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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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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What is a urinary tract infection?

A urinary tract infection (UTI) affects the kidneys, bladder, and urethra. Infection occurs when bacteria builds in the urinary tract when waste isn’t removed or the bladder isn’t emptied. When the bladder is involved in the infection, it is called cystitis. If the kidneys are involved, it is a more serious condition called pyelonephritis.

In general, UTIs are more common in girls. They can occur more often when children are potty training. Boys who have not been circumcised by the age of 1 are at risk of UTIs as well. Kids who have vesicoureteral reflux (VUR) may get UTIs more often. VUR is a condition in which urine can flow back into the urinary tract. VUR typically is present at birth.

Path to improved health

The sooner you detect a UTI, the quicker treatment can begin. It is important to know the symptoms. Common UTI symptoms include:

• Burning feeling or pain when you urinate
• Feeling like you need to urinate more often than usual
• Feeling the urge to urinate but not being able to
• Stomach pain
• Low back pain

Your child may not be able to communicate these symptoms. You should look for the following warning signs:

• Cloudy, dark, smelly, or bloody urine
• Fever or chills
• Vomiting
• Diarrhea
• Fussiness
• Poor appetite or less active
• Going through more diapers than usual
• Wetting clothes even though they are potty trained

Contact your doctor right away if you think your child has a UTI. The doctor will review symptoms and do a physical exam. The doctor also will do a urine test (urinalysis) to confirm the diagnosis. Getting a sample of urine can be hard in young children. There are several ways a doctor can collect urine.

• Catheterized specimen urine culture: The doctor places a thin plastic tube (catheter) into the child’s bladder.
• Subrapubic urine collection: The doctor inserts a thin needle through the child’s lower stomach into their bladder. This is usually a last resort when other methods have failed.
• Urine collection bag: The doctor places a plastic bag beneath the child’s vagina or penis to collect urine. This method is the least reliable.

Based on the test result, the doctor may perform other tests to rule out conditions similar to UTIs or determine the cause.

If your child has frequent infections, your family doctor may order an ultrasound or voiding cysto-urethrogram (VCUG) before referring you to a specialist. A VCUG allows your doctor to evaluate your child’s bladder and urethra using contrast and X-rays.

Treatment for a UTI depends on the cause and your child’s age. Infants often require treatment in the hospital. This is because they need antibiotics through an IV (intravenous) or catheter. Older children can take medicine at home.

Things to consider

There are several things you can do to help prevent UTIs in children.

• Keep your child’s genital area clean. This helps prevent bacteria from forming or spreading.
• Have your child drink plenty of non-sugar-sweetened fluids, especially water.
• Teach your child not to hold it too long when they need to go to the bathroom. A backup of urine in the bladder can lead to bacteria growth.
• Teach your child to wipe from front to back when they go to the bathroom. This is especially important for girls.
• Do not dress your child in clothes that are too tight.
• Always bathe your child after swimming or being active.

When to see a doctor

Call the doctor if your child’s symptoms don’t improve or get worse with medicine. If your child gets a UTI more than once in 6 months, the doctor may want to switch treatments.

Questions to ask your doctor

• How did my child get a UTI?
• How long will my child need to take antibiotics?
• What is the risk of my child getting more UTIs in the future?
• Does treatment vary if my child gets UTIs often?
• What conditions are related to UTIs?

Resources

Urology Care Foundation: Urinary Tract Infections in Children

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