Summary
Definition
History and exam
Key diagnostic factors
- HIV-positive
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
Investigations to consider
- high-resolution computed tomography (HRCT) chest
- pulmonary function testing
- bronchoscopy and bronchoalveolar lavage (BAL)
- biopsy
Emerging tests
- polymerase chain reaction (PCR)
- plasma S-adenosylmethionine level
- serum (1,3)-beta-D-glucan level
Treatment algorithm
high-risk for Pneumocystis pneumonia (PCP) infection
adults or adolescents: HIV-positive
children: HIV-positive or at risk for HIV
immunocompromised adults or adolescents: HIV-negative and not solid-organ transplant recipients
immunocompromised adults or adolescents or children: HIV-negative and solid-organ transplant recipients
completed successful treatment of PCP infection
Contributors
Authors
Alison Morris, MD, MS
Professor of Medicine
Pulmonary, Allergy, Critical Care, and Sleep Medicine
University of Pittsburgh
Pittsburgh
PA
Disclosures
AM is an author of a number of references cited in this topic.
Ioannis Konstantinidis, MD, MS
Assistant Professor of Medicine
Pulmonary, Allergy, Critical Care, and Sleep Medicine
University of Pittsburgh
Pittsburgh
PA
Disclosures
IK declares that he has no competing interests.
Acknowledgements
Dr Alison Morris and Dr Ioannis Konstantinidis would like to gratefully acknowledge Dr Eric Nolley and Dr Matthew Gingo, previous contributors to this topic.
Disclosures
EN and MG declare that they have no competing interests.
Peer reviewers
Peter D. Walzer, MD, MSc
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.
David Spencer, MBChB(UCT), MMed (Wits)
Specialist Physician and Consultant
Toga Laboratory and Kimera Consultants
Edenvale
Johannesburg
South Africa
Disclosures
DS declares that he has no competing interests.
Graeme Meintjes, MBChB, MRCP, FCP, DipHIVMan
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.
Differentials
- Coronavirus disease 2019 (COVID-19)
- Bacterial pneumonia
- Coccidioidomycosis
More DifferentialsGuidelines
- Primary prophylaxis of bacterial infections and Pneumocystis jirovecii pneumonia in patients with hematologic malignancies and solid tumors
- Pneumocystis jiroveci in solid organ transplantation
More Guidelines
Log in or subscribe to access all of BMJ Best Practice
Use of this content is subject to our disclaimer