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Pneumocystis pneumonia 

Pneumocystis pneumonia
Chapter:
Pneumocystis pneumonia
DOI:
10.1093/med/9780198729228.003.0101
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date: 17 June 2019

Pneumocystis, first identified as a protozoan, was reclassified as a fungus on the basis of DNA analysis. Human Pneumocystis now is called Pneumocystis jirovecii. Pneumocystis pneumonia (PCP) remains a severe opportunistic infection with high mortality rates. The epidemiology of this infection is only beginning to emerge, and it includes the transmission of organisms between susceptible hosts, as well as probable acquisition from environmental sources. Clinical significant disease occurs almost entirely in immunocompromised people with deficient cell-mediated immunity, particularly people with human immunodeficiency virus (HIV) infection, recipients of immunosuppressive therapy after solid organ, haematopoietic stem cell transplantation, or treatment for malignant neoplasm, and children with primary immunodeficiency syndromes. PCP remains one of the most important AIDS indicator diseases among HIV-infected children. Classically, PCP presents with a characteristic syndrome of subacute diffuse pneumonitis with fever, tachypnoea, and cough. The severity of these signs and symptoms can vary. No combination of symptoms, signs, and chest radiographic findings is diagnostic of PCP. A definitive diagnosis of PCP requires the visualization of the organism in pulmonary tissue or respiratory tract secretion specimens in the presence of pneumonitis. Trimethoprim–sulfamethoxazole remains the mainstay of treatment and prophylaxis against PCP. Adjunctive corticosteroid therapy in severe cases suppresses pulmonary inflammation. Alternatively, pentamidine isethionate can be used. For mild to moderate cases, atovaquone, dapsone/trimethoprim, and clindamycin/primaquine are acceptable alternatives. The accumulation of knowledge about this organism is continuous, and many aspects of disease pathogenesis and treatment remain to be elucidated.

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