Pneumocystis Pneumonia in Human Immunodeficiency Virus-infected Adults and Adolescents: Current Concepts and Future Directions

Abstract

Pneumocystis jirovecii pneumonia (PCP) is one of the most common opportunistic infections in human immunodeficiency virus-infected adults. Colonization of Pneumocystis is highly prevalent among the general population and could be associated with the transmission and development of PCP in immunocompromised individuals. Although the microscopic demonstration of the organisms in respiratory specimens is still the golden standard of its diagnosis, polymerase chain reaction has been shown to have a high sensitivity, detecting Pneumocystis DNA in induced sputum or oropharyngeal wash. Serum β-D-glucan is useful as an adjunctive tool for the diagnosis of PCP. High-resolution computed tomography, which typically shows diffuse ground-glass opacities, is informative for the evaluation of immunocompromised patients with suspected PCP and normal chest radiography. Trimethoprim-sulfamethoxazole (TMP-SMX) is the first-line agent for the treatment of mild to severe PCP, although it is often complicated with various side effects. Since TMP-SMX is widely used for the prophylaxis, the putative drug resistance is an emerging concern.

Keywords: Pneumocystis pneumonia; human immunodeficiency virus; polymerase chain reaction; prophylaxis; trimethoprim-sulfamethoxazole; β-D-glucan.

Figure 1

High-resolution computed tomographic image of Pneumocystis jirovecii pneumonia in a 45-year-old male patient with AIDS, showing diffuse GGO with inhomogeneous distribution unrelated to secondary lobules and with spared peripheral lung parenchyma.

Figure 2

High-resolution computed tomographic image of Pneumocystis jirovecii pneumonia, showing diffuse GGO with interlobular septal lines and cyst formation.

Figure 3

High-resolution computed tomographic image of Pneumocystis jirovecii pneumonia, showing small nodular lesions surrounded by diffuse GGO