Download - Pneumocystis Jeroveci Pneumonia
Questions
Would you consider his chest condition to be potentially infectious to others?
Should you isolate the patient in the mean time until his condition proven to be non-infectious?
Outline treatment plan for the patient
Case PJP Management Treatment Summary
Case
Positive Symptoms Fever Dyspnea Fatigue Qat use Smoking Unprotected sex Chest pain Pain and difficulty swallowing Non-productive cough Oral thrush Weight loss Sinus tachycardia
SaO2 91%
Negative Symptoms No alcohol No blood transfusions No asthma No illicit drug abuse No respiratory tract infections No urethral discharges No diarrhea No headache No enlarged lymph nodes Chest sound clear No abnormal heart sounds No skin abnormalities
Case PJP Management Treatment Summary
Diagnosis
Opportunistic infection by Pneumocystis Jiroveci
formerly P. carinii
Case PJP Management Treatment Summary
Pneumocystis Jirovesi
Commonly found in lungs of healthy people
Most common cause of pneumonia in HIV patients
CD4 < 200
Classified as Fungal pneumonia
Does not respond to antifungal treatment
Case PJP Management Treatment Summary
Infectious or Not Infectious?
Opportunistic infection!
Standard precaution
Avoid placement in the same room with an immunocompromised patient.
Case PJP Management Treatment Summary
Treatment Plan
1st Line
• TMP-SMX (trimethoprim-sulfamethoxazole): IV, 3 times a day
• 21 Days
2nd Line
• Pentamidine or TMP-dapsone: IV, 3 times a day • 21 Days
3rd Line
• Corticosteroids • In severe hypoxia
Case PJP Management Treatment Summary
Treatment Plan
High rate of adverse reactions with TMP-SMX treatment
Adverse effects with TMP-SMX are dose related.
clinical visit with laboratory evaluation one week after discharge from the hospital.
patient with an adverse reaction may still be able to tolerate lower dose used for PJP prophylaxis.
Case PJP Management Treatment Summary
Treatment Plan
Intravenous therapy for PCP is required in any of the following situations:
Respiratory status: Wide A-a gradient Poor oxygenation Respiratory failure
When oral treatment cannot be administered because of clinical status or gastrointestinal issues
In patients who require Pentamidine (usually because of multiple drug intolerances)
c
Suggested by: above 45 mmHg partial pressure of arterial
oxygen < 60 mmHg suggested by a high respiratory
rate or a PaCO2 that is normal or higher than normal in a patient with hypoxia
Case PJP Management Treatment Summary
Inpatient Vs. Outpatient
Indications for hospitalization: Disease severe enough to
warrant treatment with corticosteroids
Initial treatment with intravenous Pentamidine,
Patients for whom compliance with therapy or laboratory monitoring is likely to be difficult
Case PJP Management Treatment Summary