Moffitt AM Report Pearls 7/15: PCP pneumonia

Test characteristics of LDH

  • Old paper from 1988 (PMID 3258483)
    • Normal LDH values only found in 7% of HIV positive patients with PCP
  • Multiple small series papers: LDH is sensitive test for PCP (unlikely if LDH <220-250 depending on the study)
  • Take home: highly sensitive (i.e. unlikely to be PCP if LDH <200’s) but NOT specific. Most likely, it is just a marker of lung inflammation and injury.

Test characteristics of beta-D-glucan (sensitive, not specific)

  • Component of fungal cell wall
  • False positives
    • Other fungi: Histoplasma, Candida, Aspergillus
    • Clinical variables affecting test: hemodialysis, IVIg, albumin, IV Augmentin (but a diff formulation than available in the US), certain bacterial bloodstream infections
  • Beta-d-glucan >80pg/mL is 92% sensitive and 65% specific for PCP (reference PMID 21690628)

Indications for steroids: used in moderate to severe disease

  • PaO2 <70mmHg on room air and/or
  • A-A gradient of >35mmHg

High dose IV TMP-SMX treatment pearls (courtesy of HH)

  • Watch out for hyponatremia (comes in D5W)
  • Watch out for hyperkalemia (often needs to be monitored but not treated). Mechanism is not totally clear, but some evidence that TMP is chemically similar to amiloride (K-sparing diuretic) and inhibits Na channel in distal nephron, impairing renal excretion of K (reference PMID 23326725)

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