PANCE Blueprint Pulmonary (10%)

HIV-related pneumonia

Patient will present as → a 32 year-old male with dyspnea and a nonproductive cough. His is tachycardic, tachypneic and febrile. Auscultation of his chest reveals scattered rhonchi. His chest x-ray demonstrates a diffuse interstitial infiltrate. His ABG demonstrates moderate hypoxemia and his LDH is elevated

Formerly PCP Pneumonia now called (PJP) Pneumocystis jiroveci (there are other HIV related pnuemonias but this is the one you will need to know for the test)

  • Common in HIV-infected patients with a low CD4 count of less than 200

CXR is the cornerstone of diagnosis.  The radiograph shows diffuse interstitial or bilateral perihilar infiltrates

  • Diagnose with a bronchoalveolar lavage (PCR), labs and an HIV test.
  • Will often have very low O2 saturation despite supplemental O2

Treat with Trimethoprim-sulfamethoxazole (BACTRIM) and steroids

  • If allergic treat with Pentamidine

Prophylaxis for high risk patients with a CD4 count of less than 200 or with a history of PJP infection.

  • Daily Bactrim is the prophylaxis antibiotic of choice.

Diffuse, bilateral, interstitial infiltrates

Diffuse, bilateral, interstitial or perihilar infiltrates

_IM_Pneumocystis-Jiroveci_v1.5_ Pneumocystis jiroveci is a fungal infection which typically presents with hypoxia and fever in the lungs of immunocompromised patients. The infection is usually diagnosed using classic x-ray findings of diffuse interstitial infiltration bilaterally. Definitive diagnosis can be made using lavage or biopsy, were it can be identified by methenamine on silver stain. In order to prevent the disease in patients with HIV and CD4 counts below 200, TMP-SMX is used prophylactically. TMP-SMX is also used as treatment for diagnosed disease.

Pneumocystis jiroveci Picmonic

Question 1
A 47 year-old HIV positive female presents with a complaint of a nonproductive cough. She is febrile, tachypneic and tachycardic. Lung exam reveals bilateral rales. Chest x-ray shows diffuse interstitial infiltrates. What is the recommended treatment in this patient?
A
trimethoprim-Sulfamethoxazole (Bactrim
B
tetracycline (Sumycin)
Hint:
Tetracycline, amantadine and ticarcillin are not effective against PCP.
C
amantadine (Symmetrel)
Hint:
Tetracycline, amantadine and ticarcillin are not effective against PCP.
D
ticarcillin (Ticar)
Hint:
Tetracycline, amantadine and ticarcillin are not effective against PCP.
Question 1 Explanation: 
TMP-SMX is the drug of choice for all forms of pneumocystis
Question 2
A 47 year-old HIV positive female presents with a complaint of a nonproductive cough. She is febrile, tachypneic and tachycardic. Lung exam reveals bilateral rales. Chest x-ray shows diffuse interstitial infiltrates. What is the recommended treatment in this patient?
A
trimethoprim-Sulfamethoxazole (Bactrim
B
tetracycline (Sumycin)
Hint:
Tetracycline, amantadine and ticarcillin are not effective against PCP.
C
amantadine (Symmetrel)
Hint:
Tetracycline, amantadine and ticarcillin are not effective against PCP.
D
ticarcillin (Ticar)
Hint:
Tetracycline, amantadine and ticarcillin are not effective against PCP.
Question 2 Explanation: 
TMP-SMX is the drug of choice for all forms of pneumocystis
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Fungal pneumonia (Prev Lesson)
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