Pneumocystis pneumonia (PCP) is an opportunistic fungal infection affecting the lungs among people having compromised immunity. The disease is often seen in people suffering from HIV, cancer patients undergoing chemotherapy, or people taking immunosuppressant medicines for a long time. Fungus responsible for pneumocystis pneumonia is called pneumocystis jiroveci, formerly known as P. carinii.
Transmission of fungus occurs through air. The organism is ubiquitous in its distribution and most children normally get exposed and fight out the infection by the age of 3 to 4 years. The problem occurs only in immunocompromised states.It can be potentially life threatening in them.
Before the advent of antiretroviral medicines for HIV, majority of people at some point suffered from pneumocystis pneumonia. But in recent times preventive medications have reduced the incidences, although still a patient may contract the infection if his CD4 count becomes less than 200. Treatment of patients suffering from PCP requires use of appropriate antimicrobial therapy which is often combined with steroids.
Signs And Symptoms Of Pneumocystis Pneumonia
Pneumocystis pneumonia presents itself as a slow and progressive disease. Initially the symptoms may be mild. Below are given important symptoms of pneumocystis pneumonia:
- Low grade fever since many days, especially if the patient has HIV infection.
- Dry and non productive cough. In pneumocystis pneumonia, sputum production is less unless there is an additional bacterial infection.
- Breathlessness especially with physical exertion.
- Drenching sweat during night.
- Severe fatigue
- Pain in chest
- Oral thrush
- Rapid heart rate
- Loss of weight
In some cases pneumothorax may develop if the tiny tissues of lung rupture. Pneumothorax is collection of air in the space between the chest wall and lung. Patient may experience severe, sudden and sharp pain in chest, shortness of breath, and reduced air entry in the affected lung. Pneumothorax although rare is one of the complications of pneumocystis pneumonia.
Causes Of Pneumocystis Pneumonia
Pneumocystis pneumonia is caused by fungus called pneumocystis jiroveci. It is a rare form of pneumonia. Usually a healthy person with strong immunity does not suffer from this fungal infection of lung, although a subclinical infection may have occurred during the young age.
Since the fungus is opportunistic, people with HIV infection, person taking chemotherapy for cancer, or people who have recently undergone organ transplant, people taking medications for autoimmune disease etc are prone to get infected. It is because of low immunity in such people.
Transmission occurs through air. In humans, the pathogen remains confined into the lung once it enters through air. In pre-AIDS era, pneumocystis pneumonia was often seen in malnourished people and premature babies. However, now majority of cases across the world are seen in HIV infected individuals, especially if the CD4 count is less than 200.
Diagnosis And Treatment Of Pneumocystis Pneumonia
The diagnosis of pneumocystis pneumonia is confirmed with the help of several tests. X-ray chest shows infiltration marking in the lungs with ground glass opacity of lungs. CT scan of chest, blood PCR test, sputum PCR test, bronchoscopic biopsy all assist in determining and confirming pneumocystis jiroveci causing pneumonia.
In majority of the treatment choice remains use of antibacterial medicines. The doctor after selecting appropriate dose of antibacterial medicine either recommends the patient to take it orally or may need intravenous administration of the drug.
Oral formulations are found to be effective in mild or moderate cases, while in serious life threatening pneumocystis pneumonia the drug is administered intravenous route. Steroids are often combined with the therapy.