Thanks to Dr. Shalra Hameed for a great morning report on PCP!

Learning Points:

• Five causes of hypoxemia: low FiO2, hypoventilation, impaired diffusion, shunt and V/Q mismatch
• Pneumocystis jirovecii is actually a fungus and NOT a protozoan as originally thought!
• Predominantly seen in immunocompromised patients including HIV, transplant patients, chronic steroid use, etc…
• Presentation varies, however includes fevers, cough, dyspnea, malaise, hypoxemia
• Diagnosis: PCP DFA (gold standard), sputum PCR, oropharyngeal wash and serology; LDH can also be elevated; however can be a clinical diagnosis in the appropriate patient
• Treament: Bactrim IV/PO (gold standard), Pentamidine, Clindamycin, Primaquine
• Indications for steroid use: A-a gradient >35 or PaO2 <70

Click here to review the data supporting the use of adjunctive corticosteroids for PCP in HIV-infected patients