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Pneumocystis jiroveci

Nude Mona Sisters in a Jeep
Pneumocystis jiroveci is a fungal infection which typically presents with hypoxia and fever in the lungs of immunocompromised patients.  The infection is usually diagnosed using classic x-ray findings of diffuse interstitial infiltration bilaterally.  Definitive diagnosis can be made using lavage or biopsy, were it can be identified by methenamine on silver stain.  In order to prevent the disease in patients with HIV and CD4 counts below 200, TMP-SMX is used prophylactically.  TMP-SMX is also used as treatment for diagnosed disease.  

The organism was long thought of as a protozoan but has been reclassified as a yeast.


Patients who are immunosuppressed, such as having HIV/AIDS or on chemotherapy, are susceptible to infection.


Fever is a classic initial presentation of the disease.


Hypoxemia is a common symptom of the disease because of its predilection for the lung.

Bronchoalveolar Lavage
Lung Lava

Bronchoalveolar lavage is a medical procedure in which a bronchoscope is used to squirt fluid into a small part of the lung which is then recollected for examination. This method is one of the ways to make a definitive diagnosis of the pneumocystis jiroveci infection in the lungs.

Biopsy needle

Biopsy is one of the ways to make a definitive diagnosis of the infection. The lung tissue can be stained by methenamine silver to show the organism.

Methenamine Silver Stain
Moth-mine Silver

Methenamine silver stain of the biopsied lung tissue is diagnostic of the infection.

Saucer/cup shaped yeast forms
Cup and Saucer

Saucer/cup shaped yeast forms are the classic description of the yeast form of Pneumocystis jiroveci.

Diffuse interstitial pneumonia CXR
Nude-Mona with X ray sheets showing diffuse interstitial pattern

Diffuse interstitial pneumonia is the characteristic finding on chest x-ray, which can aid in the diagnosis of disease.

Tampon on SMX-snowmobile

TMP-SMX (Trimethoprim /sulfamethoxazole) is a sulfonamide antibiotic that disturbs folate metabolism. It is used both as treatment and prophylactically for the disease in patients with HIV and CD4 count below 200.

Start prophylaxis when CD4 drops under 200
Purple-axes Dropping CD (4) Fork (200) Tooth-fairy

HIV patients should be started on prophylactic treatment of TMP-SMX when CD4+ counts drop below 200 because they are prone to disease. Management includes TMP-SMX while trying to increase the CD4+ count.

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