Pneumocystis jirovecii pneumonia

Last reviewed: 24 Apr 2022
Last updated: 26 Jan 2021

Summary

Definition

History and exam

Key diagnostic factors

  • HIV-positive
More key diagnostic factors

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
  • dyspnea
  • fatigue
  • normal chest examination
  • tachycardia
  • tachypnea or respiratory distress
  • cyanosis
  • extrapulmonary manifestations
  • pleuritic chest pain
  • unilateral diminished breath sounds
Other diagnostic factors

Risk factors

  • CD4 cell count <200 cells/microliter
  • immunocompromised state
  • chronic corticosteroid therapy
  • prior Pneumocystis pneumonia
More risk factors

Diagnostic investigations

1st investigations to order

  • chest x-ray
  • arterial blood gas
  • serum LDH level
  • induced sputum
More 1st investigations to order

Investigations to consider

  • high-resolution computed tomography (HRCT) chest
  • pulmonary function testing
  • bronchoscopy and bronchoalveolar lavage (BAL)
  • biopsy
More investigations to consider

Emerging tests

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

Treatment algorithm

INITIAL

high-risk for Pneumocystis pneumonia (PCP) infection

ACUTE

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

ONGOING

completed successful treatment of PCP infection

Contributors

Authors

Alison Morris, MD, MS
Alison Morris

Professor of Medicine

Pulmonary, Allergy and Critical Care Medicine

University of Pittsburgh

Pittsburgh

PA

Disclosures

AM is an author of a number of references cited in this topic.

Ioannis Konstantinidis, MD

Fellow

Pulmonary, Allergy and Critical Care 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.

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