Pneumonia due to Pneumocystis Jirovecii
What is Pneumocystis pneumonia? — Pneumocystis pneumonia is a lung infection that causes coughing, fever, and trouble breathing (figure 1). It is caused by a fungus. Pneumocystis pneumonia is also called "PCP" or "PJP."
Pneumocystis pneumonia is most common in people who have conditions that weaken the body's infection-fighting system, called the "immune system." If the immune system is weak, it cannot fight off the fungus that causes Pneumocystis pneumonia. People with healthy immune systems rarely get this infection.
Certain conditions and medicines can increase a person's risk of Pneumocystis pneumonia. They include:
HIV infection – HIV is a virus that affects the immune system.
An organ transplant or stem cell transplant – Stem cells are special cells that can turn into many different types of cells. For transplant, they can be taken from bone marrow or blood.
Cancer, especially blood cancers such as leukemia
Medicines that partly "turn off" the immune system, such as high doses of steroids – This is especially true for people who also have one of the conditions above.
What are the symptoms of Pneumocystis pneumonia? — The symptoms of Pneumocystis pneumonia can include:
Cough – Most people have a dry cough that does not bring up mucus
Feeling much more tired than usual
Chest pain, especially when taking a deep breath
Losing weight without trying
Should I see a doctor or nurse? — Yes. If you have HIV or another condition that weakens your immune system, and have any of the symptoms above, call or see a doctor or nurse as soon as possible. Pneumocystis pneumonia can be very serious. It is important to get treatment right away.
Will I need tests? — Yes. Your doctor or nurse will ask about your symptoms and do an exam. He or she will probably do a chest X-ray to look for infection in your lungs.
If the chest X-ray does not show infection, your doctor might do an imaging test called a "CT scan" if he or she still thinks you could have Pneumocystis pneumonia. A CT scan creates a better image of the lungs than an X-ray does.
You might also have other tests. These can include:
Tests on fluid from your lungs
How is Pneumocystis pneumonia treated? — Pneumocystis pneumonia is treated with medicines to kill the fungus that causes it. These include trimethoprim-sulfamethoxazole (brand names: Bactrim, Septra), atovaquone (brand name: Mepron), and other medicines.
Depending on your situation, your doctor might also give you steroid medicine to help your lungs get better. Steroids help by reducing inflammation in your lungs. This medicine is not the same as the steroids athletes take to build up muscle.
Some people can take medicine at home, but many people need treatment in the hospital. People who are treated in the hospital might get medicine through a thin tube that goes into their vein, called an "IV." Some people also get extra oxygen to help them breathe more easily. People who are having a very hard time breathing might be treated with a breathing machine called a "ventilator."
How soon will I feel better? — Most people start to feel better 4 to 7 days after they start taking medicine. If you do not start feeling better, the doctor can give you a different medicine or give you medicine through an IV.
Can Pneumocystis pneumonia be prevented? — Sometimes. Doctors can give antibiotics to people with certain medical conditions, such as HIV, and to some people with lowered immune systems who are also taking steroid pills or getting IV steroid medicines for a long time. The antibiotics help prevent Pneumocystis pneumonia.
All topics are updated as new evidence becomes available and our peer review process is complete.
This topic retrieved from UpToDate on: Mar 30, 2020.
Topic 17209 Version 8.0
Release: 28.2.2 - C28.105
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