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Pneumocystis jirovecii pneumonia

Última revisão: 12 Aug 2025
Última atualização: 19 Nov 2024

Resumo

Definição

História e exame físico

Principais fatores diagnósticos

  • HIV-positive
Detalhes completos

Outros fatores diagnósticos

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

Fatores de risco

  • CD4 cell count <200 cells/microliter
  • immunocompromised state
  • chronic corticosteroid therapy
  • prior Pneumocystis pneumonia
Detalhes completos

Investigações diagnósticas

Primeiras investigações a serem solicitadas

  • chest x-ray
  • arterial blood gas
  • serum LDH level
  • induced sputum
Detalhes completos

Investigações a serem consideradas

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

Novos exames

  • polymerase chain reaction (PCR)
  • plasma S-adenosylmethionine level
  • serum (1,3)-beta-D-glucan level

Algoritmo de tratamento

Inicial

high-risk for Pneumocystis pneumonia (PCP) infection

AGUDA

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

CONTÍNUA

completed successful treatment of PCP infection

Colaboradores

Autores

Alison Morris, MD, MS
Alison Morris

Professor of Medicine

Pulmonary, Allergy, Critical Care, and Sleep Medicine

University of Pittsburgh

Pittsburgh

PA

Declarações

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

Declarações

IK declares that he has no competing interests.

Agradecimentos

Dr Alison Morris and Dr Ioannis Konstantinidis would like to gratefully acknowledge Dr Eric Nolley and Dr Matthew Gingo, previous contributors to this topic.

Declarações

EN and MG declare that they have no competing interests.

Revisores

Peter D. Walzer, MD, MSc

Associate Chief of Staff for Research

Cincinnati VA Medical Center

Professor of Medicine

University of Cincinnati

Cincinnati

OH

Declarações

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

Declarações

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

Declarações

GM declares that he has no competing interests.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

Referências

Nossas equipes internas de editoria e de evidências trabalham em conjunto com colaboradores internacionais especializados e pares revisores para garantir que forneçamos acesso às informações o mais clinicamente relevantes possível.

Principais artigos

Palella FJ, Delaney KM, Moorman FC, et al. Declining morbidity and mortality among patients with advanced human immunodeficiency virus infection. N Engl J Med. 1998 Mar 26;338(13):853-60.Texto completo  Resumo

National Institutes of Health, Centers for Disease Control and Prevention, HIV Medicine Association of the Infectious Diseases Society of America, Pediatric Infectious Diseases Society, and American Academy of Pediatrics. Panel on Opportunistic Infections in Children with and Exposed to HIV. Guidelines for the prevention and treatment of opportunistic infections in children with and exposed to HIV: Pneumocystis jirovecii pneumonia. Nov 2013 [internet publication].Texto completo

National Institutes of Health, Centers for Disease Control and Prevention, HIV Medicine Association, and Infectious Diseases Society of America. Panel on Guidelines for the Prevention and Treatment of Opportunistic Infections in Adults and Adolescents with HIV. Guidelines for the prevention and treatment of opportunistic infections in adults and adolescents with HIV. Pneumocystis pneumonia. Sep 2024 [internet publication].Texto completo

Taplitz RA, Kennedy EB, Bow EJ, et al. Antimicrobial prophylaxis for adult patients with cancer-related immunosuppression: ASCO and IDSA clinical practice guideline update. J Clin Oncol. 2018 Oct 20;36(30):3043-54.Texto completo  Resumo

Tomblyn M, Chiller T, Einsele H, et al. Guidelines for preventing infectious complications among hematopoietic cell transplantation recipients: a global perspective. Biol Blood Marrow Transplant. 2009 Oct;15(10):1143-238.Texto completo  Resumo

Fishman JA, Gans H, AST Infectious Diseases Community of Practice. Pneumocystis jiroveci in solid organ transplantation: guidelines from the American Society of Transplantation Infectious Diseases Community of Practice. Clin Transplant. 2019 Sep;33(9):e13587. Resumo

Limper AH, Knox KS, Sarosi GA, et al. An official American Thoracic Society statement: treatment of fungal infections in adult pulmonary and critical care patients. Am J Respir Crit Care Med. 2011 Jan 1;183(1):96-128.Texto completo  Resumo

Ewald H, Raatz H, Boscacci R, et al. Adjunctive corticosteroids for Pneumocystis jiroveci pneumonia in patients with HIV infection. Cochrane Database Syst Rev. 2015 Apr 2;(4):CD006150.Texto completo  Resumo

Cooley L, Dendle C, Wolf J, et al. Consensus guidelines for diagnosis, prophylaxis and management of Pneumocystis jirovecii pneumonia in patients with haematological and solid malignancies, 2014. Intern Med J. 2014 Dec;44(12b):1350-63.Texto completo  Resumo

Maertens J, Cesaro S, Maschmeyer G, et al. ECIL guidelines for preventing Pneumocystis jirovecii pneumonia in patients with haematological malignancies and stem cell transplant recipients. J Antimicrob Chemother. 2016 Sep;71(9):2397-404.Texto completo  Resumo

Classen AY, Henze L, von Lilienfeld-Toal M, et al. Primary prophylaxis of bacterial infections and Pneumocystis jirovecii pneumonia in patients with hematologic malignancies and solid tumors: 2020 updated guidelines of the Infectious Diseases Working Party of the German Society of Hematology and Medical Oncology (AGIHO/DGHO). Ann Hematol. 2021 Jun;100(6):1603-20.Texto completo  Resumo

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.
  • Pneumocystis jirovecii pneumonia images
  • Diagnósticos diferenciais

    • Coronavirus disease 2019 (COVID-19)
    • Bacterial pneumonia
    • Coccidioidomycosis
    Mais Diagnósticos diferenciais
  • Diretrizes

    • Guidelines for the prevention and treatment of opportunistic infections in adults and adolescents with HIV: pneumocystis pneumonia
    • Primary prophylaxis of bacterial infections and Pneumocystis jirovecii pneumonia in patients with hematologic malignancies and solid tumors
    Mais Diretrizes
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