Pneumocystis jirovecii Pneumonia (PJP)

Question 1

Overview

Answer 1

Fungas

Question 2

Transmission

Answer 2

airborne route

Question 3

Presentation

Answer 3

Hypoxemia, fever, non-productive cough, chest discomfort

Question 4

Diagnosis

Answer 4

Physical exam

pO2 < 70 mmHg
LDH > 500 mg/dL
CXR: diffuse, bilateral, interstitial infiltrates

Question 5

Treatment

Answer 5

Start ART within 2 weeks of diagnosis

Mild-moderate:
Preferred: Bactrim 15-20 mg/kg/day or DS PO TID
Alternative: TMP-SMZ + Dapsone (check G6PD), Primaquine + clindamycin (check G6PD), Atovaquone

Moderate-severe:
Preferred: Bactrim 15-20 mg/kg/day x 21 days
Alternative: Primaquine + clindamycin (check G6PD), Pentamidine
Adjunctive steroids (mild-mod PJP + pO2 < 70): Prednisone 40 mg PO BID x 5 days within 72 hours of ART x 21 days

Question 6

Primary prophylaxis

Answer 6

CD4 cell count < 100 or 100-200 + high HIV RNA level

D/C: CD4 count > 200 x 3 months on ART

Restart: CD4 count < 100

Question 8

Secondary prophylaxis

Answer 8

Completion of treatment for an acute episode of PJP