PCP
(Pneumocystis jiroveci originally known as Pneumocystis carinii pneumonia)

PCP is an infection of the lungs caused by Pneumocystis jiroveci, which is a common micro-organism in people. It causes disease only in people with weakened immune systems, such as those who have had transplants, chemotherapy, or advanced HIV infection. As the infection progresses, the air spaces in the lungs fill with fluid, making it harder to breathe. Very occasionally the organism can also affect other parts of the body, such as lymph nodes, bone marrow, spleen, liver and occasionally the eyes. PCP is still one of the most common AIDS defining illnesses, however, because of advances in treatment and prevention, it now rarely occurs in those receiving (and taking) care. However it is still seen in people who do not come forward for HIV tests or who do not get HIV care and can be very serious.

Symptoms
Symptoms of PCP include:

* fever;
* shortness of breath;
* fatigue;
* night sweats;
* dry persistent cough;

Non-smokers develop the dry cough characteristic of PCP, but smokers may produce some sputum when they cough. At first, these symptoms may be so mild that they go unnoticed for several weeks, but as the condition worsens, they will be more noticeable. A ‘tight’ chest and shortness of breath when climbing stairs and then eventually when doing nothing. If you have any of the symptoms, then check with a doctor as soon as possible.

Diagnosis
There are a number of tests used to help with the diagnosis of PCP, but the only way to diagnose it definitely, is by looking for the pneumocystis organisms themselves. This is done by taking a sample of sputum (spit) from deep inside the lungs. This procedure is called an Induced Sputum test. A mist of salty water is breathed in, and the sputum that comes up is tested in a lab to find out if P. carinii is present. A Bronchoscopy might also be done, where a piece of equipment called a bronchoscope is passed through the mouth and throat, and into the lungs, usually under a local anaesthetic. Salty water is then squirted into the lungs and sucked out again. Both procedures are uncomfortable, but necessary.

Other tests to determine how severe the infection is are a blood gas test to see how much oxygen/carbon dioxide are being carried from and to the lungs. PCP is either mild, moderate, or severe, and treated either at home, in hospital or in intensive care. Steroids are used in severe cases of PCP.

Prevention
PCP has become one of the most easily prevented illnesses associated with HIV infection. Those people who have HIV and who are most at risk of developing PCP are those who:

* have a CD4+ count below 200;
* have had a previous episode of PCP;
* have a CD4+ count below 300 with signs of immunosuppression (persistent fever or candida in the mouth or throat);
* Drugs used as PCP prophylaxis (prevention) are Septrin (co-trimoxazole), aerosolised pentamidine, or dapsone;

Treatment for PCP
* Intravenous co-trimoxazole until improvement of breathing and fever, then in tablet form for 2/3 weeks. Some people experience side effects, and have to change to another treatment.
* Clindamycin/Primaquine – is an alternative if allergic or intolerant to co-trimoxazole.
* Intravenous Pentamidine is used in people who cannot tolerate the above. It has no effect against other infections.

The choice of which drugs used, is based on a person's general health, drug allergies and lifestyle, and would be discussed with your doctor.