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Questions and Answers
What is the CD4 count threshold for Pneumocystis jiroveci prophylaxis to begin?
What is the CD4 count threshold for Pneumocystis jiroveci prophylaxis to begin?
- Below 500
- Below 200 (correct)
- Below 1000
- Below 100
What is the characteristic appearance of lungs on x-ray in Pneumocystis jiroveci infection?
What is the characteristic appearance of lungs on x-ray in Pneumocystis jiroveci infection?
- Ground glass or patchy infiltrate (correct)
- Diffuse consolidation with air bronchograms
- Patchy infiltrate with nodules
- Pleural effusions with lung collapse
What is the mechanism of damage to the lungs in Pneumocystis jiroveci infection?
What is the mechanism of damage to the lungs in Pneumocystis jiroveci infection?
- Inhibits surfactant production
- Damages alveolar macrophages
- Damages alveolar epithelium and causes serum leaks (correct)
- Causes bronchospasm and airway constriction
Why is it difficult to diagnose Pneumocystis jiroveci infection?
Why is it difficult to diagnose Pneumocystis jiroveci infection?
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What is the alternative to Bactrim (TMP/SMX) for prophylaxis in patients with sulfa allergies?
What is the alternative to Bactrim (TMP/SMX) for prophylaxis in patients with sulfa allergies?
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Study Notes
Pneumocystis jirovecii (PCP)
- Associated with AIDS, typically occurring when CD4 counts are below 200
- Symptoms are evident in immunocompromised individuals, such as those with AIDS or young children
Diagnosis
- Bronchoalveolar lavage (BAL) is used for diagnosis
- Methenamine silver stain is used to identify the fungus, which appears as disc-shaped yeasts
Radiographic Appearance
- Ground glass appearance in both lungs
- Patchy infiltrate appearance on x-ray
- Foamy honeycomb appearance, damaging alveolar epithelium and causing serum leaks
Treatment and Prophylaxis
- Prophylaxis begins when CD4 count is below 200
- Bactrim (TMP/SMX) is used for prophylaxis
- Pentamidine can be used as an alternative for those with sulfa allergies
Characteristics of Pneumocystis jirovecii
- Obligate extracellular fungus, cannot be cultured
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