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Pneumocystis Pneumonia, Emergency Medicine

Alan M. Kumar Reviewed 06/2017
 


Basics

Description

  • Originally called Pneumocystis carinii pneumonia, then renamed Pneumocystis jirovecii but still referred to as PCP

  • Most common opportunistic infection in patients with HIV, even with ...

Diagnosis

Signs and Symptoms

  • Subacute presentation

  • Up to 7% of patients can be asymptomatic.

  • Patients on inhaled pentamidine prophylaxis may have milder symptoms:

    • Increased incidence of pneumothorax

    • Increa...

Treatment

Pre-Hospital

Provide supplemental oxygen for symptomatic patients. 

Initial Stabilization/Therapy

  • ABCs

  • Provide adequate oxygenation with nasal cannula up to 100% nonrebreather.

  • Perform endotrache...

Follow-Up

Disposition

Admission Criteria

  • Moderate to severe disease (PaO2 <70 mm Hg or A–a gradient >35 mm Hg)

  • Inability to digest medications

  • Inability to return for careful follow-up

Discharge Criteria

Pearls and Pitfalls

  • Include PCP in differential diagnosis in any patient presenting with shortness of breath who is immunocompromised or is suspected of having undiagnosed HIV.

  • Patients considered for ...

Additional Reading

  • Thomas  CF Jr, Limper  AH. Pneumocystis pneumonia. N Engl J Med.  2004;350:2487–2498.

  • Huang  L, Quartin  A, Jones  D, et al. Intensive care of patients with HIV infection. N Eng...

Codes

ICD9

136.3 Pneumocystosis 

ICD10

B59 Pneumocystosis 

SNOMED

  • 415125002 Pneumocystosis jiroveci pneumonia (disorder)

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