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Concept
Pneumocystis pneumonia
Summary
Pneumocystis pneumonia (PCP), also known as Pneumocystis jirovecii pneumonia (PJP), is a form of pneumonia that is caused by the yeast-like fungus Pneumocystis jirovecii.
Pneumocystis specimens are commonly found in the lungs of healthy people although it is usually not a cause for disease. However, they are a source of opportunistic infection and can cause lung infections in people with a weak immune system or other predisposing health conditions. PCP is seen in people with HIV/AIDS (who account for 30-40% of PCP cases), those using medications that suppress the immune system, and people with cancer, autoimmune or inflammatory conditions, and chronic lung disease.
Signs and symptoms may develop over several days or weeks and may include: shortness of breath and/or difficulty breathing (of gradual onset), fever, dry/non-productive cough, weight loss, night sweats, chills, and fatigue. Uncommonly, the infection may progress to involve other visceral organs (such as the liver, spleen, and kidney).
Cough - typically dry/non-productive because sputum becomes too viscous to be coughed up. The dry cough distinguishes PCP from typical pneumonia.
Pneumothorax is a well-known complication of PCP. Also, a condition similar to acute respiratory distress syndrome (ARDS) may occur in patients with severe Pneumocystis pneumonia, and such individuals may require intubation.
The risk of PCP increases when CD4-positive T-cell levels are less than 400 cells/μL. In these immunosuppressed individuals, the manifestations of the infection are highly variable. The disease attacks the interstitial, fibrous tissue of the lungs, with marked thickening of the alveolar septa and alveoli, leading to significant hypoxia, which can be fatal if not treated aggressively. In this situation, lactate dehydrogenase levels increase and gas exchange is compromised. Oxygen is less able to diffuse into the blood, leading to hypoxia, which along with high arterial carbon dioxide () levels, stimulates hyperventilatory effort, thereby causing dyspnea (breathlessness).
Official source
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