With pneumonia, gas exchange in the lungs is disrupted, inflammation covers the structures of the lower respiratory tract. There is a type of disease caused by an unusual microorganism. It is resistant to drugs, so the disease is difficult. This form of pneumonia is called Pneumocystis Pneumonia (Pneumocystosis). It is rare, but everyone is at risk of contracting it.

Features of the course of the disease

The causative agent of pneumocystosis is a microorganism (yeast-like fungus Pneumocystis Jirovecii ), which is an intermediate link between the fungus and protozoa. Such a rare form of existence helps him to be resistant to medication. This parasite has been identified only in humans; it is unable to infect animals.

The causative agent of a special form of pneumonia is often found in the lungs of healthy people. It is capable of causing an inflammatory process only in an organism with a weak immune defense. The risk group includes patients with serious illnesses, HIV-infected, weakened children.

In HIV-infected patients

The pathological process in the lungs of patients with HIV infection is slow. From infection to the appearance of clear signs of pneumonia, it takes up to 12 weeks. To exclude such cases, at each suspicion of infection, such patients undergo fluorography.

The main signs of pneumocystosis in patients with HIV infection:

• long-term (from 2 to 3 months) high temperature up to 40 ° С;
• a sharp decrease in weight;
• dry cough;
• dyspnea;
• increasing respiratory failure.

Common pneumonia in AIDS-infected people has similar manifestations, so it is not immediately possible to identify a special pneumocystic type. Time is wasted, it is difficult for a weakened immune system to fight an atypical pathogen. Often a bacterial infection joins the weakened organism. A cough with phlegm begins, the temperature rises.

The child has

The disease can affect children from 6 months. Often these are weakened babies with prematurity, rickets, diseases of the central nervous system, oncology, HIV infection.

A feature is the gradual development of the disease; in newborn children, pneumocystosis can proceed without visible manifestations. The child begins to eat poorly, does not gain weight, becomes lethargic, but the temperature does not rise. Shortness of breath begins, a strong, prolonged cough, blue skin.

In severe cases, there is a risk of developing pulmonary edema, in which the baby may die. On the X-ray picture, focal shadows are observed.

Symptoms

In the clinical picture of pneumocystosis, there are several stages with their own manifestations. In some patients, the disease can disguise itself as laryngitis, bronchitis and other pathologies. Symptoms of pathologies are similar, but knowledge of the characteristics of SARS helps in differentiation.

The incubation period lasts from 7 to 10 days. The signs of each stage are presented in the table.

Name	Duration	Description of symptoms
Edematous	From a week to 10 days.	The temperature is normal, cough with a small amount of thick mucus, weakness, constant fatigue, poor appetite. When listening, breathing is hard without wheezing.
Atelectatic	Not more than a month.	There is shortness of breath, a prolonged severe cough with transparent, difficult to separate sputum, blue skin. Wheezing is detected when listening
Emphysematous	Up to 20 days.	Chest pain, blue nasolabial triangle, rapid pulse, wheezing in the lungs.

Without timely competent therapy, the pathogen can spread from the lower lungs to other internal organs. This is a dangerously serious complication.

Risk group

The likelihood of catching an atypical infection is in different categories of adults and children. At risk are:

• children under 8 years of age due to insufficient development of immunity;
• patients with tuberculosis, HIV-infected;
• premature babies;
• patients with cancer who are undergoing chemotherapy courses, radiation, take immunosuppressants;
• organ transplant recipients;
• elderly people;
• people with severe pathologies that suppress immunity (cirrhosis of the liver, cytomegalovirus infection, rheumatoid arthritis, other diseases);
• patients taking hormones.

People with weak immunity who work in hospitals are at risk of becoming infected. The pathogen is transmitted by airborne droplets, therefore it is widespread. Community-acquired infection is rare.

Reasons for development

The causative agent of a special type of pneumonia, Pneumocystis Jirovecii, is known as a pneumocyst. This unicellular parasite lives in lung tissue and is not dangerous for healthy people. With a decrease in immunity, he has a chance to reproduce. In addition to the transmission of the virus by airborne droplets, infection during pregnancy from mother to fetus is possible.

The waste products of the pathogen enter the circulatory system, causing poisoning of the body. The disease does not lead to the formation of immunity. Etiology (the science of the causes of disease) identifies several genotypes of pneumocystis. Recurrence of pneumonia is possible upon contact with each new species. In 25% of cases in HIV-infected patients, pneumocystosis recurs.

Diagnostics

The diagnosis is made by infectious disease specialists and pulmonologists. It is important to determine the cause that may have caused the infection. For this, a thorough survey of the patient is carried out, data is collected about his work, environment, possible contact with the patient, an anatomical examination is carried out, which reveals tachycardia, shortness of breath, and respiratory failure.

Diagnostics includes the following activities:

• listening to the lungs;
• polymerase chain reaction, which allows you to identify the genetic remnants of the infection in the blood;
• a general blood test, which allows you to see the presence of inflammation in the body;
• X-rays to determine areas of darkening (for Pneumocystis pneumonia, a special type of lung is characteristic of the picture);
• sputum analysis to detect antibiotic susceptibility.

On the recommendation of the doctor, other studies are carried out to obtain a more complete picture of the patient’s condition.

Treatment methods

The principle of therapy is to reduce the development of complications that are often fatal. The causative agent of pneumocystosis is resistant to most antibiotics. Those drugs that help fight it are highly toxic, causing serious side effects in debilitated patients and children. They often cause disturbances in the digestive system, fever, skin rashes, hepatitis, neuropathy.

5 days after the start of pneumonia treatment, the patient’s condition deteriorates sharply, this is due to the death of a large number of pneumocysts . The state of health is restored through medication.

To relieve the symptoms of the disease, expectorant drugs, sputum thinning agents, and anti-inflammatory medicines are prescribed. Antibiotics are used to ease breathing and reduce inflammation. Traditional methods of treatment are not used. They can be useful during the recovery period to improve the condition and strengthen the immune system.

The survival rate for Pneumocystis pneumonia reaches 90%, but frequent relapses lower these rates to 60%. More than half of HIV patients have recovered within a year. They need to undergo chemotherapy.

The duration of therapy depends on the patient’s condition. The average pattern is 14 days. Those infected with AIDS need to be treated for 3 weeks.

Forecast

Predicting the outcome of Pneumocystis pneumonia treatment is difficult. The disease quickly becomes chronic if the immune system is not restored. Relapses often occur, which negatively affect the state of the respiratory system.

With timely treatment, the prognosis is favorable. Neglected cases lead to mortality up to 60% in childhood, up to 90% in adult patients. Respiratory failure is often the cause of death.

Prophylaxis

The prevention of the development of pneumocystis pneumonia several times reduces the incidence. Regular prophylaxis is carried out in children’s medical institutions, in inpatient departments for hematological and oncological patients. All personnel are examined to identify the causative agent of the disease.

For people at risk, it is advisable to limit contact with the sick, to take antibiotics in advance with a decrease in lymphocytes in the blood test. After recovery, special prophylaxis is carried out in order to reduce the likelihood of a relapse.

Disinfection with chloramine where the disease occurs reduces the risk of infecting people with weak immune status. Timely isolation of patients with Pneumocystis pneumonia blocks the path of infection.

Complications

The disease must be treated for a long time and seriously. It is required to constantly improve immunity, to fight the underlying disease that destroys the body’s natural defenses. The negative consequences of Pneumocystis pneumonia are very serious. They are caused by disturbances caused by the causative agent of the pathology of the respiratory system.

Complications become:

Pneumothorax

• pneumothorax;
• acute respiratory failure;
• lung abscess;
• pleurisy;
• bronchial obstruction syndrome.

The disease quickly turns into bilateral pneumonia, pneumocysts spread to internal organs, including the brain and heart.

Strong immunity is able to protect the body from many serious diseases, such as pneumocystis pneumonia. Man should constantly strengthen his natural defenses. Another factor in the prevention of pneumocystosis is the regular passage of fluorography, to which many are frivolous.