Download - pneumocystis jiroveci pneumonia in HIV
![Page 1: pneumocystis jiroveci pneumonia in HIV](https://reader035.vdocuments.us/reader035/viewer/2022062307/55654fccd8b42a902d8b5251/html5/thumbnails/1.jpg)
Case BMaryam AL-
Qahtani.G:6
![Page 2: pneumocystis jiroveci pneumonia in HIV](https://reader035.vdocuments.us/reader035/viewer/2022062307/55654fccd8b42a902d8b5251/html5/thumbnails/2.jpg)
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.
![Page 3: pneumocystis jiroveci pneumonia in HIV](https://reader035.vdocuments.us/reader035/viewer/2022062307/55654fccd8b42a902d8b5251/html5/thumbnails/3.jpg)
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.
![Page 4: pneumocystis jiroveci pneumonia in HIV](https://reader035.vdocuments.us/reader035/viewer/2022062307/55654fccd8b42a902d8b5251/html5/thumbnails/4.jpg)
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.
![Page 5: pneumocystis jiroveci pneumonia in HIV](https://reader035.vdocuments.us/reader035/viewer/2022062307/55654fccd8b42a902d8b5251/html5/thumbnails/5.jpg)
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?
![Page 6: pneumocystis jiroveci pneumonia in HIV](https://reader035.vdocuments.us/reader035/viewer/2022062307/55654fccd8b42a902d8b5251/html5/thumbnails/6.jpg)
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
![Page 7: pneumocystis jiroveci pneumonia in HIV](https://reader035.vdocuments.us/reader035/viewer/2022062307/55654fccd8b42a902d8b5251/html5/thumbnails/7.jpg)
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.
![Page 8: pneumocystis jiroveci pneumonia in HIV](https://reader035.vdocuments.us/reader035/viewer/2022062307/55654fccd8b42a902d8b5251/html5/thumbnails/8.jpg)
ISOLATING
BUT…{
Avoid placement in the same room with an immunocompromised patient.
{Standard Precautions
![Page 9: pneumocystis jiroveci pneumonia in HIV](https://reader035.vdocuments.us/reader035/viewer/2022062307/55654fccd8b42a902d8b5251/html5/thumbnails/9.jpg)
Treatment of
Pneumocystis jiroveci
Pneumonia + HIV
![Page 10: pneumocystis jiroveci pneumonia in HIV](https://reader035.vdocuments.us/reader035/viewer/2022062307/55654fccd8b42a902d8b5251/html5/thumbnails/10.jpg)
HIV Treatment
![Page 11: pneumocystis jiroveci pneumonia in HIV](https://reader035.vdocuments.us/reader035/viewer/2022062307/55654fccd8b42a902d8b5251/html5/thumbnails/11.jpg)
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
![Page 12: pneumocystis jiroveci pneumonia in HIV](https://reader035.vdocuments.us/reader035/viewer/2022062307/55654fccd8b42a902d8b5251/html5/thumbnails/12.jpg)
Non-pharmacologic
![Page 13: pneumocystis jiroveci pneumonia in HIV](https://reader035.vdocuments.us/reader035/viewer/2022062307/55654fccd8b42a902d8b5251/html5/thumbnails/13.jpg)
Pharmacologic
Standard antiretroviral therapy (ART)
![Page 14: pneumocystis jiroveci pneumonia in HIV](https://reader035.vdocuments.us/reader035/viewer/2022062307/55654fccd8b42a902d8b5251/html5/thumbnails/14.jpg)
Antiretrovirals
![Page 15: pneumocystis jiroveci pneumonia in HIV](https://reader035.vdocuments.us/reader035/viewer/2022062307/55654fccd8b42a902d8b5251/html5/thumbnails/15.jpg)
CLASSTake 3 different antiretroviral drugs from 2
different classes , to maximally
suppress the HIV virus and stop
the progression of HIV disease.
![Page 16: pneumocystis jiroveci pneumonia in HIV](https://reader035.vdocuments.us/reader035/viewer/2022062307/55654fccd8b42a902d8b5251/html5/thumbnails/16.jpg)
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
![Page 17: pneumocystis jiroveci pneumonia in HIV](https://reader035.vdocuments.us/reader035/viewer/2022062307/55654fccd8b42a902d8b5251/html5/thumbnails/17.jpg)
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.
![Page 18: pneumocystis jiroveci pneumonia in HIV](https://reader035.vdocuments.us/reader035/viewer/2022062307/55654fccd8b42a902d8b5251/html5/thumbnails/18.jpg)
Preferred drug
Trimethoprim-sulfamethoxaz
ole
Treatment
![Page 19: pneumocystis jiroveci pneumonia in HIV](https://reader035.vdocuments.us/reader035/viewer/2022062307/55654fccd8b42a902d8b5251/html5/thumbnails/19.jpg)
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
![Page 20: pneumocystis jiroveci pneumonia in HIV](https://reader035.vdocuments.us/reader035/viewer/2022062307/55654fccd8b42a902d8b5251/html5/thumbnails/20.jpg)
Dapsone (Avlosulfon)
Dosage 100 mg daily
CI: hypersensitivity, G-6-PD deficiency
ADR: fever, rash, hemolytic anemia, nausea, vomiting, methemoglobinemia, hepatitis
Treatment
![Page 21: pneumocystis jiroveci pneumonia in HIV](https://reader035.vdocuments.us/reader035/viewer/2022062307/55654fccd8b42a902d8b5251/html5/thumbnails/21.jpg)
Atovaquone
Dosage 750 mg
CI: Hypersensitivity
ADR: rash, GI intolerance, diarrhea, headache, fever,
Treatment
![Page 22: pneumocystis jiroveci pneumonia in HIV](https://reader035.vdocuments.us/reader035/viewer/2022062307/55654fccd8b42a902d8b5251/html5/thumbnails/22.jpg)
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
![Page 23: pneumocystis jiroveci pneumonia in HIV](https://reader035.vdocuments.us/reader035/viewer/2022062307/55654fccd8b42a902d8b5251/html5/thumbnails/23.jpg)
Summary
![Page 24: pneumocystis jiroveci pneumonia in HIV](https://reader035.vdocuments.us/reader035/viewer/2022062307/55654fccd8b42a902d8b5251/html5/thumbnails/24.jpg)
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
![Page 25: pneumocystis jiroveci pneumonia in HIV](https://reader035.vdocuments.us/reader035/viewer/2022062307/55654fccd8b42a902d8b5251/html5/thumbnails/25.jpg)
Thank you