Pneumonia is an infection of the lungs. Pneumocystis pneumonia is a serious, possibly life-threatening illness. More than half of people survive if treated, but survival is lower for people with severe immune (infection-fighting) system problems. Pneumocystis pneumonia can come back after treatment if preventive drugs aren’t used.
Pneumocystis jiroveci (formerly called Pneumocystis carinii) is a fungal or protozoal organism that usually causes pneumonia in people with weak immune systems. Such people include those with human immunodeficiency virus (HIV) infection and those getting cancer chemotherapy, long-term prednisone therapy, or drugs to stop transplant rejection. It’s unclear how this pneumonia develops. The fungus may spread person to person. It may also be inactive for years and then become active when the immune system is weak.
Symptoms usually start slowly and become worse over time. The most common symptoms are shortness of breath, dry cough, and fever. Others are weight loss, chest discomfort, and chills.
The health care provider uses chest x-rays and blood tests to decide the severity of the illness. Special tests may be needed, including sputum tests for Pneumocystis and bronchoscopy. For bronchoscopy, the doctor looks at the lungs with a lighted tube passed through the nose or mouth. Lung fluids are collected and biopsy samples may be taken.
The medication trimethoprim/sulfamethoxazole (TMP/SMX) is usually the first drug tried. It’s given orally or intravenously. Other drugs include pentamidine, for those allergic to sulfa or who don’t get better with TMP/SMX. Therapy is usually given for up to 21 days. Anti-inflammatory steroids (corticosteroids) are used in severe cases to help reduce lung inflammation.
Severely ill patients are hospitalized for supportive treatments such as supplemental oxygen and mechanical ventilation in an intensive care unit. The most common side effects include rash, nausea, fever, and low white blood cell counts.
Oral TMP/SMX is effective for preventing this pneumonia. It can be given as one tablet three times per week or daily. People who are HIV-positive, have low CD4 counts, had previous pneumocystis pneumonia, or are using corticosteroids or other immunosuppressant drugs should receive this preventive therapy.
Prognosis is worse for people with lung disease, with pneumothorax, needing mechanical ventilation, and when diagnosis and treatment are delayed.
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Copyright © 2016 by Saunders, an imprint of Elsevier, Inc.
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