The Internet Book of Critical Care Podcast IBCC Episode 121 - Pneumocystis Jiroveci Pneumonia
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Feb 21, 2022 A deep dive into Pneumocystis pneumonia, from recognizing risk in people with HIV and those taking steroids or living with transplants to interpreting lung imaging and choosing diagnostic tests. The discussion explores bronchoscopy versus noninvasive sampling, when to start treatment before results, and the role of steroids and antimicrobial therapy.
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Different Immune Responses in HIV Status
- HIV-positive patients with Pneumocystis jiroveci pneumonia (PJP) typically have a higher pathogen burden but mount a weaker immune response.
- HIV-negative patients mount stronger immune responses, often resulting in more acute, fulminant illness and worse outcomes.
Changing Epidemiology of PJP in HIV
- PJP is now mainly seen in HIV patients unaware of their status or not adhering to treatment.
- Highly active antiretroviral therapy has greatly reduced PJP incidence in well-controlled HIV patients.
Steroid and Immunosuppression Risks for PJP
- Chronic steroid use (>15 mg prednisone >2 months) is the leading cause of PJP in HIV-negative patients.
- Risk depends on context, with malignancy, rheumatologic disease, and transplant status increasing susceptibility.