Which findings suggest pneumocystis (carinii) jiroveci pneumonia (PJP) in patients with community-acquired pneumonia (CAP) and HIV infection?

Updated: Oct 31, 2019
  • Author: Stephanie L Baer, MD; Chief Editor: Michael Stuart Bronze, MD  more...
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Answer

Answer

Patients with HIV infection and a normal or slightly decreased CD4 count with focal infiltrates have approximately the same pathogen distribution as otherwise healthy hosts (eg, S pneumoniae is most common) and thus warrant the same diagnostic strategies as the general population. Pneumocystisjiroveci pneumonia (PJP) should be suspected in patients with a CD4 count of less than 200 cells/µL (or CD4% < 14%) presenting with gradually progressive dyspnea, nonfocal infiltrates on chest radiography, nonproductive cough, and hypoxemia. A definitive diagnosis of PJP requires visualization of the PJP cysts (ie, using special stains such as Giemsa or methenamine silver); bronchoscopy with bronchoalveolar lavage (BAL) is often necessary to obtain an adequate specimen.


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