturation of 91% on room air. He reported chest pain and difficulty swallowing. Given his symptoms and risk factors, Pneumocystis jiroveci pneumonia was suspected. As an opportunistic infection, it posed an infectious risk to those with compromised immunity. Standard precautions including isolation were recommended until diagnosis was confirmed or ruled out. Treatment would involve 21 days of trimethoprim-sulfamethoxazole with cortic

1. Case B
Maryam AL-Qahtani.
G:6

2. 30-year old man
was admitted
with history of
fever and
dyspnoea on
exertion since 3
weeks.
He was a party
smoker for age
16 until recently .
He admitted
having
unprotected sex
with multiple
partners
He had no
known
exposure to
tuberculosis ,
No asthma, he
denied blood
transfusion in
the past.

3. He admitted
having slight
chest pain but
having some
pain and
difficulty in
swallowing.
His chest
complaints were
accompanied
with non
productive cough
Respiratory rate
36 respiration
Heart fast but
regular
oxygen
saturation was
only 91% while
breathing room
air

4. Objectives
Would you
consider his
chest condition
to be potentially
infectious to
others?
Should you
isolate this
person in the
meantime until
his condition
proven to be non
– infectious ?
Outline the
treatment plan
for this disorder.

5. Would you consider his chest condition to be potentially
infections to others?
Should you isolate this person in the meantime until his
condition proven to be non-infections?

6. In healthy individuals
- present without any manifestation
because they are under the control of
immune system
- CD4+ T cells responsible for
elimination of the organism.
- PCP remained in a latent state unless
the patient became
immunosuppressed.
Immunocompromised individuals
-There is evidence of Transmission only
between the immunocompromised
people.
The primary mode of transmission of P. jirovecii is via the
airborne route.
Transmission of PCP

7. For our patient we
suspect that he has
pneumocystis jiroveci
pneumonia.
The fungal infection
Pneumocystis pneumonia
is the most prevalent
opportunistic infection in
patients with AIDS.
Infectious
“immunocompromised “
The jiroveci is one of opportunistic fungi infection which means that
the fungi can be present in a normal person without any manifestation
they do not cause a disease for a healthy immune system, but they
affect the immunecompromised patient.

8. Avoid placement in the same room with an
immunocompromised patient.
Standard Precautions

10. HIV Treatment

11. Are designed to reduce HIV in
the body.
 Keep the immune system as
healthy as possible.
 Decrease the complications that
may develop.
HIV Treatment
Aim:
There is no cure for HIV or AIDS, but medications are
effective in fighting HIV and its complications

12. Non-pharmacologic

13. Pharmacologic
Standard antiretroviral therapy (ART)

15. Take 3 different
antiretroviral
drugs from 2
different classes ,
to maximally
suppress the HIV
virus and stop the
progression of
HIV disease.

16. o Untreated PCP is almost always
fatal.
o In patients infected with HIV, the
treatment response typically takes
longer but should occur within the
first 8 days.
o The length of treatment is 21 days
in HIV-infected patients.
Treatment

17. may have one or more of the following :
o Antibiotic medicine for kill germs.
o Steroids: When patient do not have enough oxygen in the
blood. ”severe”
o Oxygen: may need extra oxygen to help patient breathe easier.
o A ventilator is a machine that gives patient oxygen and
breathes ,when patient cannot breathe well.

18. Preferred
drug
Trimethoprim-
sulfamethoxazole
Alternative
drugs
1/ dapsone
2/Atovaquone
3/Pentamidine
4/ Clindamycin
Treatment

19. Treatment
Trimethoprim-sulfamethoxazole
• Is the drug of choice.
• Use as a pill or intravenously through the vein (by IV) in a hospital.
In moderate to severe disease should receive corticosteroids
(prednisone 40 mg × 5 days)
 Dosage
5 mg/kg of TMP every 8 hrs
 Contraindication
hypersensitivity, megaloblastic anemia due to folate deficiency
 Common adverse affects
skin reaction (mild rash to anaphylaxis), drug fever, bone marrow
suppression, nausea and vomiting, diarrhea, pancreatitis,
nephritis,
and hyperkalemia

20. Dapsone (Avlosulfon)
Dosage 100 mg daily
CI: hypersensitivity, G-6-PD deficiency
ADR: fever, rash, hemolytic anemia, nausea,
vomiting, methemoglobinemia, hepatitis
Clindamycin
Dosage 900 mg IV q 8h
CI: hypersensitivity, ulcerative colitis, Hepatic
impairment,
ADR: diarrhea, nausea, vomiting, rash,
Treatment

21. Atovaquone
Dosage 750 mg
CI: Hypersensitivity
ADR: rash, GI intolerance, diarrhea,
headache, fever,
Pentamidine
Dosage: 4 mg/kg/d IV/IM
CI: hypersensitivity
ADR: nausea, cardiac arrthytmias,
hyperkalemia
Treatment

22. Prophylaxis
 All patients with a history of the
pneumocystis infection.
 Severely immunocompromised patients.
 All HIV-positive individuals once their CD4
T-cell count falls below 200 cells/mm3.
 It should be considered for:
Secondary Prophylaxis to Prevent Recurrence of Disease

24. • Sax, PE, Tietjen, PA. Treatment of Pneumocystis carinii (P. jiroveci)
• infection in HIV-infected patients. www.uptodate.com 2013
•http://www.uptodate.com/contents/clinical-presentation-and-diagnosis-of-
pneumocystis-pulmonary-infection-in-hiv-infected-
patients?source=search_result&search=Pneumocystis+jirovecii.&selectedTitle=1
~150
•http://depts.washington.edu/hivaids/oit/case2/discussion.html
• http://www.drugs.com/cg/pneumocystis-jiroveci-pneumonia.html
• http://aids.gov/hiv-aids-basics/just-diagnosed-with-hiv-aids/treatment-
options/overview-of-hiv-treatments/
• http://emedicine.medscape.com/article/225976-overview#showall

25. Thank you