Pneumocystis pneumonia: A case study

Discussion 8 Derek Smith, a 31 y.o., Caucasian male injection drug user, who is homeless, presents to the ED with a chief complaint of shortness of breath. He describes a 1-month history of intermittent fevers and night sweats associated with a nonproductive cough. He has become progressively more short of breath, initially only with exertion, but now he feels dyspneic at rest. He appears to be in moderate respiratory distress. His vital signs are abnormal, with fever to 39°C, heart rate of 112 bpm, respiratory rate of 20/min, and oxygen saturation of 88% on room air. Physical examination is otherwise unremarkable but notable for the absence of abnormal lung sounds. Chest x-ray film reveals a diffuse interstitial infiltrate characteristic of pneumocystis pneumonia, an opportunistic infection. In this discussion: Describe and discuss with your colleagues the underlying disease most likely responsible for this patient’s susceptibility to pneumocystis pneumonia. Describe and discuss the immunosuppression caused by this underlying disease. Describe and discuss the natural history of this disease and some of the common clinical manifestations seen during its progression. Describe your plan of care for this patient following his hospitalization (he will likely be admitted to the “medical respite floor,” of a local homeless shelter, which has the services of a Nurse Practitioner three times per week—with on-call weekend consultation, and a registered nurse, Monday through Friday). Include citations from the text or the external literature in your discussions. Pneumocystis pneumonia: A case study

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Pneumocystis pneumonia, also known as pneumocystis or PCP, is among the most common opportunistic infections associated with HIV. When untreated, more than 80% of HIV positive people will develop PCP at some point. While the condition is at this time very preventable, it has, in the past, been known to be a significant killer for HIV positive individuals. The current mortality rate due to the disease is roughly 10%, according to Bienvenu at al. (2016).

The symptoms displayed by the patient indicate the presence of Pneumocystis pneumonia with the underlying cause being HIV. The patient likely contracted HIV from sharing needles while injecting drugs intravenously. HIV positive people are prone to this condition when their CD4+ T-cell levels fall below 200 (Bienvenu et al., 2016). This is because T4 cells are essential cells in the immune system that are typically targeted by HIV.

During the late 80s, before the development of a treatment for HIV, nearly three out of every four HIV positive people would develop PCP. However, now, Antiretroviral therapy prevents people with HIV from contracting AIDS and, for this reason, reduces the number of people who get PCP (Bienvenu et al., 2016). Research has traced PCP from when it was merely an obscure pulmonary pathogen to its current placement as one of the most prominent causes of lung infection for people with AIDS.  Better care has been achieved in time through improvements in diagnosis and treatment. Furthermore, the nature of the organism has been better understood through basic molecular immunologic investigations.

A sound care plan for a patient such as Derek Smith, who is likely to receive care from the “medical respite floor,” of a homeless shelter should include two components. These are assessment and therapeutic interventions. Assessment will target the depth, rhythm, and rate of respiration, cough productivity and effectiveness, the patient’s hydration status, auscultation of lung fields, and observation of the sputum while noting changes in odor, color, and viscosity. Therapeutic interventions will involve encouraging ambulation to reduce atelectasis, monitoring the effects of different respiratory therapies, maintaining patient hydration, and teaching the patient relevant deep-breathing exercises. The health care provider will also need to perform suction to stimulate cough or mechanically clear the patient’s airway if they cannot do it themselves (Schmidt et al., 2018). Pneumocystis pneumonia: A case study

References

Bienvenu, A. L., Traore, K., Plekhanova, I., Bouchrik, M., Bossard, C., & Picot, S. (2016). Pneumocystis pneumonia suspected cases in 604 non-HIV and HIV patients. International Journal of Infectious Diseases, 46, 11-17.

Schmidt, J. J., Lueck, C., Ziesing, S., Stoll, M., Haller, H., Gottlieb, J., … & David, S. (2018). Clinical course, treatment, and outcome of Pneumocystis pneumonia in immunocompromised adults: a retrospective analysis over 17 years. Critical Care, 22(1), 1-9. Pneumocystis pneumonia: A case study