Pneumocystis jiroveci

TABLE 52-7. Prophylactic Options for Pneumocystis jiroveci Pneumonia and CMV50 51... 

Pneumocystis jiroveci prophylaxis See Table 52-7 Sulfa allergy... 

Pneumocystis jiroveci (formerly P. carinii)a b aMost common. 

This patient has the subjective symptoms of weight loss, decreased appetite, shortness of breath, and cough. Abnormal laboratory values include elevated temperature, decreased hemoglobin and hematocrit, and decreased CD4 count. Chest x-ray shows diffuse interstitial infiltrates bilaterally. Physical exam reveals thrush. The assessment is possible AIDS with CD4 count of 150 cells/mm3, thrush, a respiratory illness (possibly Pneumocystis jiroveci pneumonia), and anemia of chronic disease. He also has a history of hepatitis B, hypertension, and GERD (on famotidine), poor adherence to his anti hypertensive medications, and likely has an irregular daily regimen due to his occupation as a truck driver. 

For PCP Oxygen saturation on room air, induced sputum or bronchoalveolar lavage for presence of Pneumocystis jiroveci organisms... 

PCa cancCT of the prostate PCI pCTCutaneous coronary intCTvention PCN penicillin PCP phencyclidine PCP Pneumocystis jiroveci (fonuCTly carinii) pneumonia (a t5 pe of infection common in HIV infected or immunocompromised patients)... 

If it is decided to treat an upper RTI in general 5-7 days treatment suffices. In lower RTI generally 10-14 days are recommended. Two to three weeks of treatment is advised for Staphylococcus aureus, Legionella pneumophila. Pseudomonas aeruginosa, Pneumocystis jiroveci (formerly carinii) and severe aspiration-pneumonia. Tuberculosis, actinomycosis, nocardiosis, aspergillosis, melioidosis and anaerobic lung abscesses require many months of treatment. 

Prevention of infection caused by the acquisition of specific microorganisms which can lead to overt infection, e.g. meningococci, malaria parasites, mycobacteria, Pneumocystis jiroveci. 

Briel M, Bucher HC, Boscacci R, Furrer H. Adjunctive corticosteroids for Pneumocystis jiroveci pneumonia in patients with HlV-infection. Cochrane Database Syst Rev 2006. 

Clindamycin is indicated for the treatment of skin and soft-tissue infections caused by streptococci and staphylococci. It is often active against community-acquired strains of methicillin-resistant S aureus, an increasingly common cause of skin and soft tissue infections. Clindamycin is also indicated for treatment of anaerobic infection caused by bacteroides and other anaerobes that often participate in mixed infections. Clindamycin, sometimes in combination with an aminoglycoside or cephalosporin, is used to treat penetrating wounds of the abdomen and the gut infections originating in the female genital tract, eg, septic abortion and pelvic abscesses and aspiration pneumonia. Clindamycin is now recommended rather than erythromycin for prophylaxis of endocarditis in patients with valvular heart disease who are undergoing certain dental procedures. Clindamycin plus primaquine is an effective alternative to trimethoprim-sulfamethoxazole for moderate to moderately severe Pneumocystis jiroveci pneumonia in AIDS patients. It is also used in combination with pyrimethamine for AIDS-related toxoplasmosis of the brain. 

Sulfonamides are infrequently used as single agents. Many strains of formerly susceptible species, including meningococci, pneumococci, streptococci, staphylococci, and gonococci, are now resistant. The fixed-drug combination of trimethoprim-sulfamethoxazole is the drug of choice for infections such as Pneumocystis jiroveci (formerly P carinii) pneumonia, toxoplasmosis, nocardiosis, and occasionally other bacterial infections. 

Trimethoprim- sulfamethoxazole Synergistic combination of folate antagonists blocks purine production and nucleic acid synthesis Bactericidal activity against susceptible bacteria Urinary tract infections Pneumocystis jiroveci pneumonia toxoplasmosis nocardiosis Oral, IV renal clearance (half-life 8 h) dosed every 8-12 h t formulated in a 5 1 ratio of sulfamethoxazole to trimethoprim Toxicity Rash, fever, bone marrow suppression, hyperkalemia... 

Several drugs closely related to the sulfonamides have been used effectively in the long-term treatment of leprosy. The most widely used is dapsone (diaminodiphenylsulfone). Like the sulfonamides, it inhibits folate synthesis. Resistance can emerge in large populations of M leprae, eg, in lepromatous leprosy, if very low doses are given. Therefore, the combination of dapsone, rifampin, and clofazimine is recommended for initial therapy. Dapsone may also be used to prevent and treat Pneumocystis jiroveci pneumonia in AIDS patients. 

Other synergistic antimicrobial combinations have been shown to be more effective than monotherapy with individual components. Trimethoprim-sulfamethoxazole has been successfully used for the treatment of bacterial infections and Pneumocystis jiroveci (carinii) pneumonia. 3-Lactamase inhibitors restore the activity of intrinsically active but hydrolyzable 3-lactams against organisms such as S aureus and Bacteroides fragilis. Three major mechanisms of antimicrobial synergism have been established ... 

Pneumocystis jiroveci is a fungal organism found in humans (P carinii infects animals) that responds to antiprotzoal drugs. See Chapter 52. 

Pneumocystis jiroveci pneumonia (PCP) High-risk patients (eg, AIDS, leukemia, transplant) Trimethoprim-sulfamethoxazole, dapsone, or atovaquone Excellent... 

Pneumocystis jiroveci, P carinii3 Trimethoprim-sulfamethoxazole, 15-20 mg trimethoprim component/kg/d IV, or two double-strength tablets every 8 hours for 21 days Pentamidine... 

In a retrospective study, the use of glucocorticoids during Pneumocystis jiroveci pneumonia (mean total dose methylprednisolone 420 mg, mean treatment duration 12 days) did not increase the risk of development or relapse of tuberculosis or other AIDS-related diseases (SEDA-20, 377 322). The study included 129 patients (72 who took glucocorticoids and 57 who did not) who were... 

Pneumocystis jiroveci pneumonia has been precipitated or aggravated by glucocorticoids (SEDA-20, 377 SEDA-22, 450 272,350,351). There is some concern about the use of glucocorticoids as adjunctive therapy in patients with AIDS who develop Pneumocystis jiroveci pneumonia. The immunosuppressant properties of glucocorticoids have been reported to enhance the risk of tuberculosis and other AIDS-related diseases (for example Kaposi s sarcoma or cytomegalovirus infection). 

Pneumonia due to Pneumocystis jiroveci (formerly Pneumocystis carinii) has been attributed to high-dose corticotropin (30). 

Pneumocystis jiroveci Pneumonia Trimethoprim-sulfamethoxazole, pentamidine, or atovaquone... 

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