Pneumocystis Pneumonia: Causes, Symptoms & Treatment

Every year, more than 600,000 people in Germany alone contract pneumonia, technically known as pneumonia. This inflammation of the lung tissue can have different causes and is divided into several subcategories. A particularly dangerous form of pneumonia is Pneumocystis pneumonia (PCP).

What is pneumocystis pneumonia?

Pneumocystis pneumonia is an interstitial type of pneumonia. In other words, the inflammation does not affect the alveoli, but rather the interstitium. This is the narrow layer of connective tissue located between the alveoli and the blood vessels. So-called opportunistic pathogens are involved in the development of Pneumocystis pneumonia. Therefore, this disease belongs to the opportunistic infections. Opportunistic pathogens can be fungi, viruses or bacteria. They take advantage when the body is in a precarious situation. Most often, these pathogens attack the organism when the immune system is weakened, i.e. immunodeficiency is present. Since this is characteristic of people who have AIDS, Pneumocystis pneumonia is considered the most common AIDS-defining disease. Because this type of pneumonia occurs mainly when the affected person already has a preexisting condition, it is a secondary pneumonia.

Causes

The opportunistic pathogen that is causative for this form of lung disease is Pneumocystis jirovecii, a sac fungus that is found everywhere in the environment. Humans are constantly exposed to it. Because transmission is airborne, the likelihood of contact with the pathogen is very high. Most people become infected during childhood. However, the immune defense system of a healthy body is normally able to prevent the disease without any problems. However, if the immune system is weakened, the patient is acutely at risk. Reasons for a weakened immune system can be, for example, chemotherapy, congenital immune deficiency or HIV infection. HIV infection has such a critical effect because the HI virus gradually destroys the T-helper cells that are responsible for antibody formation. Without sufficient antibodies, the body is no longer able to successfully fight invading pathogens. Thus, the immune cells also no longer manage to successfully fight off the fungal pathogen Pneumocystis jirovecii. This results in the critical inflammation of the lung tissue.

Symptoms, complaints, and signs

The onset of pneumonia is gradual. Initially, the affected person manifests a dry cough that becomes more severe over time. In addition, patients suffer from increasing shortness of breath, also known as dyspnea. Fever may occur, but is not a characteristic symptom, as an overly weakened body may no longer be able to fight an infection with fever. Another symptom is tachypnea. This is when the patient’s breathing rate is increased. So he or she has to take several breaths per minute. Since the body is severely weakened by the infection, inadequate treatment over several weeks leads to weight loss in the affected person. This can amount to several kilos. Typically, a so-called oral thrush can be detected in the mouth of the affected person. This is a fungal infection of the oral mucosa, which appears with white or yellowish coatings. If the disease remains untreated, the patient’s condition deteriorates continuously. In such a case, it can quickly happen that the disease takes a fatal course.

Diagnosis and course of the disease

For those with previously undiagnosed HIV infection, it can often take a very long time to be diagnosed with PCP. This is because even when the physician x-rays with a presumption of pneumonia, in many cases the image does not show any abnormalities. Only rarely does a butterfly-shaped structure already indicate the presence of pneumonia during the X-ray. A reliable diagnosis can only be made by means of bronchoscopy with bronchial lavage. In this procedure, a thin tube is inserted through the throat into the bronchi. Tissue samples are taken with small brushes and forceps. During bronchial lavage, the airways are flushed with a saline solution. The solution is then aspirated.The samples obtained during the examination are microbiologically tested to detect the fungus. Since the procedure is very uncomfortable for the patient, it is possible to have it performed under sedation or anesthesia.

Complications

In the worst case, pneumocystis can be fatal for the affected person. However, death usually occurs when pneumocystis is not treated and the inflammation can spread to other regions of the body. In this disease, the affected person primarily suffers from very severe breathing difficulties and further also from a permanent cough. The throat also hurts and shortness of breath may occur. Due to the breathing difficulties, the internal organs are also supplied with less oxygen, so that in the worst case irreversible damage can occur. Pneumocystis also puts a strain on the heart, as the body has to transport more blood to supply the organs with oxygen. This can also lead to a heart attack. Furthermore, pneumocystis not infrequently leads to weight loss and the mucous membranes are attacked by fungi. Treatment of pneumocystis is usually not associated with complications. With the help of antibiotics, the symptoms are completely treated. The life expectancy of the affected person is not affected if treatment is successful.

When should you go to the doctor?

Symptoms such as a dry to mucous cough, chest pain, and high fever indicate pneumonia. A doctor must determine if pneumocystis pneumonia is present and start treatment right away, if necessary. Depending on the severity of the pneumonia, it may already be sufficient to prescribe mild antibiotics. If the symptoms are severe, inpatient treatment in a specialist clinic is necessary. In order to be able to decide this at an early stage, a rapid medical clarification is absolutely necessary. Therefore, medical advice should be sought at the latest when chest pain increases or fever rises. Patients with an immunodeficiency, for example AIDS patients and people with an immune disorder, are particularly at risk. Anyone who belongs to the risk groups should see their family doctor quickly if the complaints mentioned at the beginning occur. In addition, an ENT specialist or a lung specialist can be consulted. During antibiotic therapy, a physician must monitor the healing process. If complications arise, the patient must be taken to the hospital immediately. If infants or young children show signs of pneumocystis pneumonia, emergency medical services should be called.

Treatment and therapy

Once Pneumocystis pneumonia has been diagnosed, high-dose therapy with antibiotics is given. This usually must be continued for at least three weeks. This usually involves intravenous administration of cotrimoxazole. If the patient is intolerant, this is very problematic, as all alternative preparations are less effective and some have very dangerous side effects. Since the patient’s condition initially deteriorates after the start of treatment, sometimes even requiring respiratory assistance, the patient is usually admitted to a hospital as an inpatient. Only in very mild cases may the patient treat the disease at home by taking oral antibiotics. Cortisone preparations may also be administered to curb the inflammatory reactions in the lungs.

Prevention

While Pneumocystis jirovecii infection cannot be prevented, appropriate prophylactic measures can be used to prevent the onset of the disease. Healthy people protect themselves best by taking primary care to avoid infection with HIV. For patients who are already HIV-positive or have an immune deficiency for some other reason, antibiotics are administered as a preventive measure.

Follow-up

The person affected by Pneumocystis pneumonia usually has few and limited measures of follow-up care available to him or her. For this reason, the patient should seek medical attention at the first symptoms and signs of the disease to prevent further complications. As a rule, the disease cannot be cured on its own, so that the affected person is always dependent on medical examination and treatment. The earlier a doctor is consulted, the better the further course of the disease often is.Most of those affected are dependent on taking various medications, whereby attention must be paid to the correct dosage and regular intake. Furthermore, when taking antibiotics, it should be noted that they must not be taken together with alcohol. Likewise, regular checks and examinations by a doctor are very important in order to detect further damage caused by Pneumocystis pneumonia at an early stage. Possibly, there is a reduced life expectancy of the affected person due to this disease.

What you can do yourself

In the field of self-help, the affected person should take various measures to support his body’s defense system in its functional activity. In order for the organism to defend itself sufficiently against pathogens and germs, the affected person should attach importance to a healthy lifestyle. The food intake should be balanced and rich in vitamins. Overweight is to be avoided, since this represents an additional load for the body. It is advised that the affected person pays attention to have a self-weight in the normal range of the BMI. Sports activities, good sleep hygiene and stays in fresh air strengthen the immune system. Stress, hectic and states of strain are to be avoided. Likewise, the consumption of harmful substances is to be refrained from. These include, in particular, nicotine, alcohol, drugs or non-prescribed medications. Environments that are enriched with pollutants, such as gases or or other unpleasant odors should be avoided. Since the condition may cause a state of respiratory distress, panicky reactions should be avoided. These exacerbate anxiety and cause further deterioration of health. Calmness should be maintained at all times to avoid secondary symptoms. Pneumocystis pneumonia can lead to premature death of the affected person in severe cases. Therefore, it is especially important to seek medical attention at the first signs of irregularity.