Klin Farmakol Farm. 2005;19(2):106-110

Pneumocystis pneumonia

doc. MUDr. Jana Skřičková CSc

Klinika nemocí plicních a tuberkulózy, FN Brno Bohunice

Pneumocystis jiroveci (carinii) pneumonia occurs in immunosuppressed patients, mostly those with depression of T-lymphocyte immunity, or, less commonly, in those with severe hypogammaglobulinaemia. In individuals with no immune derangement, Pneumocystis jiroveci (carinii) is considered to be a harmless ubiquitous pathogen; the frequent occurrence of anti-pneumocystis antibodies in four-year-olds seems to corroborate this opinion. Comparative DNA analysis has confirmed that Pneumocystis jiroveci (carinii) is a fungal organism. The diagnosis of Pneumocystis jiroveci (carinii) is established by identification of the organism in lung samplings. As sputum is only seldom produced by the patients, the most commonly used samplings include saline lavage samples obtained via fiberoptic bronchoscopyand sputum induced by inhaled nebulized hypertonic saline. The cyst phase of the organism may be identified on microscopy after methamine silver staining, Giemsa staining may demonstrate the small punctated nuclei of trophozoites and intracystic sporozoites, and fluorescent-tagged monoclonal antibodies may also be used. More recently, DNA amplification has been developed for diagnosis. The principal symptom is almost invariably dyspnoea, which is exertional initially, but eventually presents at rest. Cough occurs in approximately half of the cases. Febrile symptoms are present in half of the cases. Chest pain and wheeze are not among the typical features. Crackles may be heard in about a third of cases. The presence of tachypnoea and cyanosis depends on the severity of the disease. The chest X-ray shows diffuse bilateral radiological changes in the great majority of cases. At present, trimethoprim with sulfamethoxazole is considered to be the therapy of choice for pneumocystis pneumonia. The intravenous route is preferred at the start; as soon as clinical improvement occurs, oral therapy is possible unless prevented by gastrointestinal problems. Parenteral application of pentamidine is an alternative for patients with such untoward reactions after trimethoprim with sulfamethoxazole and for patients failing to improve after trimethoprim and sulfamethoxazole within 7–10 days.

Keywords: Key words: Pneumocystis jiroveci (carinii), Pneumocystis jiroveci (carinii) pneumonia, HIV, immunosuppression, treatment.

Published: January 1, 2006  Show citation