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Questions and Answers
What is the CD4 count threshold for Pneumocystis jiroveci prophylaxis to begin?
What is the characteristic appearance of lungs on x-ray in Pneumocystis jiroveci infection?
What is the mechanism of damage to the lungs in 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?
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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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