Abstract
Pneumocystis jiroveci pneumonia (PJP) is one of the major infections in patients with impaired immunity. The entity is common in HIV-seropositive individuals but quite very rare in HIV-seronegative individuals especially children. We report here a case of 16-week-old HIV-seronegative infant with chief complaint of chronic cough of one month of evolution. Sweat chloride test for diagnosis of cystic fibrosis was positive. Bronchoalveolar lavage (BAL) fluid was collected and Pseudomonas aeruginosa was isolated on culture. Empirical antibiotic regimen comprising ceftriaxone and azithromycin was initiated that was switched to meropenem as per antimicrobial susceptibility report, but the patient did not improve. Subsequently, an immunofluorescence staining of BAL fluid was performed and P. jiroveci cysts were detected. Following a laboratory confirmation of Pneumocystis pneumonia, cotrimoxazole was added and the clinical condition of the patient significantly improved. This is an unusual case wherein unsuspected PJP occurred and since signs and symptoms of the patient persisted even after the initiation of antimicrobial therapy for Pseudomonas infection and resolved only after treatment for PJP was started, it suggests a causative role of P. jiroveci rather than colonization/contamination.
Highlights
Pneumocystis jiroveci, formerly called Pneumocystis carinii, is an ascomycetous fungus that causes an opportunistic pneumonia
Pneumocystis jiroveci was initially classified as a protozoan based on the histologic characteristics of its trophozoite and cyst forms and its treatment response with the antiprotozoan medication pentamidine [4]
It causes an opportunistic pneumonia in immunocompromised hosts who usually have T-cell defects and even in those with B-cell deficiencies
Summary
Pneumocystis jiroveci, formerly called Pneumocystis carinii, is an ascomycetous fungus that causes an opportunistic pneumonia. Pneumocystis jiroveci pneumonia (PJP) is one of the major infectious complications in immunocompromised patients, whether those living with human immunosuppressive virus (HIV) or with non-HIV immunosuppressive states [1]. PJP was first described by Otto Jirovec in European infants with pneumonia [2]. The mortality rates of PJP in patients with or without AIDS remain high at 30%–60% [3]. The clinical diagnosis of PJP is complicated by the nonspecific signs and symptoms and due to lack of reliable culture system for the organism [2]. Pneumocystis infections are almost always limited to the lungs and microorganism cannot be cultured reliably outside the lungs [2]. We are presenting a case of unsuspected PJP in an 16-week-old HIVseronegative female child with complaint of chronic cough of one month of evolution
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