Algorithm for the Diagnostic Evaluation and Management of Patients with Suspected Pneumocystis Pneumonia

Algorithm for the Diagnostic Evaluation and Management of Patients with Suspected Pneumocystis Pneumonia - Flowchart Pneumonia, Pneumocystis Jirovecii (Carinii) Pneumonia, Pneumocystis Jirovecii (Carinii)

«Flowchart»

Management algorithm for syndromes clinically compatible with pneumocystosis

CXR

Reticular/Granular infiltrate

Normal

Diagnostic workup

Empiric treatment

Observe
No Rx

End

Observe
No Rx

Ground-glass opacification (GGO)

No GGO

Observe

Neg.

Positive
GMS, IFA, DQ, PCR

Positive

Induced sputum
Neg.

Induced sputum

BAL

Positive
GMS, IFA, DQ, PCR

Positive

HRCT scan

DL_CO

_CO DL(CO)

Clinical evaluation

PaO₂ <70
Moderate-Severe
Steroids
IV TMP/SMX
or
Clindamycin/Primaquine
Pentamidine

O ₂

PaO(2) <70

PaO₂ >70
Mild-Moderate
TMP/SMX
TMP Dapsone
Pentamidine
Atovaquone
Clindamycin/Primaquine

O ₂

PaO(2) >70

Clinical response 21 days treatment

Clinical response

Progression after 4 to 8 days treatment
Exclude second pathogen
Consider change in treatment:

Clindamycin/Primaquine
Pentamidine

Progression after 4 to 8 days treatment
Exclude second pathogen
Consider change in treatment:

Clindamycin/Primaquine
Pentamidine

Clindamycin/Primaquine
Pentamidine Progression after 4 to 8 days

<75% predicted

<75%

>75%