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Pneumonia por Pneumocystis jirovecii

Última revisão: 13 Apr 2025
Última atualização: 19 Nov 2024

Resumo

Definição

História e exame físico

Principais fatores diagnósticos

  • vírus da imunodeficiência humana (HIV)-positivo
Detalhes completos

Outros fatores diagnósticos

  • candidíase orofaríngea
  • pneumonia bacteriana recorrente
  • perda de peso
  • duração prolongada dos sintomas (pacientes HIV-positivos)
  • início rápido dos sintomas (pacientes HIV-negativos)
  • febre
  • tosse seca
  • dispneia
  • fadiga
  • exame normal do tórax
  • taquicardia
  • taquipneia ou dificuldade respiratória
  • cianose
  • manifestações extrapulmonares
  • dor torácica pleurítica
  • murmúrio vesicular unilateral diminuído
Detalhes completos

Fatores de risco

  • contagem de células CD4 abaixo de 200 células/microlitro
  • pacientes imunocomprometidos
  • corticoterapia crônica
  • pneumonia por Pneumocystis anterior
Detalhes completos

Investigações diagnósticas

Primeiras investigações a serem solicitadas

  • radiografia torácica
  • gasometria arterial
  • nível de lactato desidrogenase (LDH) sérica
  • escarro induzido
Detalhes completos

Investigações a serem consideradas

  • tomografia computadorizada de alta resolução (TCAR) do tórax
  • teste de função pulmonar
  • broncoscopia e lavagem broncoalveolar (LBA)
  • biópsia
Detalhes completos

Novos exames

  • reação em cadeia da polimerase
  • nível de S-adenosilmetionina no plasma
  • nível de (1,3)-beta-D-glicano sérico

Algoritmo de tratamento

Inicial

risco elevado de infecção por pneumonia por Pneumocystis (PPC)

AGUDA

adultos ou adolescentes: HIV-positivo

crianças: HIV-positivas ou sob risco de HIV

adultos ou adolescentes imunocomprometidos: HIV-negativos e não receptores de transplante de órgão sólido

adultos, adolescentes ou crianças imunocomprometidos: HIV-negativos e receptores de transplante de órgão sólido

CONTÍNUA

tratamento da infecção por pneumonia por Pneumocystis (PPC) concluído com sucesso

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.

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.
  • Pneumonia por Pneumocystis jirovecii images
  • Diagnósticos diferenciais

    • Doença do coronavírus 2019 (COVID-19)
    • Pneumonia bacteriana
    • Coccidioidomicose
    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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