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Brian L. Block [1] and Tejas Mehta [2] and Gabriel M. Ortiz [3] and Sean P. Ferris [4] and Thienkhai H. Vu [5] and Laurence Huang [1; 6] and Adithya Cattamanchi [1]

Academic Editor: Sinésio Talhari

1, Division of Pulmonary and Critical Care Medicine, University of California, San Francisco, CA, USA, ucsf.edu

2, SBKS Medical Institute and Research Centre, Gujarat, India, sumandeepuniversity.co.in

3, Division of Hospital Medicine, Priscilla Chan and Mark Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA, USA, ucsf.edu

4, Division of Pathology and Laboratory Medicine, University of California, San Francisco, CA, USA, ucsf.edu

5, Department of Radiology and Biomedical Imaging, Priscilla Chan and Mark Zuckerberg San Francisco General Hospital and Trauma Center and University of California, San Francisco, CA, USA, ucsf.edu

6, HIV, Infectious Diseases, and Global Medicine Division, University of California, San Francisco, CA, USA, ucsf.edu

Received Jul 26, 2017; Accepted Aug 30, 2017

This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

1. Introduction

Pneumocystis jirovecii pneumonia (PCP) is a potentially life-threatening infection that most often occurs in immunocompromised hosts. PCP was the most frequent complication of HIV/AIDS in the early phases of the epidemic, and while its incidence has declined substantially in the current era of combination antiretroviral therapy, it remains one of the most common HIV-associated opportunistic infections.

Generally, the diagnosis of PCP is suggested by a subacute illness featuring fever, nonproductive cough, malaise, and progressive shortness of breath [1]. Dyspnea and hypoxemia can be profound. Lung auscultation and chest roentgenogram can both be normal, but computed tomography (CT) of the chest typically demonstrates “ground glass opacities” [2, 3]. This is likely due to the accumulation of cellular debris, fibrin, and organisms within the alveolar spaces [2], as well as interstitial inflammation. Other radiographic patterns of PCP include a predilection for upper lobes (particularly in patients who use aerosolized pentamidine for prophylaxis), a preference for central rather than peripheral zones, and a tendency to form cysts [1, 4, 5]. Several serum tests can be used to help determine the likelihood of PCP, but microscopic visualization of induced sputum or bronchoalveolar lavage fluid specimens remains...

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