Pneumocystis pneumonia (PCP) management

Pneumocystis pneumonia (PCP) management

Pneumocystis pneumonia (PCP), also known as Pneumocystis jirovecii pneumonia (PJP), is an opportunistic fungal infection that commonly occurs in immunocompromised individuals, particularly patients with HIV/AIDS.

Clinical presentation

• Dry or productive cough

• Exertional dyspnoea

• Fever

• Tachypnoea

• Chest pain

• Signs of AIDS may be present, including:

  • Oral thrush

  • Oral hairy leucoplakia

  • Kaposi's sarcoma

• Scattered crackles and wheeze may be present on auscultation

• Rarely, signs of focal consolidation may be present

• Pulse oximetry may show low oxygen saturation (SaO₂) at rest

• Extra-pulmonary disease may manifest as:

  • Hepatosplenomegaly

  • Lymphadenopathy

  • Ocular disease

Investigations

• Elevated lactate dehydrogenase (LDH)

• Arterial blood gas (ABG) may show hypoxia

• Increased alveolar-arterial oxygen tension gradient

• Serum (1→3)-Beta-D-glucan levels may be elevated

• Chest X-ray

• CT chest

  • Ground-glass infiltrates may be present

  • Has low sensitivity and specificity

• Gallium scan

  • Highly sensitive

  • Low and variable specificity

• Pulmonary function tests (PFTs)

  • Reduced vital capacity (VC)

  • Reduced total lung capacity (TLC)

Pharmacological treatment

First-line treatment

• Co-trimoxazole (PO) 1920 mg every 8 hours for 21 days

AND

• Folic acid (PO) 5 mg every 24 hours if cytopenic

Sulpha allergy

• Clindamycin (PO) 450–600 mg every 6 hours for 21 days

Severe PCP

• Add Prednisolone 30–40 mg for 14 days.

• Consider tapering after recovery.