Pneumocystis jiroveci pneumonia (pjp)

Exam Cram

• Respiratory fungal infection in lymphopenic / immunocompromised individuals (HIV, leukaemia, recieving chemotherapy/ immune suppression)

• Presentation: dry cough, fevers, CXR- bilateral lymphadenopathy

• Diagnosis: sputum PJP PCR

• Management: co-trimoxazole

Outline

Background

• PJP is a fungus that causes respiratory infections in the immunocompromised

• An easily missed and dangerous source of respiratory distress that won't respond to anti-bacterial antibiotics

Assessment

History

• 1-3 weeks 

• Dry cough, reduced exercise tolerance, fatigue

• PMH: immunocompromise- lymphopenic: leukaemia, HIV, transplant

Examination

• Hypoxic- rapid decline on walking

Investigations

• CXR: 'bat wing' appearance

• PJP sputum: +ve

• Raised BDG (1,3-B-D-glucan)

Diagnosis

Diagnostic criteria: induced sputum +ve (with symptoms)

Differentials: Pneumonia 

Management

Acute

1. Co-Trimoxazole PO

2. PO prednisolone + IV pentamidine

Long term prophylaxis 

Indications

• Long term steroids > 3 weeks: Giant Cell Arteritis, renal transplants

• Haematological malignancies

• Previous PJP infection (secondary prevention)

Deeper Dive

Management

British HIV association advice addition of prednisolone to co-trimoxazole if hypoxic. [1]

Resources and References

1. https://bhiva.org/clinical-guideline/OI-guidelines-pulmonary/

Links

• Body systems: respiratory, haemotopoetic & immune

• Disease: infection

• Speciality: respiratory, infectious diseases, genitourinary disease

Written in 2025