Overview
Extrapulmonary Pneumocystis jirovecii infection refers to the occurrence of Pneumocystis jirovecii outside the lungs, primarily affecting immunocompromised individuals 1.Diagnosis
Clinical and radiological features are crucial for initial suspicion 2.
Non-invasive tests show promise but vary in sensitivity and specificity; systematic review indicates mixed performance 1.
Bronchoalveolar lavage (BAL) is recommended for definitive diagnosis despite delays in treatment initiation 2.
Delaying treatment based on awaiting BAL results is discouraged in high-risk patients 2.Management
First-line treatment: High-dose trimethoprim/sulfamethoxazole (TMP/SMX) 2.
Alternative regimen: Primaquine plus clindamycin for TMP/SMX intolerance 2.
Duration: Typically 3 weeks of antimicrobial therapy 2.
Secondary prophylaxis: Indicated post-treatment in all patients 2.
Respiratory failure: Non-invasive ventilation is not superior to intubation and mechanical ventilation 2.
Glucocorticoids: Use individualized based on clinical judgment 2.Special Populations
No specific guidance provided for pregnancy, pediatrics, elderly, or comorbidities in the given abstracts [].Key Recommendations
Initiate empirical treatment for suspected Pneumocystis jirovecii pneumonia based on clinical and radiological findings without awaiting BAL results (Evidence: Moderate 2).
High-dose trimethoprim/sulfamethoxazole should be the first-line treatment for PCP (Evidence: Strong 2).
Consider secondary prophylaxis after completing initial treatment course in all patients (Evidence: Moderate 2).References
1 Senécal J, Smyth E, Del Corpo O, Hsu JM, Amar-Zifkin A, Bergeron A et al.. Non-invasive diagnosis of Pneumocystis jirovecii pneumonia: a systematic review and meta-analysis. Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases 2022. link
2 Maschmeyer G, Helweg-Larsen J, Pagano L, Robin C, Cordonnier C, Schellongowski P. ECIL guidelines for treatment of Pneumocystis jirovecii pneumonia in non-HIV-infected haematology patients. The Journal of antimicrobial chemotherapy 2016. link