high fever; cough; shortness of breath, especially on exertion; weight loss; night sweats; sputum production
The clinical diagnosis can be confirmed by the characteristic appearance of the chest x-ray which shows widespread infiltrates, and an arterial oxygen level (pO2) strikingly lower than would be expected from symptoms. The diagnosis can be definitively confirmed by pathologic identification of the causative organism in bronchial washings obtained by bronchoscopy.
Antipneumocystic medication is used with concomitant steroids in order to avoid inflammation that causes an exacerbation of symptoms which typically appears four days after treatment begins if steroids are not used. By far the most commonly used medication is trimethoprim/sulfamethoxazole; other medications that are used, alone or in combination, include pentamidine, trimetrexate, dapsone and clindamycin. Treatment is usually for a period of about 21 days.
Much of the incidence of PCP has been reduced by instituting a standard practice of using oral trimethoprim/sulfamethoxazole to prevent the disease in people with CD4 counts less than 200/mm³.