Pneumocystis Jeroveci Pneumonia

HIV and Pneumonia

Mariam Alosfoor 213117271Tutor: Dr. Shahzeen

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

Case PJP Management Treatment Summary

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


Diagnosis

Opportunistic infection by Pneumocystis Jiroveci

formerly P. carinii


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


Infectious or Not Infectious?

Opportunistic infection!

Standard precaution

Avoid placement in the same room with an immunocompromised patient.


Treatment Plan

1st Line

• TMP-SMX (trimethoprim-sulfamethoxazole): IV, 3 times a day

• 21 Days

2nd Line

• Pentamidine or TMP-dapsone: IV, 3 times a day • 21 Days

3rd Line

• Corticosteroids • In severe hypoxia


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.


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


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


SummaryMost 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


Education

Pneumocystis Jeroveci Pneumonia