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Pneumocystis jiroveci pneumonia

Definition

Pneumocystis jiroveci pneumonia is a fungal infection of the lungs. The disease used to be called Pneumocystis carinii.

Alternative Names

Pneumocystosis; PCP; Pneumocystis carinii

Causes, incidence, and risk factors

This type of pneumonia is caused by the fungus Pneumocystis jiroveci. This fungus is common in the environment and does not cause illness in healthy people.

However, it can cause a lung infection in people with a weakened immune system due to:

• Cancer
• Chronic use of corticosteroids or other medications that weaken the immune system
• HIV/AIDS
• Organ or bone marrow transplant

Pneumocystis jiroveci was a relatively rare infection before the AIDS epidemic. Before the use of preventive antibiotics for the condition, most people in the United States with advanced AIDS would develop it.

Symptoms

Pneumocystis pneumonia in those with AIDS usually develops slowly over days to weeks or even months, and is less severe. People with pneumocystis pneumonia who do not have AIDS usually get sick faster and are more acutely ill.

Symptoms include:

• Cough -- often mild and dry
• Fever
• Rapid breathing
• Shortness of breath -- especially with activity (exertion)

Signs and tests

• Blood gases
• Bronchoscopy (with lavage)
• Lung biopsy
• X-ray of the chest
• Sputum exam to check for fungus that causes the infection

Treatment

Antibiotics can be given by mouth (orally) or through a vein (intravenously), depending on the severity of the illness.

People with low oxygen levels and moderate to severe disease are often prescribed corticosteroids as well.

Support Groups

Expectations (prognosis)

Pneumocystis pneumonia can be life threatening, causing respiratory failure that can lead to death. People with this condition need early and effective treatment. For moderate to severe pneumocystis pneumonia in people with AIDS, the short term use of corticosteroids has decreased death.

Complications

• Pleural effusion (extremely rare)
• Pneumothorax (collapsed lung)
• Respiratory failure (may require breathing support)

Calling your health care provider

If you have a weakened immune system due to AIDS, cancer, transplantation, or corticosteroid use, call your doctor if you develop a cough, fever, or shortness of breath.

Many infections can lead to similar symptoms. Your health care provider can help rule out opportunistic infections such as pneumocystis.

Prevention

Preventive therapy is recommended for:

• Patients with AIDS who have CD4 counts below 200
• Bone marrow transplant recipients
• Organ transplant recipients
• People who take long-term, high-dose corticosteroids
• People who have had previous episodes of this infection

References

Feinberg JE. Pneumocystis pneumonia. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 362.