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V Pneumocystis carinii pneumonia (PCP) is a form of

pneumonia, caused by the yeast-like fungus (which had


previously been erroneously classified as a protozoan)
  
  . This pathogen is specific to humans; it
has not been shown to infect other animals, while other species
of    that parasitize other animals have not been
shown to infect humans.

V    is commonly found in the lungs of healthy people,


but being a source of opportunistic infection it can cause a lung
infection in people with a weak immune system.   
pneumonia is especially seen in people with cancer, HIV/AIDS
and the use of medications that affect the immune system.
›espiratory System:
V rimary function is to obtain oxygen for use by
body's cells & eliminate carbon dioxide that cells
produce
V Includes respiratory airways leading into (& out
of) lungs plus the lungs themselves
V athway of air: nasal cavities (or oral cavity) >
pharynx > trachea > primary bronchi (right &
left) > secondary bronchi > tertiary bronchi >
bronchioles > alveoli (site of gas exchange)
The exchange of gases (O2 & CO2) between the alveoli & the
blood occurs by simple diffusion:
V O2 diffusing from the alveoli into the blood
V CO2 from the blood into the alveoli.

Diffusion requires a concentration gradient. So, the


V concentration (or pressure) of O2 in the alveoli must be kept
at a higher level than in the blood
V concentration (or pressure) of CO2 in the alveoli must be kept
at a lower lever than in the blood.

We do this, of course, by breathing - continuously bringing


fresh air (with lots of O2 & little CO2) into the lungs & the
alveoli.
V ëreathing is an active process requiring the
contraction of skeletal muscles.
V The primary muscles of respiration include the
external intercostal muscles (located
between the ribs) and the diaphragm (a sheet
of muscle located between the thoracic &
abdominal cavities).
CONT› CTION OF
CONT› CTION OF
EXTE›N  INTE›COST 
SCES
DI PH› 

V elevation of ribs & V diaphragm moves


sternum downward
V increased front- to-back V increases vertical
dimension of thoracic dimension of thoracic
cavity cavity
V lowers air pressure in V lowers air pressure in
lungs lungs
V air moves into lungs V air moves into lungs:
V relaxation of external intercostal muscles &
diaphragm
V return of diaphragm, ribs, & sternum to
resting position
V restores thoracic cavity to pre-inspiratory
volume
V increases pressure in lungs
V air is exhaled
V ›ole of Pulmonary Surfactant

Surfactant decreases surface tension which:


ÿ increases pulmonary compliance (reducing the
effort needed to expand the lungs)
ÿ reduces tendency for alveoli to collapse
V neumocystis jirovecii
V CD4+ T-lymphocyte cell count <200 per mm3
V Unexplained fever of >37.7°C for >two weeks
V Hx of oropharyngeal candidiasis
V ersons with HIV infection
V ersons with primary immune deficiencies (hypogammaglobulinemia,
severe combined immunodeficiency (SCID).
V ersons receiving long-term immunosuppressive regimens for
connective-tissue disorders, vasculitides, or solid-organ transplantation
(heart, lung, liver, kidney)
V ersons with hematologic and nonhematologic malignancies (solid
tumors, lymphomas)
V ersons with severe malnutrition
›isk factors
Inhalation of P. jiroveci

Organism attach to the alveolar septal wall

symptomatic infection in the lungs occur

The organism persists in an active or latent state unless the host becomes
immunocompromised.

lveolar macrophages activated but unable to eradicate organism due to


absence of CD4+ cells (T-4 cells, ‫خ‬helper cells)
ulti host immune defects

llowing replication of organisms


and development of illness

›esulting in diffuse alveolitis and impaired


oygenation

  

 
Induced sputum ëronchoalveolar lavage
V ebulized saline inhaled by V Saline instilled through
patient to promote deep cough bronchoscope wedged in
V Inexpensive; noninvasive airway and fluid withdrawn
V More expensive, more
invasive, risk of
periprocedural sedation,
V Specimen processing more requires skilled personnel
complex, may delay diagnosis V Larger samples can be sent for
of another pathogen staining and can be used to
diagnose other infections
(bacterial, fungal, viral and
V Less sensitive mycobacterial cultures)
V >95 percent sensitive
IGU› 1A. BILAT ›AL IT ›STITIAL IGU› 1B. V TILATO›-ASSOCIAT D
IILT›AT S I A HIV-I CT D ATI T ›IGHT-SID D  UMOTHO›AX I TH
WITH  UMOCYSTIS CA›III  UMOIA SAM ATI T.
(C).
V Progressive exertional dyspnea (95%)

V Implementation of appropriate nursing interventions, including medications,


controlled oxygen therapy, ventilation modalities, and strategies for secretion
clearance, energy conserving, relaxation, nutrition, and breathing retraining
V ›emaining with patient during episodes of acute respiratory distress
V Implementation of smoking cessation strategies
V Administration of the following pharmacological agents as prescribed:
bronchodilators, oxygen, corticosteroids, antibiotics, psychotropics, opioids
V Assessment of inhaler technique and coaching, if required
V Discussion of medications with patients
V Administration of oxygen therapy as prescribed
V Support of disease self-management strategies including action plan development
and end-of-life decision making directives
V romotion of exercise training and pulmonary rehabilitation as appropriate
V atient education and referrals, if necessary
V ever/Chills (>80%)

V Increase fluid intake


V Apply tepid sponge bath
V Give antipyretic drugs
V Antibiotic -trimethoprim-sulfamethoxazole
(Bactrim, Septra)
V onproductive cough (95%)

V ncourage deep breathing and coughing


exercises
V lace patient on semi- to-high fowlers position
V ncourage to increase fluid intake
V rovide polluted-free environment
V Administer mucolytic and bronchodilator
V Chest discomfort

V rovide relaxation techniques (biofeedback,


guided imagery, back rubbing)
V Assist into comfortable position
V Administer oxygen inhalation
V Weight loss
V Weigh patient periodically
V rovide small, frequent feeding
V Incorporate foods and maintain as near- normal food
consistency as possible( soft or refinely ground food with
gravy or liquid added
V romote a pleasant environment for eating, with company
as possible
V ncourage the use of spices (other than sodium) to the
clientૹs personal taste
V Have healthy snack foods (cheese, crackers, soup, fruit)
V Consult dietician
V Administer vitamin/ mineral supplements as indicated
V Hemoptysis (rare)
V Maintaining an open airway
V Monitor O2 saturation by using pulse oximetry
V Administer oxygen inhalation
V Instruct client to cough/sneeze and expectorate
into tissue and to refrain from spitting.
V Administer epinephrine solution to stop the
hemorrhage
V Cyanosis
V rovide supplemental oxygen to relieve shortness of breath,
improve oxygenation, and decrease cyanosis.
V osition the patient comfortably to ease breathing.
V Administer bronchodilator, antibiotic as needed.
V Make sure that the patient gets sufficient rest between
activities to prevent dyspnea.
V repare the patient for such tests as arterial blood gas
analysis, complete blood count, and imaging studies and
scans to determine the cause of cyanosis.
Enigmatic fungus causes pneumonia
3  
V The origin of a fungus that causes pneumonia in people with poor immune
systems is a mystery, medical experts heard today (Thursday 13 September
2001) at the bi-annual meeting of the Society of General Microbiology at
the University of ast Anglia.

V Dr ›obert Miller of the ›oyal ree and University College Medical


School, London" says, ૼ the majority of healthy children and adults have
antibodies to the fungus neumocystis carinii but we cannot detect it in
fluid or lung tissue from healthy individuals. Apart from those patients
with . carinii pneumonia the fungus can only be found in a small number
of HIV positive or mildly immunosuppressed patients who have other
respiratory diseases. So the source of new infections of this disease, which
affects approximately 150 immunocompromised patients in the UK each
year, is unknown.૽

V
V According to Dr Miller, ૼThere are many different species of . carinii, which affect
man and other mammals. However studies of the genetics of the fungus have shown
that it is not possible to pass infection from different host species to man so we know
that animals are not the source of the infections.૽

ૼWe now think that there must be a small infectious reservoir of the disease in
otherwise healthy people with chronic obstructive lung disease, such as people with
cystic fibrosis or cancer, and they are acting as a focus for transmission to
immunosuppressed patients,૽ says Dr Miller.

ૼIf our theories are correct than this could have implications for how we handle
people with . carinii pneumonia in hospitals and in the community. It may be
necessary to keep patients with . carinii pneumonia in respiratory isolation from
other immunosuppressed patients. It should also inform decisions about rational use
of preventative treatments in targeted immunosuppressed groups, ૽ says Dr Miller.

V Society for General Microbiology


V