PNEUMOCYSTIS CARINII PNEUMONIA

·         A lung disease caused Pneumocystis jiroveci (fungus)

·         Most common opportunistic infction & major cause of mortality in HIV infected individuals especially in children.

·         People with HIV are potentially at risk from PCP if their CD4 cell count falls <200 cells/mm³.

·         It is usually the first sign of AIDS.

Signs & Symptoms:

ü  Fever & chills

ü  Non-productive cough

ü  Shortness of breath (especially with activity )

ü  Tachypnea

ü  Tachycardia

ü  Weight loss (wasting)

Additional findings in children:

ü  Cyanosis

ü  Nasal flaring

ü  Intercostal retractions

Diagnostic Exams:

§  Sputum induction: identifies presence of organism in the sputum

§  Bronchial-alveolar lavage: an invasive procedure which identifies presence of organism in lung tissue.

§  Transbronchial biopsy

§  Chest X-ray: widespread pulmonary infiltrates

§  CT Scan & Gallium 67 scan: helpful if CXR is vague.

§  ABG: to evaluate the need for possible adjunctive corticosteroid

Complications:

·         Pneumothorax

·         Respiratory Failure

   

Treatment:

Medications:

·         Prophylactic treatment for adults with HIV should start if CD4 count is <200/µL.

·         trimethoprim (TMP)/ sulfamethoxazole (SMX) (Bactrim^®, Septra^®): standard first-line treatment

Adverse Effects: rash, neutropenia, thrombocytopenia & Steven-Johnson syndrome, photophobia

·         pentamidine (Nebupent^®, Pentacarinat^®): antiprotozoal medication, used as 2^nd-line therapy for patient who can’t take TMP/SMX.

·         atovaquone (Mepron^®): broad-spectrum antiprotozoal compound

·         clindamycin (Dalacin^®, Evoclin^®): inhibits bacterial growth

·         trimetrexate (Neutrexin^®): licensed treatment for people who do not respond to, or are allergic to co-trimoxazole. It has to be taken with folinic acid to protect human cells against the drug's toxicities and target its effects against the PCP organisms.

·         Dapsone (Dapsone^®): given with trimethoprim;  inhibit bacterial growth

·         Corticosteroid: initial therapy for patients with severe PCP.

·         Mechanical ventilation/ endotracheal tube insertion

·         Prophylactic treatment with TMP-SMX for infant with HIV infected mother should start at 4-6 weeks of life.

Nursing Interventions:

·         Monitor CD4 cell count.

·         Administer prescribed medications; carefully assess for adverse effects.

·         Promote rest periods.

·         Assist patient in semi or High Fowler’s position.

·         Provide pulmonary care (cough, deep breathing, postural drainage and vibration).

·         Decrease viscosity of secretions by humidifying inspired air as prescribed.

·         Administer oxygen therapy as ordered. < 90% SO₂

·         Assist with ET intubation and maintain settings of mechanical ventilation as ordered.

·         Perform tracheal suctioning as needed.