Pneumocystis Pneumonia Diagnosis

Doctors can diagnose pneumocystis pneumonia either by x-rays or by finding the organism in lab tested samples of lung fluids. The doctor may need to use a bronchoscope to extract a tissue sample from inside the child’s lungs. The sample is then sent to a lab where special chemical stains can identify the pneumocystis organism.

Even if your child has no other medical problems, it is advisable to call the doctor immediately if the child has unusually rapid breathing or has difficulty breathing, is coughing or has a bluish grey tinge to his nails, lips or skin.

The clinical diagnosis is confirmed by the typical appearance of the chest x-ray which reveals widespread pulmonary infiltrates, and an arterial oxygen level drastically lower than would be expected from the symptoms. The diagnosis can be fully confirmed by the pathologic identification of the disease causing organism in induced sputum or bronchial washings which when obtained by bronchoscopy with coloration by toluidine blue or immunofluorescence assay, show characteristic cysts.

Pneumocystis Pneumonia Treatment

Antibiotics are used either singly or in special combinations to treat pneumocystis pneumonia. They may be taken orally or administered intravenously (into the veins) for atleast 2 weeks. The antibiotic treatment will prolong upto 3 weeks if the child suffers from AIDS. The doctor may add a steroid medication depending on the severity of the PCP infection.

In the event that your child has a weakened immune system due to any previous infection, consult your doctor about treating your child with antibiotics to prevent pneumocystis infection as a precautionary measure.

All infants born to HIV positive mothers should be started on PCP prophylaxis at 1 month of age until a confirmed diagnosis is obtained on their HIV status.

The generally prescribed drug is trimethoprim-sulfamethoxazole (TMP-SMX) 20 mg/kg/day (trimethoprim) in four doses IV or po for 21 days. Even if the diagnosis is not confirmed, the commencement of therapy should not be delayed, as cysts may persist for weeks. The main potential side effects, especially in patients suffering from AIDS, are fever, skin rash and neutropenia. Alternative treatments are pentamidine 3 to 4 mg/kg IV once daily, atovaquone 750 mg po bid, trimethoprim 20 mg/kg/day po with dapsone 100 mg/day po, or clindamycin 300 to 450 mg po qid with primaquine base 15 mg/day po. All treatment courses should be followed for 21 days. One of the main limitations of pentamidine is the high incidences of toxic side effects, including hepatotoxicity, renal failure, leucopenia, fever, rash, hypoglycemia, and gastric intolerance. The overall mortality rate of hospitalized patients is 15 to 20%. For those with a PaO2 < 70 mm Hg, adjunctive therapy with corticosteroids is advised. The prescribed regimen is prednisone 40 mg bid (or its equivalent) for the first 5 days, 20 mg bid for the next 5 days, and then 20 mg/day for the duration of treatment. Hypoxemia, the need for intubation and late fibrosis is reduced by corticosteroids. Supportive treatment consists of O2 theraapy, sometimes needing positive end-expiratory pressure to maintain PaO2 >= 60 mm Hg.

It is recommended that AIDS patients who have also suffered from P carinii pneumonia or those who have a CD4 count < 200/mm3 should receive prophylaxis with TMP-SMX 80/400 mg/day; In case this treatment is not well tolerated, aerosolized pentamidine 300 mg monthly or dapsone 100 mg/day po, can be administered. These prophylactic regimens are also often advocated for other vulnerable populations.