Pneumocystis jirovecii pneumonia - Revision history

Rossdonaldson1 at 18:06, 2 December 2021

2021-12-02T18:06:59Z

← Older revision		Revision as of 18:06, 2 December 2021
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	''Note: this page is about the infection. For the drug PCP, see [[~~Phencyclidine~~]]''		''Note: this page is about the infection. For the drug PCP, see [[phencyclidine toxicity]]''
	==Background==		==Background==
	*Formerly known known as "pneumocystis ''carinii'' pneumonia" (i.e. "PCP")		*Formerly known known as "pneumocystis ''carinii'' pneumonia" (i.e. "PCP")

Rossdonaldson1: /* Corticosteroids */

2021-12-02T17:47:21Z

Corticosteroids

← Older revision		Revision as of 17:47, 2 December 2021
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	===Corticosteroids===		===Corticosteroids===
			''When used early, found to reduce the risk of progression of hypoxemia, respiratory failure, and death. <ref>Chapman, M., Muse, V., Mojica, J., & Anahtar, M. (2021). Case 35-2021: A 50 Year Old woman with Pain in the Left Upper Quadrant and Hypoxemia. The New England Journal of Medicine, 385(21), 1995–2001. </ref>''
	*Only in patients with [[HIV]] with severe respiratory parameters:		*Only in patients with [[HIV]] with severe respiratory parameters:
	**Room air PaO2 < 70 mmHg		**Room air PaO2 < 70 mmHg
	**'''OR''' A-a gradient > 35 mmHg		**'''OR''' A-a gradient > 35 mmHg
	** U.S. & European trials demonstrated that when used early, glucocorticoids were found to reduce the risk of progression of hypoxemia, respiratory failure, & even deaths in the patients who match above criteria. <ref>Chapman, M., Muse, V., Mojica, J., & Anahtar, M. (2021). Case 35-2021: A 50 Year Old woman with Pain in the Left Upper Quadrant and Hypoxemia. The New England Journal of Medicine, 385(21), 1995–2001. </ref>
	*Treatment schedule for moderate to severe PCP<ref>Wilken A, Feinberg J. Pneumocystis carinii Pneumonia: A Clinical Review. Am Fam Physician. 1999 Oct 15;60(6):1699-1708. http://www.aafp.org/afp/1999/1015/p1699.html.</ref>		*Treatment schedule for moderate to severe PCP<ref>Wilken A, Feinberg J. Pneumocystis carinii Pneumonia: A Clinical Review. Am Fam Physician. 1999 Oct 15;60(6):1699-1708. http://www.aafp.org/afp/1999/1015/p1699.html.</ref>
	**Day 1-5: 40mg [[prednisone]] BID		**Day 1-5: 40mg [[prednisone]] BID

Rossdonaldson1 at 17:45, 2 December 2021

2021-12-02T17:45:28Z

← Older revision		Revision as of 17:45, 2 December 2021
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	''Note: this page is about the infection. For the drug PCP, see [[Phencyclidine]]''		''Note: this page is about the infection. For the drug PCP, see [[Phencyclidine]]''
	==Background==		==Background==
	*~~Abreviations: PCP (formerly~~ known as ~~Pneumocystis~~ carinii pneumonia~~) or PJP~~		*Formerly known known as "pneumocystis ''carinii'' pneumonia" (i.e. "PCP")
	*Pneumocystis (~~carinii~~) ~~jiroveci~~		*An atypical fungus <ref>Chapman, M., Muse, V., Mojica, J., & Anahtar, M. (2021). Case 35-2021: A 50 Year Old woman with Pain in the Left Upper Quadrant and Hypoxemia. The New England Journal of Medicine, 385(21), 1995–2001. </ref>
	*~~It is an~~ atypical fungus <ref>Chapman, M., Muse, V., Mojica, J., & Anahtar, M. (2021). Case 35-2021: A 50 Year Old woman with Pain in the Left Upper Quadrant and Hypoxemia. The New England Journal of Medicine, 385(21), 1995–2001. </ref>
	*Most common opportunistic infection in [[AIDS]] patients		*Most common opportunistic infection in [[AIDS]] patients
	*Most common identifiable cause of death		**Most common identifiable cause of death

	===Risk factors===		===Risk factors===
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	*Chemistry		*Chemistry
	*LDH elevation - sensitive but not specific		*LDH elevation - sensitive but not specific
	*ABG		*[[ABG]]
	*CD4 count		*CD4 count
	*[[CXR]] - bat wing appearance (bilat interstitial infiltrates)		*[[CXR]] - bat wing appearance (bilat interstitial infiltrates)
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	==Management==		==Management==
	===[[Antibiotics]]===		===[[Antibiotics]]===
	*Require [[HCAP]] or [[CAP]] (ceftriaxone and azithromycin) coverage as well<ref>Rothmans RE, Marco CA, Yang S. Human immunodeficiency virus infection and acquired immunodeficiency syndrome, in Tintinalli JE, Stapczynski JS, Ma OJ, et al (eds): Tintinalli’s Emergency Medicine, ed 7. New York, The McGraw-Hill Companies Inc., 2011.</ref>		*Require [[HCAP]] or [[CAP]] ([[ceftriaxone]] and [[azithromycin]]) coverage as well<ref>Rothmans RE, Marco CA, Yang S. Human immunodeficiency virus infection and acquired immunodeficiency syndrome, in Tintinalli JE, Stapczynski JS, Ma OJ, et al (eds): Tintinalli’s Emergency Medicine, ed 7. New York, The McGraw-Hill Companies Inc., 2011.</ref>
	{{PCP pneumonia antibiotics}}		{{PCP pneumonia antibiotics}}

Rossdonaldson1: /* Evaluation */

2021-12-02T17:42:27Z

Evaluation

← Older revision		Revision as of 17:42, 2 December 2021
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	==Evaluation==		==Evaluation==
			[[File:PMC3392316 jkss-83-50-g002.png\|thumb\|PA [[CXR]] and CT of pneumocystis jirovecii pneumonia before (A and B) and after (C and D) treatment.]]
	[[File:PMC4536784 ccrpm-suppl.1-2015-019f3.png\|thumb\|CT of Pneumocystis jirovecii pneumonia, showing small nodular lesions surrounded by diffuse GGO.]]		[[File:PMC4536784 ccrpm-suppl.1-2015-019f3.png\|thumb\|CT of Pneumocystis jirovecii pneumonia, showing small nodular lesions surrounded by diffuse GGO.]]
	[[File:PMC4536784 ccrpm-suppl.1-2015-019f2.png\|thumb\|CT of Pneumocystis jirovecii pneumonia, showing diffuse GGO with interlobular septal lines and cyst formation.]]		[[File:PMC4536784 ccrpm-suppl.1-2015-019f2.png\|thumb\|CT of Pneumocystis jirovecii pneumonia, showing diffuse GGO with interlobular septal lines and cyst formation.]]

Rossdonaldson1: /* Evaluation */

2021-12-02T17:35:19Z

Evaluation

← Older revision		Revision as of 17:35, 2 December 2021
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	==Evaluation==		==Evaluation==
	[[File:PMC4536784 ccrpm-suppl.1-2015-019f3.png\|thumb\|CT of Pneumocystis jirovecii pneumonia, showing small nodular lesions surrounded by diffuse GGO.]]		[[File:PMC4536784 ccrpm-suppl.1-2015-019f3.png\|thumb\|CT of Pneumocystis jirovecii pneumonia, showing small nodular lesions surrounded by diffuse GGO.]]
			[[File:PMC4536784 ccrpm-suppl.1-2015-019f2.png\|thumb\|CT of Pneumocystis jirovecii pneumonia, showing diffuse GGO with interlobular septal lines and cyst formation.]]
	[[File:PMC4536784 ccrpm-suppl.1-2015-019f1.png\|thumb\|CT of Pneumocystis jirovecii pneumonia showing diffuse GGO with inhomogeneous distribution unrelated to secondary lobules and with spared peripheral lung parenchyma.]]		[[File:PMC4536784 ccrpm-suppl.1-2015-019f1.png\|thumb\|CT of Pneumocystis jirovecii pneumonia showing diffuse GGO with inhomogeneous distribution unrelated to secondary lobules and with spared peripheral lung parenchyma.]]
	===Workup===		===Workup===

Rossdonaldson1: /* Evaluation */

2021-12-02T17:32:33Z

Evaluation

← Older revision		Revision as of 17:32, 2 December 2021
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	==Evaluation==		==Evaluation==
	[[File:PMC4536784 ccrpm-suppl.1-2015-019f3.png\|thumb\|CT of Pneumocystis jirovecii pneumonia, showing small nodular lesions surrounded by diffuse GGO.]]		[[File:PMC4536784 ccrpm-suppl.1-2015-019f3.png\|thumb\|CT of Pneumocystis jirovecii pneumonia, showing small nodular lesions surrounded by diffuse GGO.]]
			[[File:PMC4536784 ccrpm-suppl.1-2015-019f1.png\|thumb\|CT of Pneumocystis jirovecii pneumonia showing diffuse GGO with inhomogeneous distribution unrelated to secondary lobules and with spared peripheral lung parenchyma.]]
	===Workup===		===Workup===
	*CBC		*CBC

Rossdonaldson1: /* Evaluation */

2021-12-02T17:30:09Z

Evaluation

← Older revision		Revision as of 17:30, 2 December 2021
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	==Evaluation==		==Evaluation==
			[[File:PMC4536784 ccrpm-suppl.1-2015-019f3.png\|thumb\|CT of Pneumocystis jirovecii pneumonia, showing small nodular lesions surrounded by diffuse GGO.]]
			===Workup===
	*CBC		*CBC
	*Chemistry		*Chemistry
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	**Increased in PCP pneumonia secondary to decreased diffusion thru thick aveoli		**Increased in PCP pneumonia secondary to decreased diffusion thru thick aveoli

			===Diagnosis===
	*Imaging		*Imaging
	**[[CXR]]		**[[CXR]]

Jonrako: /* Corticosteroids */

2021-11-29T00:39:16Z

Corticosteroids

← Older revision		Revision as of 00:39, 29 November 2021
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	**Room air PaO2 < 70 mmHg		**Room air PaO2 < 70 mmHg
	**'''OR''' A-a gradient > 35 mmHg		**'''OR''' A-a gradient > 35 mmHg
			** U.S. & European trials demonstrated that when used early, glucocorticoids were found to reduce the risk of progression of hypoxemia, respiratory failure, & even deaths in the patients who match above criteria. <ref>Chapman, M., Muse, V., Mojica, J., & Anahtar, M. (2021). Case 35-2021: A 50 Year Old woman with Pain in the Left Upper Quadrant and Hypoxemia. The New England Journal of Medicine, 385(21), 1995–2001. </ref>
	*Treatment schedule for moderate to severe PCP<ref>Wilken A, Feinberg J. Pneumocystis carinii Pneumonia: A Clinical Review. Am Fam Physician. 1999 Oct 15;60(6):1699-1708. http://www.aafp.org/afp/1999/1015/p1699.html.</ref>		*Treatment schedule for moderate to severe PCP<ref>Wilken A, Feinberg J. Pneumocystis carinii Pneumonia: A Clinical Review. Am Fam Physician. 1999 Oct 15;60(6):1699-1708. http://www.aafp.org/afp/1999/1015/p1699.html.</ref>
	**Day 1-5: 40mg [[prednisone]] BID		**Day 1-5: 40mg [[prednisone]] BID

Jonrako: /* Background */

2021-11-29T00:29:19Z

Background

← Older revision		Revision as of 00:29, 29 November 2021
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	*Abreviations: PCP (formerly known as Pneumocystis carinii pneumonia) or PJP		*Abreviations: PCP (formerly known as Pneumocystis carinii pneumonia) or PJP
	*Pneumocystis (carinii) jiroveci		*Pneumocystis (carinii) jiroveci
			*It is an atypical fungus <ref>Chapman, M., Muse, V., Mojica, J., & Anahtar, M. (2021). Case 35-2021: A 50 Year Old woman with Pain in the Left Upper Quadrant and Hypoxemia. The New England Journal of Medicine, 385(21), 1995–2001. </ref>
	*Most common opportunistic infection in [[AIDS]] patients		*Most common opportunistic infection in [[AIDS]] patients
	*Most common identifiable cause of death		*Most common identifiable cause of death

Mholtz: Text replacement - "==Treatment==" to "==Management=="

2017-12-11T19:21:47Z

Text replacement - "==Treatment==" to "==Management=="

← Older revision		Revision as of 19:21, 11 December 2017
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	***May see ground glass infiltrative pattern		***May see ground glass infiltrative pattern

	==~~Treatment~~==		==Management==
	===[[Antibiotics]]===		===[[Antibiotics]]===
	*Require [[HCAP]] or [[CAP]] (ceftriaxone and azithromycin) coverage as well<ref>Rothmans RE, Marco CA, Yang S. Human immunodeficiency virus infection and acquired immunodeficiency syndrome, in Tintinalli JE, Stapczynski JS, Ma OJ, et al (eds): Tintinalli’s Emergency Medicine, ed 7. New York, The McGraw-Hill Companies Inc., 2011.</ref>		*Require [[HCAP]] or [[CAP]] (ceftriaxone and azithromycin) coverage as well<ref>Rothmans RE, Marco CA, Yang S. Human immunodeficiency virus infection and acquired immunodeficiency syndrome, in Tintinalli JE, Stapczynski JS, Ma OJ, et al (eds): Tintinalli’s Emergency Medicine, ed 7. New York, The McGraw-Hill Companies Inc., 2011.</ref>