| Pneumocystis Carinii Pneumonia
(PCP)
What is PCP?
PCP is short for Pneumocystis carinii pneumonia. Pneumonia is an
illness characterized by inflammation of the lungs. There are many
different kinds of germs that can cause pneumonia. The germ that
causes PCP is called Pneumocystis carinii. Although PCP is most
often found in the lungs, it sometimes attacks other parts of the
body.
Most of us are infected with the germ that causes PCP in childhood,
since it is everywhere in the environment. A healthy immune system
is enough to keep the germ from making us sick. Only when our immune
system becomes very weak can PCP cause illness.
Who is at risk for PCP?
Although PCP is largely preventable and treatable, it remains one
of the leading causes of illness and death in people with HIV. Because
some people with HIV are more at risk of developing PCP than others,
it is strongly recommended that the following people with HIV take
medication to prevent PCP:
- People who have T-cell counts below 200;
- People who have oral thrush or unexplained fevers lasting more
than two weeks, whether or not their T-cell counts below 200;
- People who have had PCP before, no matter their current T-cell
count.
What are the signs and symptoms of PCP?
In people with HIV, it is common for the symptoms of PCP to develop
slowly, so that you may not realize something is wrong until you
are quite sick. Also, many of the symptoms of PCP can be mistaken
for many other infections.
Fever, chest tightness, shortness of breath, lack of energy, dry
cough and weight loss are all possible signs of PCP. Weakness may
be the only symptom if you are taking medication to prevent PCP.
Talk to your doctor right away if you have any of these symptoms.
How does a doctor tell if I have PCP?
The doctor will usually order a chest x-ray if she suspects that
you have PCP. However, it is common for people with HIV to have
PCP but not have it show up on their chest x-ray, especially when
the illness is caught early.
In order to make a definitive diagnosis of PCP, your doctor needs
to find P. carinii in the lungs and examine it under a microscope.
This can be done by (1) taking a sputum sample (thick fluid from
deep in the lungs); (2) doing a procedure called a bronchoscopy
that looks at the lung area with a lens attached to a tube; or (3)
doing a procedure called a lung biopsy which takes a sample of the
tissue in the lungs to test for infection.
Can PCP be prevented?
PCP is almost entirely preventable. See section on who is at increased
risk of developing PCP.
TMP/SMX (also known as Bactrim or Septra) is the most effective
medication for preventing PCP. It is most often prescribed either
as one pill, once a day, or one pill, three times a week. The most
common side effects of this medication are rash, itching, and nausea.
If at first you have a bad reaction to this medication, your doctor
may suggest trying to desensitize you to the drug. This means restarting
the drug at a very low dose and then increasing the dose slowly,
to see if side effects can be avoided by allowing your body to get
used to the drug over time.
Dapsone and pentamidine (in an aerosol form that is inhaled) are
also used to prevent PCP.
How is PCP treated?
As with most illnesses, the earlier PCP is treated, the sooner you
will begin to get better and the less likely there will be complications
or permanent damage to your lungs as a result of advanced PCP.
PCP is treated with either oral or intravenous (IV) medication
depending on how serious you PCP is or if you have digestive problems
that make it hard for your body to absorb pills through your stomach.
Medicines used to treat PCP include:
TMP/SMX, Bactrim or Septra
can cause mild to severe skin rash, fever, nausea, aching joints
or muscles, drug induced hepatitis, anemia, low platelets, and white
blood cell counts.
Pentamidine (Pentam) can cause kidney and liver
problems, low blood sugar, high blood sugar, low white blood cell
counts, low blood pressure and inflammation of the pancreas (pancreatitis).
Aerolized pentamidine can cause coughing spells and leave a metallic
taste in the mouth.
Dapsone (Avelosulfon, DDS) can cause fever, rash,
nausea, liver problems, back, leg, or stomach pain, bluish color
change in lips and fingernails, breathing problems and low energy
levels.
Clindamycin/Primaquine can cause diarrhea, skin
rash, hepatitis, bluish color change in lips and fingernails and
breathing problems.
Atovaquone (Mepron) can cause skin rash, stomach
pain, nausea, vomiting, diarrhea and lover problems. Mepron works
better when it is taken with a fatty meal.
Prednisone or Melthylprednisolone are corticosteroids
used with other drugs to reduce chance of respiratory failure in
people with moderate to severe PCP. Corticosteroids can cause fluid
retention (puffiness in face, hands and feet), headache, thrush
or herpes outbreak and elevated liver function tests (LFTs).
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