pneumocystis jiroveci pneumonia in HIV

Case BMaryam AL-

Qahtani.G:6

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.

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.

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.

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?

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

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.

ISOLATING

BUT…{

Avoid placement in the same room with an immunocompromised patient.

{Standard Precautions

Treatment of

Pneumocystis jiroveci

Pneumonia + HIV 

HIV Treatment

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

Non-pharmacologic

Pharmacologic

Standard antiretroviral therapy (ART)

Antiretrovirals 

CLASSTake 3 different antiretroviral drugs from 2

different classes , to maximally

suppress the HIV virus and stop

the progression of HIV disease.

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.

Trea

tmen

t

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.

Preferred drug

Trimethoprim-sulfamethoxaz

ole

Treatment

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 affectsskin reaction (mild rash to anaphylaxis), drug fever, bone marrow suppression, nausea and vomiting, diarrhea, pancreatitis, nephritis, and hyperkalemia

Dapsone (Avlosulfon)

Dosage 100 mg daily

CI: hypersensitivity, G-6-PD deficiency

ADR: fever, rash, hemolytic anemia, nausea, vomiting, methemoglobinemia, hepatitis

Treatment

Atovaquone

Dosage 750 mg

CI: Hypersensitivity

ADR: rash, GI intolerance, diarrhea, headache, fever,

Treatment

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

Summary

Reference • 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

Thank you