Pneumocystis pneumonia

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

What is Pneumocystis Pneumonia?

In the Pneumocystis pneumonia it is an interstitial type of pneumonia. The inflammation does not affect the alveoli but the interstitium. This is the narrow layer of connective tissue that is located between the alveoli and the blood vessels. So-called opportunistic pathogens are involved in the development of Pneumocystis pneumonia.

Therefore, this disease is one of the opportunistic infections. Opportunistic pathogens can be fungi, viruses or bacteria. They take advantage of it when the body is in a precarious situation. These pathogens most often attack the organism when the immune system is weakened, i.e. when there is an immunodeficiency.

Since this is characteristic of people with AIDS, Pneumocystis pneumonia is considered the most common AIDS-defining disease. Since this type of pneumonia mainly occurs when the person concerned already has a previous illness, it is a secondary pneumonia.

causes

The opportunistic pathogen that causes this form of lung disease is Pneumocystis jirovecii, a hose fungus that occurs everywhere in the environment. Man is constantly exposed to it. Because it is transmitted through the air, the likelihood of contact with the pathogen is very high. Most people become infected in childhood.

However, the immune system of a healthy body is usually able to prevent disease without any problems. But if the immune system is weakened, the patient is acutely at risk. Reasons for a weakened immune system can be, for example, chemotherapy, a congenital immunodeficiency or an HIV infection.

The HIV infection is so critical because the HI virus gradually destroys the T helper cells that are responsible for the formation of antibodies. Without sufficient antibodies, the body is no longer able to successfully fight invading pathogens. The immune cells can no longer successfully fight off the fungal pathogen Pneumocystis jirovecii. This results in the critical inflammation of the lung tissue.

Symptoms, ailments & signs

The onset of pneumonia occurs gradually. First of all, the person affected has a dry cough that becomes stronger over time. In addition, the patients suffer from increasing shortness of breath, also known as dyspnea.

Fever can occur, but it is not a characteristic symptom, as an excessively weakened body may no longer be able to fight an infection with a fever. Another symptom is tachypnea. 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 can lead to weight loss for several weeks. This can amount to several kilos. Typically, a so-called oral thrush can be detected in the patient's mouth.

This means a fungal infection of the oral mucosa, which appears with white or yellowish coatings. If the disease is left untreated, the patient's condition will deteriorate continuously. In such a case, the disease can quickly become fatal.

Diagnosis & course of disease

For people with a previously undetected HIV infection, it can often take a long time before a diagnosis of PCP is made. Because even if the doctor X-rays suspecting pneumonia, in many cases there are no abnormalities in the picture. Only rarely does a butterfly-shaped structure indicate an existing pneumonia during the X-ray.

A reliable diagnosis can only be made by means of bronchoscopy with bronchial lavage. A thin tube is inserted through the throat into the bronchi. Tissue samples are taken with small brushes and forceps. In bronchial lavage, the airways are flushed with a saline solution.

The solution is then sucked off. The samples obtained during the investigation are examined microbiologically to identify 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 those affected. As a rule, however, death only occurs if the pneumocystis is not treated and the inflammation can spread to other regions of the body. With this disease, those affected primarily suffer from very severe breathing difficulties and also from a persistent cough.

The throat also hurts and you may experience difficulty breathing. Due to the breathing difficulties, the internal organs are also supplied with less oxygen, so that in the worst case this can lead to irreversible damage. Pneumocystis also stresses 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 often 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 person affected is not affected by successful treatment.

When should you go to the doctor?

Symptoms such as a dry to slimy cough, chest pain, and a high fever suggest pneumonia. A doctor must determine whether there is Pneumocystis pneumonia and, if necessary, start treatment immediately. Depending on the severity of the pneumonia, it may be enough to prescribe light antibiotics. In the case of severe complaints, inpatient treatment at a specialist clinic is necessary. In order to be able to decide this early on, a quick medical clarification is essential. Therefore, medical advice should be obtained at the latest when chest pain increases or fever increases.

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 go to the family doctor quickly if the symptoms mentioned above occur. In addition, an ENT doctor or a pulmonologist can be consulted. During antibiotic therapy, a doctor must monitor the healing process. If there are complications, the patient must be taken to hospital immediately. When infants or young children show signs of Pneumocystis pneumonia, call emergency services.

Treatment & Therapy

If the diagnosis Pneumocystis pneumonia is made, a high dose therapy with antibiotics is carried out. This usually has to be continued for at least three weeks. For this purpose, co-trimoxazole is usually administered intravenously. If the person concerned has an intolerance, this is very problematic, as all alternative preparations are less effective and some of them have very dangerous side effects.

Since the patient's condition initially worsens after the start of treatment, and sometimes they even need breathing aid, the affected person is usually admitted to a clinic. Only in very mild cases may the patient treat the disease at home by taking oral antibiotics. Cortisone preparations can also be administered to curb the inflammatory reactions in the lungs.

prevention

While the infection with Pneumocystis jirovecii cannot be prevented, suitable prophylactic measures can prevent the onset of the disease. Healthy people protect themselves best by taking care to avoid infection with the HI virus. Antibiotics are given as a preventive measure to patients who are already HIV-positive or who have an immunodeficiency for another reason.

Aftercare

In the case of Pneumocystis pneumonia, the person affected usually has only a few and limited follow-up measures available. For this reason, the patient should consult a doctor at the first symptoms and signs of the disease so that further complications can be prevented. As a rule, independent healing cannot occur, so that the person affected is usually always dependent on a medical examination and treatment.

The earlier a doctor is consulted, the better the further course of the disease is often. Most of those affected are dependent on the intake of various medications, whereby the correct dosage and regular intake must be ensured. Furthermore, when taking antibiotics, it should be noted that they must not be taken together with alcohol. Regular checks and examinations by a doctor are also very important in order to identify further damage caused by Pneumocystis pneumonia at an early stage. This disease may lead to a reduced life expectancy for the person affected.

You can do that yourself

In the area of ​​self-help, the person affected should take various measures to support his body's own defense system in its functional activity. So that the organism can defend itself sufficiently against pathogens and germs, the person affected should attach importance to a healthy lifestyle.

The food intake should be balanced and rich in vitamins. Obesity should be avoided as this puts additional stress on the body. It is advised that the person concerned makes sure that their weight is within the normal range of the BMI. Sports activities, good sleep hygiene and staying in the fresh air strengthen the immune system. Stress, hectic and stressful situations are to be avoided. The consumption of harmful substances is also prohibited. These include in particular nicotine, alcohol, drugs or non-prescribed medications. Environments that are enriched with pollutants such as gases or other unpleasant smells should be avoided.

Since the disease can lead to a state of shortness of breath, panic reactions are to be avoided. These exacerbate anxiety and further deteriorate health. Always keep calm so that no sequelae occur. In severe cases, Pneumocystis pneumonia can lead to a premature death of the person concerned.It is therefore particularly important to seek medical help as soon as the first irregularities occur.