Gender Ethnicracial And Life Span Considerations

Premature infants are at risk for PCP, as are children with immunodeficiency diseases. There are no known differences in the prevalence of PCP in males and females. In Africa, PCP occurs only in a small proportion of people with acquired immunodeficiency syndrome (AIDS); although the reason for this low incidence is unknown, it may be due to the lack of disease progression or that other, more virulent organisms, such as Mycobacterium tuberculosis, lead to pulmonary disease before PCP occurs.

^ ASSESSMENT

HISTORY. Patients with PCP often appear acutely ill and weak. They often have pallor, weight loss, and fatigue on exertion and become short of breath even when speaking. Determine if the patient has a history of leukemia, lymphoma, organ transplantation, or HIV, all of which compromise the immune system and increase the risk of PCP. Because symptoms of PCP develop over a period of weeks (4 to 8 weeks, generally), initial symptoms may be vague.

Determine if the patient has experienced nonproductive cough or increasing shortness of breath, which are frequent initial symptoms of PCP. Ask about a recent history of anorexia, nausea, vomiting, weight loss, or a low-grade intermittent fever. Note that before PCP prophylaxis in HIV-positive patients, this disease was the first indication of HIV infection in 60% of HIVpositive patients.

PHYSICAL EXAMINATION. Assess for signs of respiratory difficulties, such as stridor, nasal flaring, and rapid breathing. If the patient has a cough, note the type. Examine the patient's skin, noting its color, turgor, temperature, and whether or not it is dry and flaky. Check for pallor, flushing, and cyanosis. Note the type, amount, and color of sputum, which is commonly blood-tinged. Observe the patient's level of consciousness and irritability. Note any muscle wasting or guarding of painful areas. Auscultate the lungs for abnormal breath sounds, crackles, or diminished or absent breath sounds, either unilaterally or bilaterally. Late in PCP, when you percuss the chest, you may hear dullness from lung consolidation.

PSYCHOSOCIAL. PCP is a serious and life-threatening infection; in addition, it may be the defining condition for diagnosis of AIDS, according to the Centers for Disease Control and Prevention. The patient may experience anxiety, depression, or difficulty in coping with the change in heath status. Identify the patient's support system, and evaluate its effectiveness. The diagnosis of AIDS presents many complex familial and societal issues.

738 Pneumocystis carinii Pneumonia

Diagnostic Highlights

Test

Normal Result

Abnormality with Condition

Explanation

Lactic hydrogenase Bronchoscopy and bronchoalveolar lavage

Serum immunofluo-rescent antibodies

50-150 units/L Normal pulmonary structures and negative cultures

<1:16; no organisms observed

>220 units/L Washings positive for Pneumocystis carinii on immunofluorescent stain

Presence of organisms

Reflects onset of infection Used to view the pulmonary structures and obtain bronchoalveolar washings (more sensitive than standard sputum specimens)

Used to identify antibodies that circulate in blood, formed in response to antigens in protozoan bacterial cell wall

Other Tests: Chest x-ray, high-resolution computed tomography, arterial blood gases, gallium scan, complete blood count

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