Pneumocystis jirovecii (Pneumocystis pneumonia)

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Pneumocystis jirovecii (Pneumocystis pneumonia)

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A 65-year-old man comes to the emergency department for evaluation of three weeks of a dry cough, shortness of breath, and fever. The patient has noted significant weight loss (10 lb) over the last nine months. Past medical history is significant for dyslipidemia, HIV, and CMV retinitis. The patient is noncompliant with antiretroviral therapy. Current medications include tenofovir-emtricitabine and dolutegravir and atorvastatin. The patient is sexually active with men and uses condoms inconsistently. The patient does not use intravenous drugs, alcohol, or tobacco. The patient owns two parrots and a cat. Temperature is 38.11°C (100.0°F), pulse is 121/min, respirations are 26/min, and blood pressure is 98/75 mmHg, SpO2 is 89% on room air. The patient is using accessory muscles of respiration. Physical examination reveals anterior and posterior cervical lymphadenopathy. Oral examination reveals white, mucosal plaques on the lateral aspect of the tongue that cannot be scraped off with a tongue depressor. Rales are present in the bilateral anterior lung fields. A CT of the patient’s chest is depicted below.  CD4 count is 157 cells/microL. Which of the following organisms is the most likely etiology of this patient’s current disease process?
 
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Pneumocystis jirovecii p. , 151

dapsone p. 191

HIV-positive adults p. 174

immunocompromised patients p. 176

silver stain for p. 123

TMP-SMX p. 191

AIDS (acquired immunodeficiency syndrome)

Pneumocystis jirovecii p. , 151

Atovaquone

for Pneumocystis jirovecii p. , 151

Dapsone p. 191

Pneumocystis jirovecii p. , 151

HIV (human immunodeficiency virus) p. 173

Pneumocystis jirovecii p. , 151

Immunocompromised patients

Pneumocystis jirovecii p. , 151

Pneumonia p. 701

Pneumocystis jirovecii p. , 151

TMP-SMX p. 191

for Pneumocystis jirovecii p. , 151

Pneumocystis spp. p. 115

Pneumocystis pneumonia

HIV-positive adults p. 174

prophylaxis p. 194

Summary

Pneumocystis jirovecii sometimes referred to as Pneumocystis carinii, is a fungus known to cause a severe lung infection called Pneumocystis pneumonia (PCP). PCP commonly affects individuals with weakened immune systems, such as people with HIV/AIDS, cancer patients receiving chemotherapy, or people taking immunosuppressive drugs. Symptoms of PCP can include fever, cough, shortness of breath, and difficulty breathing. Treatment typically involves antifungal medications, such as trimethoprim-sulfamethoxazole, pentamidine, or dapsone.