PJP is the most common AIDS deifining opportunistic infection in HIV-infected individuals. The presentation in most people (>85%) includes fever, progressive cough and dyspnea. It is generally subacute developing over days to weeks. Other constitutional symptoms are common.
Radiology:
A large percent of initial CXR imaging is normal in people with PJP. As the disease progresses diffuse bilateral interstitial or alveolar infiltrates develop. Discrete infiltrates, cysts, nodules and pleural effusions have been described. If a patient suddenly deteriorates dont forget to think about the pnumothorax which is not an uncommon complication of this disease (see above). a HRCT maybe very helpful in times when the CXR is normal.
Diagnosis:
The diagnosis is confirmed based on demonstration of PJP in sputum (sens 50-90%) or BAL (sens >95%). Laboratory data is not particularly helpful for diagnosis but the 2 most common abnormalities are an elevated LDH and low CD4.
Treatment:
Anti-PCP treatment....first line is TMP-SMX - other considerations include tolerance, iv vs oral therapy. Duration 21 days.
Steroids: As people typically worsen 3-5 days into treatment with an inflammatory response, steroids become the standard of treatment in severe infection. This is defined as a PaO2 <70>35 on ABG. The original studies in this area came out of Toronto so check out this link.....
" The possible role of corticosteroid therapy for pneumocyctis pneumonia in the acquired immune deficiency syndrome" J Acquir Immune Defic Syndr. 1988;1(4):354-60
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