RT Book, Section
A1 Raffanti, Stephen P.
A1 Person, Anna K.
A2 Knoop, Kevin J.
A2 Stack, Lawrence B.
A2 Storrow, Alan B.
A2 Thurman, R. Jason
SR Print(0)
ID 1181057377
T1 Pneumocystis
T2 The Atlas of Emergency Medicine, 5e
YR 2021
FD 2021
PB McGraw-Hill
PP New York, NY
SN 9781260134940
LK accessmedicine.mhmedical.com/content.aspx?aid=1181057377
RD 2024/04/16
AB Pneumocystis  jirovecii  (formerly  carinii)  pneumonia  (PJP)  is  the  most  common  opportunistic  infection  in  HIV-infected  patients.  Clinical  suspicion  for  PJP  pneumonia  in  any  HIV  patient  presenting  with  complaints  of  dyspnea  and  nonproductive  cough  should  remain  high,  especially  in  those  with  CD4  counts  <200  cells/mm3  who  are  not  on  appropriate  PJP  prophylaxis.  Presentations  can  be  indolent,  acute,  or  subacute,  with  associated  symptoms  including  fever,  fatigue,  anorexia,  weight  loss,  and  chest  pain.  The  complete  blood  count  is  usually  normal  except  for  lymphopenia,  whereas  serum  lactate  dehydrogenase  (LDH)  is  often  elevated.  Arterial  blood  gases  (ABGs)  most  often  reveal  a  respiratory  alkalosis,  PO2  of  70  mm  Hg  or  less,  and  an  increased  A-a  gradient  of  35  mm  Hg  or  more.  Radiographic  chest  findings  are  variable  with  diffuse  interstitial  alveolar  infiltrates  being  common.  Patients  may  have  normal  oxygen  saturation  levels  at  rest,  but  with  ambulation,  they  often  have  a  rapid  desaturation.