HIV: Pneumocystis jiroveci pneumonia

Question 1

What was Pneumocystis jiroveci previously known as?

Answer 1

Pneumocystis carinii pneumonia (PCP)

Question 2

What type of organism is Pneumocystis jiroveci?

Answer 2

A unicellular eukaryote

Question 3

PCP is the most common opportunistic infectino in AIDS.

All patients with a CD4 count <200/mm should receive what?

Answer 3

They should receive PCP prophylaxis

Question 4

What are some features of PCP?

Answer 4

• Dyspnoea
• Dry cough
• Fever
• Very few chest signs

Question 5

What is a very common complication of PCP?

Answer 5

Pneumothorax

Question 6

What are some extrapulmonary manifestations of PCP? (These are rare 1-2%)

Answer 6

• Hepatosplenomegaly
• Lymphadenopathy
• Choroid lesions

Question 7

What is most commonly seen in CXR?

Answer 7

CXR: bilateral interstitial pulmonary infiltrates.

(But can also show a lobar consolidation or may even be normal)

Question 8

Can you sputum samples show PCP?

Answer 8

They often fail to and bronchoalveolar lavage is often needed to get sufficient samples.

Question 9

How is pneumocystitis jiroveci managed?

Answer 9

• Co-trimoxazole
• IV pentamidine in severe cases
• steroids if hypoxic (if pO2 < 9.3kPa then steroids reduce risk of respiratory failure by 50% and death by a third)