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Disease Name: Pneumocystis Pneumonia


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Please review the Idaho Reportable Disease Rules (IDAPA 16.02.10) for the most up-to-date information.


Overview / Case Definition

Pneumonia is caused by the fungi Pneumocystis jiroveci. In HIV-infected patients, the most common manifestations of PCP are subacute onset of progressive dyspnea, fever, non-productive cough, and chest discomfort that worsens within days to weeks. With exertion, shortness of breath may occur. Fever is apparent in most cases and may be the predominant symptom in some patients.

In mild cases, pulmonary examination usually is normal at rest. With exertion, tachypnea, tachycardia, and diffuse dry (cellophane) rales might be observed. Oral thrush is a common co infection. Fever is apparent in most cases and could be the predominant symptom in some patients.


Restrictions

None


Reporting

Within 3 working days

Reportable by Healthcare and Labs:

Reportable by Food Service Facility:

Suspect Reportable:

Reporting Timeframe: Within 3 working days



Diagnosis / Testing

Because clinical presentation, blood tests, and chest radiographs are not pathognomonic for PCP, and because the organism cannot be cultivated routinely, histopathologic or cytopathologic demonstration of Pneumocystis jiroveci in tissue, bronchoalveolar lavage (BAL) fluid, or induced sputum samples is required for a definitive diagnosis. Spontaneously expectorated sputum has low sensitivity and should not be submitted to the laboratory to diagnose PCP.

Polymerase chain reaction (PCR) is an emerging method for diagnosing PCP. The sensitivity of PCR for bronchoalveolar lavage appears to be high; the ability of PCR to distinguish colonization from disease is less clear.

1,3ß-D-glucan (a nonspecific component of fungal cell walls) may be elevated in patients with PCP. This test’s sensitivity and specificity for establishing a PCP diagnosis are problematic and other fungal diseases can produce elevation. Nonetheless, 1,3ß-D-glucan testing is often ordered when evaluating a patient for whom PCP is a suspected diagnosis.


Treatment

Treating PCP in HIV infected individuals is covered in detail in CDC’s “Treating opportunistic infections among HIV-infected adults and adolescents”, available at http://www.cdc.gov/mmwr/PDF/rr/rr5315.pdf , and in “Treating Opportunistic Infections Among HIV-Exposed and Infected Children”, available at http://www.cdc.gov/mmwr/PDF/rr/rr5314.pdf, both published December 2004.


Additional Information


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