What is pneumocystis pneumonia (PCP)?

Pneumocystis pneumonia (PCP) is a kind of pneumonia caused by a fungus called Pneumocystis jirovecior, or P. jiroveci. It used to be called Pneumocystis carinii pneumonia.

Most people exposed to P. jiroveci don’t get pneumonia because their immune systems are healthy and strong. People whose immune systems are weak because of an HIV infection or other medical conditions can get PCP. PCP is less common than it used to be. However, it’s still one of the most common serious infections in people who have advanced HIV disease in the United States.

Others who get PCP are usually taking medicines that lower the body’s ability to fight germs or sickness. They may have other medical conditions, such as:

• Blood cancer
• Inflammatory or autoimmune diseases (for example, lupus or rheumatoid arthritis)
• Organ or stem cell transplant

Symptoms of PCP

See your doctor right away if you have a weakened immune system and have the following symptoms:

• Fever
• Cough
• Trouble breathing (especially with exercise)
• Chest pain
• Chest pain
• Fatigue (extreme tiredness)

Most cases are mild. However, people with severe PCP may die if the infection isn’t treated quickly.

What causes PCP?

Most scientists believe PCP is spread in the air. They don’t know if it lives in the soil or anywhere else. The P. jiroveci fungus is common all over the world. It’s not spread through sexual contact. You can’t prevent being exposed to the fungus.

How is PCP diagnosed?

PCP is diagnosed by lab tests of fluid or tissue from your lungs.

Can PCP be prevented or avoided?

If you’re at risk of PCP because you have HIV, you may be able to lower your risk. A good medicine for preventing PCP is trimethoprim-sulfamethoxazole, or TMP-SMX. TMP-SMX is a combination of two medicines. Ask your doctor if you should be taking this medicine (or another medicine) to prevent illness.

Talk to your doctor about medicines you might be able to take if you have other medical conditions that weaken your immune system.

The pneumonia vaccine does not protect you against PCP. It protects you against a different kind of pneumonia. There is no vaccine for PCP.

PCP Treatment

If you have HIV, your doctor will test your blood regularly to check how strong your immune system is. Your doctor may prescribe TMP-SMX to prevent PCP. Your doctor may also have you start taking the medicine as a preventive therapy if you get certain symptoms. These symptoms may be a temperature above 100°F that lasts for two weeks or longer, or a yeast infection in your mouth or throat (also called “thrush”).

People who have severe cases of PCP are treated in a hospital with IV medicine. The medicine is put into a vein through a tube. As people get better, or if the illness was mild to begin with, the medicine can be taken in as a pill. If you can’t take TMP-SMX, or don’t get better quickly with it, you can take other medicines or combinations of medicines.

Living with PCP

If you have conditions that would make you more likely to get PCP, talk to your doctor about medicines that could lower your risk for getting PCP.

Know that taking TMP-SMX might cause a rash. It might make you feel sick. If you have a mild reaction, you should keep taking TMP-SMX because it works better than any other medicine to prevent PCP.

If you’ve already had PCP, you can get it again. Taking TMP-SMX can prevent second infections with PCP.

Questions to ask your doctor

• Do I have a condition that requires me to take PCP?
• How will I know if my medicine is working to treat my PCP?
• I can’t take TMP-SMX. What other medicines can I take to treat PCP?

Resources

Centers for Disease Control and Prevention: Pneumocystis Pneumonia

National Institutes of Health, MedlinePlus: Pneumocystis jirovecior pneumocystis

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You can purchase over-the-counter (OTC) medicines for your child without a prescription from your doctor. However, that doesn’t mean these medicines are harmless. If they are taken the wrong way, they can make your child feel worse and can even be harmful. Read through this list of dos and don’ts to make sure you are giving your child OTC cough and cold medicine safely.

Dos

• Do learn how to read and understand all parts of the medicine’s drug facts label.
• Do look for a medicine that will treat only the symptoms your child has. For example, if your child only has a runny nose, don’t pick a medicine that also treats headache and fever.
• Do use the correct measuring device (for example, a spoon, syringe, or cup made for measuring medicine) when giving your child the correct dose.
• Do read the medicine’s label carefully. Take note of any special instructions, such as foods or activities your child should avoid while taking the medicine.
• Do make sure everyone who takes care of your child (such as school nurses, day care workers, extended family members, or babysitters) knows what medicines your child is taking and when their dosing schedule.
• Do store medicines in their original packages to keep track of important labels and expiration dates.
• Do store all medicines up and away, out of the sight and reach of young children.
• Do keep medicines in a cool, dry place. This will help prevent them from becoming less effective before their expiration dates.

Don’ts

• Don’t give OTC cough and cold medicines to a child younger than 4 years of age unless your child’s doctor says it’s okay.
• Don’t share your adult OTC medicine with your child. OTC medicines made just for adults can be harmful for children. Once your child is a teenager, they may be old enough and big enough to take adult OTC medicines, but check with your family doctor first.
• Don’t give aspirin or a medicine that contains aspirin (check the “active ingredients” section of the drug facts label) to a child younger than 18 years of age. Aspirin can cause a serious illness called Reye syndrome if it is given to children.
• Don’t combine prescription medicines with OTC medicines unless your child’s doctor says it’s okay.
• Don’t use more than 1 OTC cough and cold medicine at the same time unless your child’s doctor says it’s okay. They may have similar active ingredients that add up to be too much medicine. For example, many OTC medicines contain acetaminophen and antihistamines.
• Don’t use an OTC medicine after its expiration date.
• Don’t store medicines in bathrooms or bathroom cabinets, which are often hot and humid.
• Don’t wait too long to take your child to the doctor. Cold symptoms should get better quickly, and OTC medicines are only meant for short-term use. If your child has been taking an OTC medicine for several days and their symptoms seem to be getting worse, call your doctor.
• Don’t give your child cough or cold medicine just to make him or her sleepy. This is a side effect of some ingredients, such as antihistamines, in cough and cold medicines. If your child has trouble falling asleep, talk to your family doctor about other things you can do to help your child sleep better.

Questions to ask your doctor

• Should I ask my doctor which over-the-counter medicine to use before I give it to my child?
• Is expired medicine harmful or just ineffective?
• What side effects should I look for when giving my child over-the-counter medicine?
• Are generics okay to use?

Resources

U. S. Food and Drug Administration: Should You Give Kids Medicine for Coughs and Colds?
National Institutes of Health, MedlinePlus: Medicines and Children

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Fall allergies (sometimes called seasonal allergies or seasonal allergic rhinitis) usually occur between the late summer in August through November. It’s like clockwork. If you have fall allergies, you know how debilitating it can be. The sneezing and itchy, watery eyes can leave you feeling exhausted. For many people, this results in missing work and school. It even forces many people who have fall allergies to stay indoors and miss outdoor activities, like camping, hiking, hayrides, bonfires, and sporting events.

Path to Improved Wellness

The following symptoms are common fall allergy symptoms:

• Itchy, watery eyes
• Itchy nose and/or throat
• Runny nose
• Sneezing
• Nasal congestion
• Allergy asthma (asthma brought on my exposure to allergens)

What causes fall allergies?

The most common cause of fall allergies is a ragweed allergy. This wild plant grows in nearly every part of the country. It is more likely to be found on the East Coast and in the Midwest. The plant’s blooms spread ragweed pollen, which is what causes allergies symptoms. The higher the pollen count, the worse your symptoms can be. In many parts of the country, ragweed pollen is highest in early to mid-September.

In warmer parts of the country, or during mild winter temperatures, some ragweed could continue to be a problem. Some people are allergic to grass. That, too, can cause fall allergies in warmer climates.

Other plants that trigger fall allergies include:

• Burning bush
• Cocklebur
• Lamb’s-quarters
• Pigweed
• Sagebrush and mugwort
• Tumbleweed and Russian thistle

Path to Improved Wellness

Knowing if you have fall allergies and what you are allergic to is a good first step to wellness. If you have experienced the symptoms described above, make an appointment with your family doctor. They will evaluate your symptoms and may refer you to an allergist for more testing.

An allergist will ask you about your symptoms and whether your family members have certain conditions. These include asthma or allergies such as hay fever, hives, or skin rashes like eczema. After the allergist does a physical exam, they will do skin testing.

Skin testing involves lying on your stomach while the allergist pricks the skin on your back with tiny needles. The tiny needles contain a small amount of plant pollens on the tip of the needle. The allergist also can test for other things, such as mold spores, dust mites, animal dander, insect stings, and various foods such as peanuts, eggs, wheat, shellfish, and milk. Testing also is available for some medicines, such as penicillin. The pricks are painless and there’s not enough of the pollen to cause a serious reaction. If you are allergic to something on the needle, it will appear as a little red bump on your skin. A blood test also can determine if you are allergic to certain things.

Once the tests are complete, your allergist will go over the results with you. You may be allergic to certain plants, certain foods, or a combination of the two. This information allows you to be better informed about the things that bother you and help make decisions about certain activities (and foods).

How to treat fall allergies

Depending on severity of your fall allergies, your family doctor or an allergist may recommend treatment in one of several ways:

• Prescription or over-the-counter medicine: This depends on your symptoms and typically includes antihistamines, decongestants, nose (nasal) sprays, or eye drops.
• Immunotherapy (allergy shots): The shots contain a tiny amount of the allergen that you are sensitive to. But the dosage increases over time. Often, it is given in shot form. But it can be given under the tongue. The idea is to gradually desensitize your immune system to the things that causes your allergies. Over time, this approach can make you less sensitive to it. And that reduces your allergy symptoms when you are exposed to it. Immunotherapy also reduces the inflammationthat comes with hay fever and asthma. Sometimes, you may need to take an over-the-counter allergy pill if you are exposed to larger amounts of the allergen.
• Lifestyle changes: This may involve limiting your time outdoors during the fall, wearing a mask if you must be outdoors for lawn care, keeping your windows closed to your home and car, and cleaning your house regularly to eliminate pollen, mold spores, or pet dander.

Things to Consider

Fall allergies can be a life-long challenge, even if you undergo immunotherapy. If you do not get immunotherapy, fall allergies may negatively influence your participation in certain activities, and that affects your quality of life. You will need to remember to take your prescription or over-the-counter medicine if you do not get immunotherapy.

If you choose immunotherapy, it will be an investment in time. It can take about 5 years to complete the therapy. It will involve weekly visits for the shot and gradually ease into monthly shots. However, if you miss a dose, you may have to go back to weekly visits to catch up. Depending on your insurance, immunotherapy can be a financial investment for those five years.

Questions to Ask Your Doctor

• Do I have allergies?
• How can I tell the difference between allergies and a cold?
• Can over-the-counter medicine relieve my symptoms?
• Does over-the-counter medicine make you sleepy?
• How do allergy shots work?
• What if the allergy shots don’t work?
• Can I take the shots if I’m pregnant?

Resources

American College of Allergy, Asthma & Immunology: Leaves are falling. Autumn is calling. So are fall allergies.

National Institute of Environmental Health Sciences: Pollen

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Bringing your baby home from the hospital is a very exciting time. But having a newborn around can be stressful for lots of reasons. One of these is concern about the new baby getting sick. How will you know? It can be hard to tell when a newborn is sick. You may not know what your baby’s normal behavior is yet. This makes it difficult to tell if your baby’s behavior is not normal. Signs of serious illness in newborns can be subtle. They aren’t always easy to spot.

It is important to be aware of what signs could mean that your newborn is sick. Their immune system is not as strong after birth, so it’s harder for them to fight off infections. And once they do get an infection, it can get worse quickly. That’s why you should know what to look for.

Path to improved health

One of the main things to look for in your newborn is if they look or act in any way that seems abnormal to you. If this happens, call your baby’s doctor right away. Some of the ways they could look or act abnormal include:

• Any symptoms of illness. These include crying more often, irritability, coughing, diarrhea, or vomiting. If your newborn vomits green (bile), call the doctor right away.
• Changes in feeding. Newborns usually eat frequently. If you have to wake your newborn to eat or they can’t finish their feedings, they could be sick.
• If your newborn has a fever, especially over 100.4 F (38 C), call the doctor.
• Low body temperature. If your baby’s temperature falls below 96.8 F (36 C), call the doctor.
• Changes in how they cry. Their cry could be weak, sound strange, or be frantic without stopping.
• Weak sucking or not being able to suck for very long
• Sweating while they eat
• Sleeping more than normal (needing to be woken up to eat, for example)
• Decreased muscle tone or floppy limbs.
• Moaning or grunting noises when they breathe.
• Decreased urination (fewer wet diapers) and dry mouth (dehydration).
• Any change in color, such as pale, bluish, or gray arms and legs

It can be hard to tell if your newborn is sick. Pay attention and watch them closely for any of these signs of illness. If you have any question at all about your newborn, call their doctor.

Things to consider

While illness is not normal for a newborn, there are some conditions that are common in the first few weeks after birth. Watch your newborn for signs of any of these conditions and call their doctor if you see symptoms.

Abdominal distension. Your baby’s abdomen (stomach) should feel soft between feedings. If it feels swollen or hard, there could be a problem. It might be gas or constipation. But if they haven’t had a bowel movement for more than a day or two, or if they are vomiting, a swollen stomach could be a sign of an intestinal problem.

Blue baby. Your newborn may show mildly blue hands and feet if they are cold. They may go a little blue around the face, tongue, or lips if they are crying hard. But if they have persistent blue coloring plus breathing or feeding difficulties, it is an emergency. It could be a sign that the heart or lungs are not working correctly. Call the doctor or go to the emergency room right away.

Coughing during feeding. Your newborn may cough or sputter a bit as they learn and adjust to a feeding routine. But if they cough or gag regularly when they are trying to eat, there could be a problem in the lungs or digestive system.

Excessive crying. Newborns cry, sometimes for no reason. If your baby won’t stop crying, make sure they are fed, burped, warm, and have a clean diaper. Then try to hold them and soothe them. You can’t “spoil” a newborn with too much attention, so don’t hesitate to pick them up when they are crying. Soon you’ll get used to your newborn’s crying patterns. But if their crying sounds different, such as shrieking, or it goes on for an unusually long time, call your doctor.

Jaundice. Many healthy newborns have a yellowish tinge to their skin. This is called jaundice. It happens when a chemical called bilirubin builds up in the baby’s blood. Mild cases of jaundice are harmless. But if the buildup gets to be too much and it isn’t treated, it can cause problems. Jaundice normally appears on the face first, followed by the chest and abdomen, and finally it spreads to the arms and legs. Sometimes the whites of the eyes can become yellowish, as well. If you notice your baby developing jaundice, call the doctor.

Respiratory distress. In most cases, if your newborn is having trouble breathing, it’s because their nasal passages are blocked. This is normally easy to remedy by using saline nasal drops and a bulb syringe to suck the mucus out. But there are other signs that could mean your baby is having serious breathing problems. These include

• Fast breathing (more than 60 breaths in one minute). Remember, though, that babies breathe faster than adults.
• This is when the stomach muscles between the ribs get sucked in with each breath, making the ribs stick out.
• Flaring of the nose.
• Grunting while breathing.
• Persistent blue coloring.

Call your newborn’s doctor right away if he or she develops any of these signs of respiratory distress.

Questions to ask your doctor

• What signs should I look for that my newborn may be sick?
• How do I know what’s normal when I just brought him or her home?
• How do I know if my baby is vomiting or just spitting up?
• My baby cries all the time. Could they have colic?

Resources

National Institutes of Health, Eunice Kennedy Shriver National Institute of Child Health and Human Development: What are some of the basics of infant health?

National Institutes of Health, MedlinePlus: Common Infant and Newborn Problems

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