Pneumocystis Jirovecii

Please click the frequently asked questions below for further information and IPC precautions required:

• What is Pneumocystis jirovecii?

  Pneumocystis jirovecii (formerly known as P. Carinii) is a yeast-like fungus of the genus Pneumocystis and is the agent that causes Pneumocystis Pneumonia (Known as PJP and previously known as PCP)

  It most commonly affects the immunocompromised and, in some cases, can be severely life-threatening. Typically, patients at risk are those with any underlying disease states that alter host immunity such as those with cancer, the HIV, transplant recipients, or those taking immunosuppressive therapies and medications.

• How does it spread?

  Pneumocystis jirovecii are usually spread from an infected person to others through:

  • close personal contact, such as touching or shaking hands
  • droplets by coughing and sneezing
  • touching an object or surface with parvovirus on it, then touching your mouth, nose, or eyes before washing your hands
• What are the symptoms of Pneumocystic jirovecii?
  • Cough is usually non-productive but productive cough may occur in up to a third of patients.
  • Exertional dyspnoea.
  • Fever.
  • Tachypnoea.
  • Chest pain.
  • There may be signs of AIDS such as thrush, oral hairy leukoplakia or Kaposi’s sarcoma.
  • Respiratory examination is highly variable and often normal. Scattered crackles and wheeze may be present, or (rarely) signs of focal consolidation.
  • Pulse oximetry may show low SpO2 at rest.
  • Extrapulmonary disease may manifest as hepatosplenomegaly, lymphadenopathy or ocular disease.

  Risk factors include:

  • PCP tends to affect HIV-positive patients who have a CD4 count below 200 cells/mm3.
  • HIV patients with oral thrush or fever, or AIDS-defining diagnosis.
  • Patients taking steroids or other immunosuppressants.
  • Patients with haematological malignancy.
  • Organ transplant recipients.
  • Connective tissue diseases such as rheumatoid arthritis.
  • Congenital immune deficiency – eg, thymic aplasia, severe combined immune deficiency (SCID), hypogammaglobulinaemia.
  • Severe malnutrition (poor nutrition in HIV-positive individuals increases risk).
  • Pre-existing lung disease.
• Why is this important?

  If NIAS staff are aware that the patient has a suspected or confirmed Pneumocystis jirovecii this should be communicated to EAC / NEAC and the receiving unit when transferring the patient to ensure effective patient care and management.

• IPC Precautions
  • Standard Precautions should be used.
  • Contact Precautions may be required with high risk patients such as those who are immunosuppressed or Neonates. This can be discussed with the IPC team.
  • Hand Hygiene should be completed as per the 5 moments in line with usual practice.
  • Eye protection should be risk assessed for any concern regarding a splash risk.
  • Gloves and Aprons should be risk assessed and worn if contact with the patient’s blood or bodily fluids.
  • Laundry should be treated as per standard policy.
• What cleaning is required?

  All equipment and the ambulance should have an in-between patient clean, paying particular attention to touch points.

• Do staff need prophylaxis or follow up?

  No follow up required.