Pneumocystitis Pneumonia (PCP)

Horace opportunistic infection lecture

which organism causes PCP

Pneumocystitis jirovecii

Pneumocystitis jirovecii was once called…

pneumo. carinii

where is Pneumocystitis jirovecii found

everywhere

what type of organism is Pneumocystitis jirovecii

fungus

Pneumocystitis jirovecii is a fungus but it shares characteristics with…

protozoa

how does Pneumocystitis jirovecii spread

air

clinical manifestations of PCP

subacute onset of progressive symptoms that worsen within days - weeks

symptoms of PCP

dyspnea, fever, non productive cough, and chest discomfort

what CD4 count is most assoc with the development of PCP

< 200

diagnosis of PCP

clinical presentation, blood tests and chest x rays are not specific enough so must get resp tract samples

what are the 4 respiratory tract sample options for diagnosing PCP?

sputum

bronchoscopy with bronchoalveolar lavage

transbronchial biopsy

open lung biopsy

what is the sensitivity of a sputum respiratory tract sample?

50-90%

(so like not that good)

what is the sensitivity of a bronchoscopy with bronchoalveolar lavage respiratory tract sample?

90-99%

what is the sensitivity of a transbronchial biopsy and open lung biopsy respiratory tract sample?

95-100%

sensitivity and specificity of respiratory tract samples depends on…

the quality of the specimens and the experience of the microbiologist/pathologist

what are the lab findings associated with PCP

hypoxemia

lactate dehydrogenase > 500 (aka high)

chest radiograph

when should pts get prophylactic tx for PCP?

if CD4 count is < 200

or

if the patient cannot monitor their CD4 counts every 1-3 months they can get it is CD4is > 200

what are the two first line tx regimens for PCP prophylaxis?

(drug name, dose, admin, interval)

Bactrim 1 double strength tablet po daily

or

Bactrim 1 single strength tablet po daily

what are the alternative tx options for PCP prophylaxis?

(drug name only)

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what is the alternative tx option for PCP prophylaxis with bactrim?

(drug name, dose, admin, interval)

bactrim 1 double strength tablet po 3x a week

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if there are no other alternative for a patient that has had a non-life-threatening ADE in response to Bactrim when being treated for PCP prophylaxis.

What would be your course of action?

pt can continue bactrim tx but on a low dose, and then you can titrate it up so they get use to it

when can pts stop taking PCP prophylaxis tx?

if their CD4 counts increase to > 200 for more than 3 months

when do pts need to restart PCP prophylaxis tx?

if their CD4 count gets < 200 again

first line therapy for moderate/severe PCP

(drug name, dose, admin, interval, duration)

bactrim (15-20 mg TMP/ 75-100 mg SMX)/kg/day

IV admin q6h or q8h, for 21 days of therapy

first line therapy options for mild/moderate PCP

(drug name, dose, admin, interval, duration)

bactrim (15-20 mg TMP/ 75-100 mg SMX)/kg/day po in 3 daily divided doses

or

bactrim 160 mg TMP/ 800 mg SMX or a double strength tablet, take 2 tablets three times a day

duration for both is 21 days

duration for PCP tx is always

21 days

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first line therapy options for pregnant pts with PCP

bactrim

alt therapy options for pregnant pts with PCP

dapsone

TMP is associated with a small risk of increasing _____ in preg ppl who take it in the 1st trimester

neural tube defects, CV defects, urinary tract defects, etc

preg pts should not take ____ in the 1st trimester due to multiple defects that could occur in the fetus

TMP

which trimester is TMP unsafe in?

1st

preg pts with PCP should be getting ultrasounds at ____ after tx

18-20 weeks

preg ppl should be taking which supplement

folic acid

dapsone use near the time of delivery increases the risks of…

hyperbilirubinemia and kernicterus

the use of which medication leads to an increased risk of hyperbilirubinemia and kernicterus at the time of delivery?

dapsone

rate of preterm labor and delivery are increased with which disease…

pnemonias

preg ppl with pneumonias should be monitored for contractions beginning at which week of pregnancy

20 weeks