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Pneumocystis carinii Pneumonia
- (usually not until CD4 counts < 200)
History
- insidious onset
- increasing shortness of breath
- non-productive cough
- fever
- malaise
Examination
- tachypnoea
- tachycardia
- cyanosis
- signs of hypoxia
- fine crackles
- pneumothorax
Investigations
- chest x-ray
- initially normal
- bilateral perihilar interstitial infiltrates
- confluent alveolar shadows throughout lungs
- nodule
- cavity
- pneumothorax
- may be localised to upper zones if patient receiving nebulised
pentamidine
- High-res CT
- 'ground glass' appearance
- Sats
- hypoxic
- desaturates on excercise
- bronchoalveolar lavage
- silver staining / immunofluorescence
Treatment
- IV co-trimoxazole (100mg / kg sulphamethoxazole + 20 mg / kg trimethoprim
for 21 days)
- Alternatives
- IV pentamidine (4mg /kg )
- dapsone + trimethoprim
- atovaquone
- clindamycin + primaquine
- Corticosteroids
Prevention
- 960mg co-trimoxazole
- nebulised pentamidine
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