The outcome of Pneumocystis jiroveci pneumonia complicated with ventilator - associated pneumonia in a patient suffering from acquired immunodeficiency syndrome: A case report

Introduction. The respiratory tract is the most common site of opportunistic infections in patients with acquired immunodeficiency syndrome, and respiratory failure is the leading cause of death in these cases. In addition, the use of mechanical ventilation in the treatment of respiratory failure carries a high risk of nosocomial pneumonia caused by multidrug-resistant strains of bacteria. Case report. We present a human immunodeficiency virus-positive patient with positive outcome of Pneumocystis jiroveci pneumonia whose condition progressed to acute respiratory distress syndrome with the development of complications associated with mechanical ventilation. As soon as an opportunistic infection was suspected, trimethoprim-sulfamethoxazole and corticosteroid therapy were initiated, with a short application of mechanical ventilation. Despite a good initial response to treatment, during the mechanical ventilation, a relapse of fever occurred, as well as development of productive cough, new zones of consolidation on chest X-ray and Acinetobacter spp. was isolated in a swab culture. According to the literature recommendations, colistinmeropenem combination was conducted with adequate response. The patient was discharged after 22 days of treatment, in good general condition, afebrile, with normal laboratory parameters and gas exchange, without subjective symptoms. Conclusion. Early identification of Pneumocystis jiroveci pneumonia, timely initiation of prophylaxis and treatment, along with antiretroviral therapy, re?duced the risk of severe clinical events and respiratory failure. Also, timely recognition of complications of mechanical ventilation, identification of infection, early extubation and application of appropriate antibiotic therapy, reduce the mortality from nosocomial pneumonia caused by multi-drug resistant hospital strains of microorganisms.