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Pneumocystis Carinii Pneumonia in Immunosuppressed Patients

Desislava Nalbantova, Yasen Petrov, Ivona Zhekova, Simona Mileva, Tsvetana Yordanova

Abstract

Introduction: Pneumocystis carinii pneumonia (PCP) is an opportunistic infection that occurs in immunosuppressed patients. Fever is a main symptom of PCP, along with a dry cough that doesn’t produce any sputum. Other chief symptoms include chest tightness and difficulty breathing as well as fatigue and night sweats. There is no blood test to determine if PCP is present in the body. The diagnostic methods of choice  include sputum induction and bronchoalveolar lavage. According to recent research 5-25% of transplant patient are affected by PCP.

Materials and Methods: The case report centers on the medical history of a man aged 28 years at the time of the diagnosis. Eight years prior to this, he underwent kidney transplantation, and from then on he was on an immunosuppressive therapy. The patient presented with progressive shortness of breath and fever. On hospitalization his general condition was impaired. At the time he was tachypnoic and the following lab results revealed hypocapnia and hypoxemia.

Results: Overview x-ray examination showed rough reticular pattern of the lungs. Three consecutive CT-scans provided the following information: CT on July 01, 2013 - bilateral pleural effusions; CT on August 02, 2013 – areas of consolidation ground glass opacities; CT on August 21, 2013 – resolution of infiltrative and cystic changes. There was a presence of fibrotic changes. The patient was immediately placed on non-invasive ventilation  in a pressure support system, which allowed him to maintain saturation above 90%. The removal of the mask caused severe problems, which prompted the need of a week-long intubation. Antimicrobial and nonspecific antibiotic treatment was conducted. As a result, the patient’s condition improved.

Conclusion: Although advances in the care of immunosuppressed patients have dramatically lowered its incidence, PCP remains a challenging clinical problem.


Keywords

immunosuppressed, Pneumocystis carinii pneumonia


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