Pneumocystis jirovecii pneumonia: A life-threatening infection of the immunocompromised
Abstract
Pneumocystis pneumonia (PCP) is a fatal pulmonary infection caused by an ascomycetous fungus, Pneumocystis jirovecii. The infection is mostly seen in patients with underlying disease conditions that alter the host immune status. However, immunocompetent hosts may also be transiently infected with self-limiting mild lower respiratory tract infection. Diagnosis of PCP requires demonstration of cysts of Pneumocystis in the lungs of the patient. Although an open lung biopsy is the most reliable method, a bronchoalveolar lavage is always more practical and nearly as sensitive. We report a case of a 32-year-old human immunodeficiency virus (HIV)-infected woman who presented with a 2-month history of nonproductive cough, respiratory distress, and fever. Her sputum examination showed growth of Klebsiella pneumonia and was sensitive only to levofloxacin. No acid-fast organisms were demonstrated. High-resolution computerized tomography scan of the thorax showed consolidated airspaces bilaterally with ground-glass opacities. Her CD4 count was 110 cells/mm3. PCP was diagnosed by performing a Giemsa stain of bronchoalveolar lavage, which revealed cysts of P. jirovecii. Diagnosis was further confirmed by the elevated serum (1-3)-β-D glucan levels. She was started on co-trimoxazole and prednisolone, following which her symptoms gradually improved. PCP is one of the most common causes of HIV-associated mortality and a rapid diagnosis with an early initiation of treatment can significantly…
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