Pneumocystis Pneumonia Health Article

Definition

Pneumocystis pneumonia is a lung infection that occurs primarily in people with weakened immune systems—especially people who are HIV-positive. The disease agent is an organism whose biological classification is still uncertain. Pneumocystis carinii was originally thought to be a one-celled organism (a protozoan), but more recent research suggests that it is a fungus. Although its life cycle is known to have three stages, its method of reproduction is not yet completely understood. The complete name of the disease is Pneumocystis carinii pneumonia, often shortened to PCP. PCP is also sometimes called pneumocystosis.

Description

Pneumonia as a general term refers to a severe lung inflammation. In pneumocystis pneumonia, this inflammation is caused by the growth of Pneumocystis carinii, a fungus-like organism that is widespread in the environment. PCP is ordinarily a rare disease, affecting only people with weakened immune systems. Many of these people are patients receiving drugs for organ transplants or cancer treatment. With the rising incidence of AIDS, however, PCP has become primarily associated with AIDS patients. In fact, as many as 75% of AIDS patients have developed PCP. It has also been the leading cause of death in AIDS patients.

Transmission

The organism that causes PCP is widely distributed in nature and is transmitted through the air. When the organism is inhaled, it enters the upper respiratory tract and infects the tiny air sacs at the ends of the smaller air tubes (bronchioles) in the lungs. These tiny air sacs are called alveoli. Under a microscope, alveoli look like groups of hollow spheres resembling grape clusters. The exchange of oxygen with the blood takes place in the alveoli. It appears that P. carinii lives in the fluid in the lining of the alveoli.

Person-to-person infection does not appear to be very common; however, clusters of PCP outbreaks in hospitals and groups of immunocompromised people indicate that patients with active PCP should not be exposed to others with weakened immune systems. It is thought that many people actually acquire mild Pneumocystis carinii infections from time to time, but are protected by their immune systems from developing a full-blown case of the disease.

Causes

P. carinii is an opportunistic organism. This means that it causes disease only under certain conditions, as when a person is immunocompromised. Under these circumstances, P. carinii can multiply and cause pneumonia. The mechanisms of the organism's growth within the alveoli are not fully understood. As the pneumocystis organism continues to replicate, it gradually fills the alveoli. As the pneumonia becomes more severe, fluid accumulates and tissue scarring occurs. These changes result in decreased respiratory function and lower levels of oxygen in the blood.

High-risk groups

Some patients are at greater risk of developing PCP. These high-risk groups include:

• premature infants
• patients with immunodeficiency diseases, including severe combined immunodeficiency disease (SCID) and acquired immunodeficiency syndrome (AIDS)
• patients receiving immunosuppressive drugs, especially cortisone-like drugs (corticosteroids)
• patients with protein malnutrition.

AIDS is currently the most common risk factor for PCP in the United States. PCP is, however, also found in countries with widespread hunger and poor hygiene.

Symptoms

The incubation period of PCP is not definitely known, but is thought to be between four and eight weeks. The major symptoms include shortness of breath, fever, and a nonproductive cough. Less common symptoms include production of sputum, blood in the sputum, difficulty breathing, and chest pain. Most patients will have symptoms for one to two weeks before seeing a physician. Occasionally, the disease will spread outside of the lung to other organs, including the lymph nodes, spleen, liver, or bone marrow.

Diagnosis

The diagnosis of PCP begins with a thorough physical examination and blood tests. Although imaging studies are helpful in identifying abnormal areas in the lungs, the diagnosis of PCP must be confirmed by microscopic identification of the organism in the lung. Samples may be taken from the patient's sputum, or may be obtained via bronchoscopy or lung biopsy. Because of the severity of the disease, many physicians will proceed to treat patients with symptoms of pneumocystis pneumonia if they belong to a high-risk group, without the formality of an actual diagnosis. The severity of PCP can be measured by x-ray studies and by determining the amount of oxygen and carbon dioxide present in the patient's blood.