Spotlights on Pneumocystis jiroveci

Document Type : Review articles

Authors

Department of Medical Microbiology and Immunology, Faculty of Medicine, Cairo University, Cairo11562, Egypt

Abstract

Pneumocystis jiroveci (P. jiroveci), previously referred to as Pneumocystis carinii (P. carinii), is the upmost encountered opportunistic infection in individuals with HIV/AIDS. Although the occurrence of Pneumocystis jiroveci pneumonia (PJP) has declined in HIV patients as a result of antiretroviral therapy, its prevalence has increased among individuals with hematologic malignancies, autoimmune diseases, recipients of stem-cell or solid-organ transplants, and those undergoing systemic chemotherapy. While diagnosis of PJP typically requires cytological staining, it is crucial not to delay treatment. In high-risk and critically ill patients, PJP treatment can be initiated before completing the diagnostic workup. The alveolar-arterial gradient is utilized to assess the severity of illness at the time of diagnosis. Antibiotics are recommended for managing PJP. Treatment of preference is trimethoprim/sulfamethoxazole (TMP-SMX). Primaquine with clindamycin is the recommended combination for individuals who have a history of intolerance to this regimen. Corticosteroids are employed as a supplementary treatment only in Patients with HIV who have severe PJP. While prophylaxis has decreased the frequency of PJP, its usage raised concerns regarding the emergence of resistant organisms. Due to the inability to cultivate human Pneumocystis in a standardized culture system, conducting routine susceptibility testing and detecting drug resistance is not feasible.

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