PCP Flashcards
what is it
Pneumocystis Pneumonia (PCP) is an infection with the fungus Pneumocystis Jiroveci. It is a common presentation associated with individuals with HIV who are noncompliant with their cART regimens or antibiotic prophylaxis.
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The patient can present with:
Fever
Non productive cough (however can have superimposed bacterial infection causing a productive cough)
Exertional breathlessness associated with onset of infection
Exertional breathlessness is a specific sign for PCP, and is used to stratify severity.
On examination, the chest is often clear, however sometimes there are end inspiratory crackles present.
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Chest x-ray commonly shows bilateral bihilar interstitial infiltrates. can be normal.
If a chest x-ray is normal and PCP is suspected, a high resolution CT can be requested, to look for cysts and nodules.
The definitive diagnostic investigation is bronchoscopy with bronchoalveolar lavage. Induced sputum samples can be used, but this is a less specific diagnostic investigation.
Samples are stained using Grocott’s silver stain, which shows a characteristic “Mexican hat” appearance.
Blood gas measurements are used to define severity of disease. If the patient has a p02 <9.3kPa and an arterial alveolar 02 gradient >4.7kPa, is it important to consider adjuvant corticosteroids. This has a proven reduction of mortality.
abx of choice
Treatment is based on clinical or radiological evidence of infection or clinical indicators of general immune deficiency.
PCP is treated with antibiotics such as co-trimoxazole.
Alternative therapy can be used if co-trimoxazole does not eliminate infection. This includes clindamycin-primaquine, dapsone, IV pentamidine.
