SFGH 4.5 AM report pearls: PCP/pneumonia

Diagnosing pneumonia by history and physical exam

– overall: individual symptoms or signs have inadequate test characteristics to rule in or out the diagnosis of pneumonia

– normal lung exam: likelihood ratio of 0.57 (CI 0.39 – 0.83) – does not substantially reduce the probability of pneumonia

– asymmetric respirations – in one study guaranteed the diagnosis of pneumonia (LR infinity, CI 3.2), but rare finding

 

PCP pneumonia diagnostic options:

– induced sputum (limited by need for trained technicians to collect a high quality sample) – diagnostic yield of 50-90%

– bronchoscopy with BAL – >90% yield in HIV infected patients

– transbronchoscopic or surgical lung biopsy

 

Indications for steroids in PCP: used in moderate to severe disease:

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

 

  • Evernote link: http://www.evernote.com/l/AoP0feWt7t9IOb4oMR8HtLpRVyHjK-t4zxE/
  • Thomas CF, Limper AH.  Pneumocystis pneumonia. NEJM 2004; 350:2487-2498.
  • Metlay JP, Kapoor WN, Fine MJ. Does This Patient Have Community-Acquired Pneumonia? Diagnosing Pneumonia by History and Physical Examination. JAMA.1997;278(17):1440-1445.
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