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Pneumocystis jirovecii 

Pneumocystis jirovecii
Chapter:
Pneumocystis jirovecii
Author(s):

Robert F. Miller

, and Christopher P. Eades

DOI:
10.1093/med/9780198746690.003.0156
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date: 05 March 2021

The ascomycete fungus Pneumocystis jirovecii (previously called Pneumocystis carinii) is the cause of pneumocystis pneumonia in humans, which occurs largely among people with impaired CD4+ T-lymphocyte function or numbers (e.g. those infected with HIV, recipients of solid organ or haematopoietic stem cell transplants, and those taking therapeutic immunosuppressive agents). The organism is restricted to humans, and disease is now thought to arise from de novo infection by inhalation from an exogenous source. Aside from supportive care, first-line therapy of pneumocystis pneumonia is sulphamethoxazole–trimethoprim (co-trimoxazole, which has a high rate of treatment-limiting adverse drug reactions), with adjunctive corticosteroids indicated for those with severe disease (i.e. hypoxaemia). In patients whose disease is failing to respond, or those intolerant of co-trimoxazole, the main alternatives are intravenous pentamidine or clindamycin with primaquine. Among HIV-infected patients, early initiation of antiretroviral therapy (i.e. within 14 days of starting antipneumocystis pneumonia therapy) is beneficial.

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