Pneumocystis Pneumonia (PCP)

Pneumocystis Pneumonia (PCP)


  • Patients with HIV (90% have a CD4 cell count <200 cells/mm³)
  • Patients on >20mg/day of prednisone for >1 month
  • Patients on Temozolomide
  • Patients on biologic therapy PLUS 2/3 of the following risk factors: >65 yo, coexisting pulmonary disease, use of steroids
  • Subacute onset of progressive dyspnea,
  • Fever,
  • Non-productive cough, AND
  • Chest discomfort that worsens within days to weeks
  • PCP Stain
    • Sputum-In-house
    • Relative diagnostic sensitivities: <50% to >90% for induced sputum, 90% to 99% for bronchoscopy with BAL, 95% to 100% for transbronchial biopsy, and 95% to 100% for open lung biopsy (order by searching for “Cytology Non Gyn Request” and write “PCP” in comment section)
  • Fungitell assay (β-glucan):
    • Blood culture-send out
    • High sensitivity, low specificity for establishing a PCP diagnosis
  • PCR
    • Sputum-Send-out
    • Highly sensitive and specific for detecting Pneumocystis; however, cannot reliably distinguish colonization from active disease


Spontaneous pneumothorax in a patient with HIV infection should raise the suspicion of PCP

Adjunctive use of corticosteroids is indicated with PaO₂ <70 mmHg at room air, or Alveolar-arterial DO₂ gradient >35 mmHg

  • Days 1–5: 40 mg PO twice daily
  • Days 6–10: 40 mg PO daily
  • Days 11–21: 20 mg PO daily

If NPO, IV methylprednisolone can be administered as 75% of prednisone dose

Second line treatment should be used in patients found to have G6PD deficiency

If not already started, ART should be initiated in patients, when possible, within 2 weeks of diagnosis of PCP