Pneumocystis jirovecii pneumonia
Resumo
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
- dyspnea
- fatigue
- normal chest examination
- tachycardia
- tachypnea or respiratory distress
- cyanosis
- extrapulmonary manifestations
- pleuritic chest pain
- unilateral diminished breath sounds
Risk factors
- CD4 cell count <200 cells/microliter
- immunocompromised state
- chronic corticosteroid therapy
- prior Pneumocystis pneumonia
Diagnostic tests
1st tests to order
- chest x-ray
- arterial blood gas
- serum LDH level
- induced sputum
Tests 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
Divulgaciones
IK declares that he has no competing interests.
Agradecimientos
Dr Alison Morris and Dr Ioannis Konstantinidis would like to gratefully acknowledge Dr Eric Nolley and Dr Matthew Gingo, previous contributors to this topic.
Divulgaciones
EN and MG declare that they have no competing interests.
Revisores por pares
Peter D. Walzer, MD, MSc
Associate Chief of Staff for Research
Cincinnati VA Medical Center
Professor of Medicine
University of Cincinnati
Cincinnati
OH
Divulgaciones
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
Divulgaciones
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
Divulgaciones
GM declares that he has no competing interests.
Agradecimiento de los revisores por pares
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Divulgaciones
Las afiliaciones y divulgaciones de los revisores por pares se refieren al momento de la revisión.
Referencias
Artículos principales
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 Resumen
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 Resumen
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 Resumen
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. Resumen
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 Resumen
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 Resumen
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 Resumen
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 Resumen
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 Resumen
Artículos de referencia
Una lista completa de las fuentes a las que se hace referencia en este tema está disponible para los usuarios con acceso a todo BMJ Best Practice.
Diferenciales
- Coronavirus disease 2019 (COVID-19)
- Bacterial pneumonia
- Coccidioidomycosis
Más DiferencialesGuías de práctica clínica
- 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
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