Last reviewed: November 2017
Last updated: November  2017

Summary

Definition

History and exam

Other diagnostic factors

  • oropharyngeal candidiasis
  • recurrent bacterial pneumonia
  • weight loss
  • longer duration of symptoms (HIV-positive patients)
  • rapid onset of symptoms (HIV-negative patients)
  • fever
  • dry cough
  • dyspnoea
  • fatigue
  • normal chest examination
  • tachycardia
  • tachypnoea or respiratory distress
  • cyanosis
  • extrapulmonary manifestations
  • pleuritic chest pain
  • unilateral diminished breath sounds

Risk factors

  • CD4 cell count below 200 cells/microlitre
  • immunocompromised state
  • chronic corticosteroid therapy
  • prior Pneumocystis pneumonia

Diagnostic investigations

1st investigations to order

  • chest x-ray
  • arterial blood gas
  • serum LDH level
  • induced sputum
Full details

Investigations to consider

  • high-resolution computed tomography (HRCT) chest
  • pulmonary function testing
  • bronchoscopy and bronchoalveolar lavage (BAL)
  • biopsy
Full details

Emerging tests

  • PCR
  • plasma S-adenosylmethionine level
  • serum (1,3)-beta-D-glucan level
Full details

Treatment algorithm

Contributors

Authors VIEW ALL

Alison Morris

Professor of Medicine

Pulmonary, Allergy and Critical Care Medicine

University of Pittsburgh

Pittsburgh

PA

Disclosures

AM declares that she has no competing interests.

Eric Nolley

Fellow

Pulmonary, Allergy and Critical Care Medicine

University of Pittsburgh

Pittsburgh

PA

Disclosures

EN declares that he has no competing interests.

Dr Alison Morris and Dr Eric Nolley would like to gratefully acknowledge Dr Matthew Gingo, a previous contributor to this monograph. MG declares that he has no competing interests.

Peer reviewers VIEW ALL

Associate Chief of Staff for Research

Cincinnati VA Medical Center

Professor of Medicine

University of Cincinnati

Cincinnati

OH

Disclosures

PDW declares that he has no competing interests.

Specialist Physician and Consultant

Toga Laboratory and Kimera Consultants

Edenvale

Johannesburg

South Africa

Disclosures

DS declares that he has no competing interests.

Infectious Diseases Physician

Institute of Infectious Diseases and Molecular Medicine

Faculty of Health Sciences

University of Cape Town

Observatory

South Africa

Disclosures

GM declares that he has no competing interests.

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