title: An Unusual Case of Cystic Fibrosis AssociatedPneumocystis jiroveciPneumonia in an Infant.
abstract: Pneumocystis jirovecipneumonia (PJP) is one of the major infections in patients with impaired immunity. The entity is common in HIV-seropositive individuals but quite very rare in HIV-seronegative individuals especially children. We report here a case of 16-week-old HIV-seronegative infant with chief complaint of chronic cough of one month of evolution. Sweat chloride test for diagnosis of cystic fibrosis was positive. Bronchoalveolar lavage (BAL) fluid was collected andPseudomonas aeruginosawas isolated on culture. Empirical antibiotic regimen comprising ceftriaxone and azithromycin was initiated that was switched to meropenem as per antimicrobial susceptibility report, but the patient did not improve. Subsequently, an immunofluorescence staining of BAL fluid was performed andP. jirovecicysts were detected. Following a laboratory confirmation ofPneumocystispneumonia, cotrimoxazole was added and the clinical condition of the patient significantly improved. This is an unusual case wherein unsuspected PJP occurred and since signs and symptoms of the patient persisted even after the initiation of antimicrobial therapy forPseudomonasinfection and resolved only after treatment for PJP was started, it suggests a causative role ofP. jirovecirather than colonization/contamination.
authors.affiliation: Department of Microbiology, Lady Hardinge Medical College and Associated Hospitals, New Delhi 110001, India.
authors.forename: Ravinder
authors.identifier: 0000-0002-9230-4188
authors.initials: R
authors.lastname: Kaur
authors.affiliation: Department of Microbiology, Maulana Azad Medical College and Associated Lok Nayak Hospitals, New Delhi 110002, India.
authors.forename: Priyanka
authors.initials: P
authors.lastname: Katariya
authors.affiliation: Department of Microbiology, Lady Hardinge Medical College and Associated Hospitals, New Delhi 110001, India.
authors.forename: Megh Singh
authors.initials: MS
authors.lastname: Dhakad
authors.affiliation: Department of Microbiology, Maulana Azad Medical College and Associated Lok Nayak Hospitals, New Delhi 110002, India.
authors.forename: Bhanu
authors.identifier: 0000-0002-7949-9734
authors.initials: B
authors.lastname: Mehra
authors.affiliation: Department of Pediatrics, Maulana Azad Medical College and Associated Hospitals, New Delhi 110002, India.
authors.forename: Urmila
authors.initials: U
authors.lastname: Jhamb
authors.affiliation: Department of Pediatrics, Maulana Azad Medical College and Associated Hospitals, New Delhi 110002, India.
authors.forename: A P
authors.initials: AP
authors.lastname: Dubey