Download - pneumocystis jiroveci pneumonia in HIV
Case BMaryam AL-
Qahtani.G:6
30-year old man was admitted with history of fever and dyspnoea on exertion since 3 weeks.
He was a party smoker for age 16 until recently .He admitted having unprotected sex with multiple partners
He had no known exposure to tuberculosis , No asthma, he denied blood transfusion in the past.
He admitted having slight chest pain but having some pain and difficulty in swallowing.
His chest complaints were accompanied with non productive cough
Respiratory rate 36 respiration Heart fast but regular oxygen saturation was only 91% while breathing room air.
Objectives
Would you consider his
chest condition to be potentially
infectious to others ?
Should you isolate this
person in the meantime until
his condition proven to be non
– infectious ?
Outline the treatment plan for this disorder.
Would you consider his chest condition to be potentially infections to others?
Should you isolate this person in the meantime until his condition proven to be non-infections?
In healthy individuals
- present without any manifestation because they are under the control of immune system
-CD4+ T cells responsible for elimination of the organism.
-PCP remained in a latent state unless the patient became immunosuppressed .
Immunocompromised individuals
-There is evidence of Transmission only between the immunocompromised people .
The primary mode of transmission of P. jirovecii is via the airborne route.
Transmission of PCP
For our patient we suspect that he has
pneumocystis jiroveci pneumonia.
The fungal infection Pneumocystis
pneumonia is the most prevalent opportunistic
infection in patients with AIDS.
Infectious “immunocompromised
“
The jiroveci is one of opportunistic fungi infection which means that the fungi can be present in a normal person without any manifestation
they do not cause a disease for a healthy immune system, but they affect the immunecompromised patient.
ISOLATING
BUT…{
Avoid placement in the same room with an immunocompromised patient.
{Standard Precautions
Treatment of
Pneumocystis jiroveci
Pneumonia + HIV
HIV Treatment
Are designed to reduce HIV in the body. Keep the immune system as healthy as possible. Decrease the complications that may develop.
HIV Treatment
Aim:
There is no cure for HIV or AIDS, but medications are effective in
fighting HIV and its complications
Non-pharmacologic
Pharmacologic
Standard antiretroviral therapy (ART)
Antiretrovirals
CLASSTake 3 different antiretroviral drugs from 2
different classes , to maximally
suppress the HIV virus and stop
the progression of HIV disease.
o Untreated PCP is almost always
fatal.
o In patients infected with HIV, the
treatment response typically takes
longer but should occur within the
first 8 days.
o The length of treatment is 21 days
in HIV-infected patients.
Trea
tmen
t
may have one or more of the following :
o Antibiotic medicine for kill germs.
o Steroids: When patient do not have enough oxygen in the
blood. ”severe”
o Oxygen: may need extra oxygen to help patient breathe easier.
o A ventilator is a machine that gives patient oxygen and
breathes ,when patient cannot breathe well.
Preferred drug
Trimethoprim-sulfamethoxaz
ole
Treatment
Treatment Trimethoprim-sulfamethoxazole • Is the drug of choice. • Use as a pill or intravenously through the vein (by IV) in a hospital.
In moderate to severe disease should receive corticosteroids (prednisone 40 mg × 5 days)
Dosage 5 mg/kg of TMP every 8 hrs
Contraindication hypersensitivity, megaloblastic anemia due to folate deficiency
Common adverse affectsskin reaction (mild rash to anaphylaxis), drug fever, bone marrow suppression, nausea and vomiting, diarrhea, pancreatitis, nephritis, and hyperkalemia
Dapsone (Avlosulfon)
Dosage 100 mg daily
CI: hypersensitivity, G-6-PD deficiency
ADR: fever, rash, hemolytic anemia, nausea, vomiting, methemoglobinemia, hepatitis
Treatment
Atovaquone
Dosage 750 mg
CI: Hypersensitivity
ADR: rash, GI intolerance, diarrhea, headache, fever,
Treatment
Prophylaxis
All patients with a history of the pneumocystis infection.
Severely immunocompromised patients.
All HIV-positive individuals once their CD4 T-cell count falls below 200 cells/mm3.
It should be considered for:
Secondary Prophylaxis to Prevent Recurrence of Disease
Summary
Reference • Sax, PE, Tietjen, PA. Treatment of Pneumocystis carinii (P. jiroveci) • infection in HIV-infected patients. www.uptodate.com 2013 •http://www.uptodate.com/contents/clinical-presentation-and-diagnosis-of-pneumocystis-pulmonary-infection-in-hiv-infected-patients?source=search_result&search=Pneumocystis+jirovecii.&selectedTitle=1~150•http://depts.washington.edu/hivaids/oit/case2/discussion.html• http://www.drugs.com/cg/pneumocystis-jiroveci-pneumonia.html• http://aids.gov/hiv-aids-basics/just-diagnosed-with-hiv-aids/treatment-options/overview-of-hiv-treatments/
• http://emedicine.medscape.com/article/225976-overview#showall
Thank you