Pneumocystis pneumonia.

Derek Smith, a 31 y.o.,  Caucasian male injection drug user, who is homeless, presents to the ED with a chief complaint of shortness of breath. He describes a 1-month history of intermittent fevers and night sweats associated with a nonproductive cough. He has become progressively more short of breath, initially only with exertion, but now he feels dyspneic at rest. He appears to be in moderate respiratory distress. His vital signs are abnormal, with fever to 39°C, heart rate of 112 bpm, respiratory rate of 20/min, and oxygen saturation of 88% on room air. Physical examination is otherwise unremarkable but notable for the absence of abnormal lung sounds. Chest x-ray film reveals a diffuse interstitial infiltrate characteristic of pneumocystis pneumonia, an opportunistic infection.

In this discussion:

Describe and discuss with your colleagues the underlying disease most likely responsible for this patient’s susceptibility to pneumocystis pneumonia.
Describe and discuss the immunosuppression caused by this underlying disease.
Describe and discuss the natural history of this disease and some of the common clinical manifestations seen during its progression.
Describe your plan of care for this patient following his hospitalization (he will likely be admitted to the “medical respite floor,” of a local homeless shelter, which has the services of a Nurse Practitioner three times per week—with on-call weekend consultation, and a registered nurse, Monday through Friday).

Opportunistic infections

Underlying medical condition

Dereck Smith is likely to be suffering from HIV/AIDS that has weakened the immune system. The exposure to this disease is from the injection of the drugs being abused. There is a high risk of contracting the disease in the population who use injection drugs due to the habits of sharing sharp objects (Fauci et al. 2020). In the process, they transmit infections to one another. As such, HIV/AIDS has been identified to be very prevalent among this population. Pneumocystis pneumonia.

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How the immune system is weakened,

Song et al. (2016), when one is infected with HIV cells, the immune system responds by activating the innate immune system that involves the macrophages, dendritic cells, and the natural killer cells, which act as first-line defense mechanisms. Due to the specificity of the immune system, the cell mediated immune system is activated. The CD8+ cells lyse the virus cells to reduce viremia. However, due to the rapid replication of the retrovirus, viremia progresses, and CD4+ cells in the body continue to decrease in numbers to a very low count. At that particular point, the immune system is weaker, and the patient is susceptible to opportunistic infection. Pneumocystis pneumonia.

Clinical manifestations

HIV/AIDS is a gradually progressive disease that symptoms present with the weakening immunity and increased risk of opportunistic infection. Tchatchouang et al. (2019) noted that early signs include fever, chills, mouth ulcers, and sore throat. It enters a clinical latency. After that, rapid weight loss, Recurring fever, unexplained tiredness, lymph node swelling, diarrhea that lasts for more than a week, Sores of the mouth, anus, or genitals, neurologic disorders occur. Often these symptoms are a result of opportunistic infections. Pneumocystis pneumonia.

Plan of care

First, stabilnzing the patient is the priority. This is through starting oxygen therpy 2L via nasal cannula. Then administer acetaminophen which will serve as an antipyretic. The patient will be started on Highly active antiretroviral treatment (HAART). Thereafter, started on sulfamethoxazile trimethoprim which will treat the current diagnosis and provide prophylaxis to other infections. Counseling is necessary to promote compliance with antiretroviral therapy. The patient will also need to be initiated on rehabilitative therapy (Fauci et al. 2020). This will reduce susceptibility to other severe opportunistic infections. Pneumocystis pneumonia.