The Intern At Work: Internal Medicine 259. The Internist's Guide to PJP
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Nov 17, 2024 Dr. Nisha Andany, a clinician teacher and infectious diseases program director at the University of Toronto, shares her expertise on Pneumocystis jirovecii pneumonia (PJP). She discusses the shifting demographics and risk factors, particularly in immunocompromised individuals. The conversation highlights how symptoms differ between HIV-positive and negatively affected patients. Dr. Andany elaborates on diagnostic strategies, treatment approaches tailored to severity, and the critical importance of prophylaxis based on CD4 counts.
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PJP Mainly Affects T-Cell Immunity
- Pneumocystis jirovecii pneumonia (PJP) affects mostly immunocompromised hosts with impaired T cell function.
- People with HIV and CD4 counts below 200 are at risk, but it increasingly occurs in HIV-negative immunocompromised patients.
Distinct PJP Presentations by HIV Status
- PJP in HIV patients typically presents subacutely with fever, nonproductive cough, and dyspnea.
- In HIV-negative immunocompromised patients, PJP has a more acute onset and worse prognosis.
Using Tests to Diagnose PJP
- In HIV patients, absence of exertional hypoxia and normal LDH help rule out PJP.
- Chest CT showing diffuse bilateral ground glass opacities supports diagnosis; confirm with direct organism visualization or PCR.