Subjective
Date of visit
Reason for visit (evaluation for suspected PCP, follow-up for PCP)
History of present illness:
Symptoms suggestive of PCP (may be insidious):
Dyspnea (shortness of breath) – progressive, worse with exertion
Fever (may be low-grade)
Non-productive cough
Fatigue
Weight loss (in some cases)
Duration of symptoms
Past medical history (relevant conditions):
HIV/AIDS diagnosis (most common risk factor)
Immunosuppressive medications (corticosteroids, chemotherapy)
Other chronic health conditions (lung disease, malignancy)
Risk factors for PCP exposure (recent travel, contact with individuals with PCP)
Medications (current medications, including antiretroviral therapy for HIV)
Allergies
Objective
Vital signs (temperature, heart rate, respiratory rate, oxygen saturation) – hypoxia (low oxygen) is common
Physical exam:
General (signs of respiratory distress)
Chest exam:
Inspection (tachypnea – rapid breathing, use of accessory muscles)
Palpation (decreased tactile fremitus)
Percussion (may be normal or hyperresonant)
Auscultation (crackles – abnormal breath sounds)
Lymphadenopathy (enlarged lymph nodes) may be present
Assessment
Suspected Pneumocystis pneumonia (PCP) based on clinical presentation and risk factors
Chest X-ray (may show bilateral infiltrates – hazy areas in the lungs) – not specific for PCP but suggestive
Consideration of alternative diagnoses (other pneumonias, heart failure)
Plan
Diagnostic workup (may include some of the following):
Arterial blood gas (ABG) – to assess oxygen levels and acid-base balance
Sputum induction or bronchoscopy with bronchoalveolar lavage (BAL) – to collect a sample of lung fluid for analysis
Direct fluorescent antibody (DFA) test – rapid test to detect Pneumocystis carinii on BAL fluid
PCR testing – more sensitive test to detect Pneumocystis carinii on BAL fluid
Treatment (initiated based on high suspicion for PCP):
Trimethoprim/sulfamethoxazole (TMP/SMX) – first-line treatment for PCP
Alternative antibiotics for patients intolerant to TMP/SMX
Supplemental oxygen therapy as needed
Education
Explain Pneumocystis pneumonia, its association with HIV/AIDS and other immunosuppressed states.
Discuss the importance of completing the diagnostic workup and adhering to treatment.
Importance of good hygiene and avoiding contact with individuals with respiratory infections.
HIV patients: emphasize the importance of consistent adherence to antiretroviral therapy to prevent PCP recurrence.
Follow-up
Schedule for close follow-up appointments:
Monitor response to treatment (clinical improvement, chest X-ray)
Repeat chest X-ray to assess response
Consider repeat BAL if initial diagnosis is uncertain
Prophylaxis for PCP recurrence (with TMP/SMX or other medications) may be recommended for high-risk patients (HIV with low CD4 count).
Disclaimer: This information is for educational purposes only and should not be interpreted as medical advice. Please consult with a qualified healthcare professional for diagnosis and treatment of Pneumocystis pneumonia.