Spontaneously expectorated sputum should not be used for diagnostic studies because it has poor sensitivity for PCP. Specimen: sputum, blood, or nasopharyngeal aspirates.Molecular testing: alternative to histopathology or cytopathology for PCP diagnosis.Methenamine silver, cresyl violet, and toluidine blue stain the cyst wall.Giemsa, Wright, and Diff-Quik stain the cystic and trophic forms but not the cyst wall.Method: Staining enables visualization of disc-shaped P.Second-line: bronchoalveolar lavage or lung tissue biopsy.Histopathology (preferred confirmatory test ): identification of P.If these findings are present, consider alternative diagnoses or additional pathology. Patients with PCP rarely present with lung cavitations or pleural effusions on chest x-ray. A normal CT effectively rules out the diagnosis.Pneumatoceles : cystic air-filled spaces within the lung tissue.Ground-glass attenuation : symmetrical, diffuse, interstitial infiltrates.Indicated if PCP is still suspected in a patient with a normal chest x-ray.CT chest without contrast ( HRCT may increase diagnostic accuracy).May be normal in the early stages of PCP.Diffuse, bilateral, symmetrical, interstitial infiltrates extending from the perihilar region (butterfly pattern).↓ CD4 count (in HIV -positive patients): typically Arterial blood gas: ↓ PaO 2 and ↑ A-a gradient. ![]() jirovecii from respiratory secretions or lung tissue. jirovecii cannot be routinely cultured, it requires confirmation via histopathological, cytopathological, or molecular identification of P. Maintain a broad differential diagnosis and seek a definitive diagnosis of PCP when possible.īecause P.
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