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Pneumocystis Jiroveci Pneumonia (PJP)
Pneumocystis Jiroveci Pneumonia (PJP)
PCP is an opportunistic respiratory infection most common in infants from 2–6 months. It presents with an acute onset of respiratory distress with minimal/absent chest signs in a child who is HIV exposed. Hypoxaemia and cyanosis are common features as the disease progresses.
Diagnoses
- Oxygen saturation: usually less than 90% on pulse oximetry in room air
- Chest X-ray: findings can vary, usually diffuse bilateral alveolar or interstitial infiltrate.
- NPA/Sputum: Indirect immunofluorescence may demonstrate Pneumocystis
Treatment
- Oxygen, 1–2 L/minute via nasal prongs
- Monitor saturation respiratory rate and other vital parameters
- Supportive care, nasogastric feeds and intravenous fluids
Meds
- Trimethoprim/ Sufamethoxazole (Bactrim) IV, load with 10mg/kg once, then 5 mg/kg/dose of trimethoprim component 6 hourly for 5 days.
- When child improves follow with oral 5 mg/kg/dose of trimethoprim component 6 hourly for 3 weeks. Bactrim: 200mg sulfamethoxazole / 40 mg trimethoprim per 5ml). PCP prophylaxis should continue after discharge.
- If hypoxic and PCP confirmed or highly suspected ADD Prednisone, oral, 1–2 mg/kg daily for 2 weeks. Beware: danger of worsening co-morbid lung CMV infection.