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Pneumocystis pneumonia

Key sources
The following summarized guidelines for the evaluation and management of pneumocystis pneumonia in HIV-negative hematology patients are prepared by our editorial team based on guidelines from the European Conference on Infections in Leukaemia (ECIL 2016).
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Guidelines

1.Classification and risk stratification

Severity assessment: classify non-HIV infected patients with Pneumocystis pneumonia as having mild versus moderate-to-severe disease severity.
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2.Medical management

Indications for treatment: use composite criteria to assess the need for diagnostic bronchoscopy and empiric treatment against P. jirovecii, as single clinical diagnostic criteria are insufficient to prove the diagnosis. Factors that increase clinical suspicion include:
patient at risk
clinical signs and symptoms: dyspnea and/or cough, fever (may rarely be absent), hypoxemia (may not yet be present), chest pain (rare; usually from pneumothorax)
radiology findings compatible with Pneumocystis pneumonia (preferably thoracic CT scan)
with or without unexplained serum LDH elevation
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  • Route of administration

  • Duration of treatment

  • First-line therapy

  • Second-line therapy

  • Adjunctive corticosteroids

3.Specific circumstances

Patients with respiratory failure: monitor patients with Pneumocystis pneumonia for acute respiratory failure requiring ICU admission, since late ICU transfers are associated with increased mortality rates.
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4.Preventative measures

Secondary prophylaxis: administer secondary anti-Pneumocystis pneumonia prophylaxis in all non-HIV patients who have been successfully treated for Pneumocystis pneumonia.
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5.Follow-up and surveillance

Assessment of treatment response: assess the efficacy of systemic antimicrobial treatment on a daily basis. While early clinical deterioration (within the first 3-5 days after treatment initiation) is common, avoid diagnostic reevaluation before 8 days of full-dose treatment.
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