What is Pneumocystis jirovecii?

Pneumocystis jirovecii is a fungus that is common throughout the world. Many people have been exposed to it as children. Some people have the fungus in their lungs. If you are healthy, it usually will not make you sick. But it can make you sick if you have a weakened immune system, for example if you:

• Have HIV
• Have an autoimmune disease
• Have cancer
• Have a chronic (long-lasting) lung disease
• Had an organ or bone marrow transplant
• Take medicines which weaken your immune system, such as chemotherapy and steroids

How does Pneumocystis jirovecii spread?

Pneumocystis jirovecii can spread from person to person through the air. You can spread it to others even if it isn't making you sick.

What is pneumocystis pneumonia (PCP)?

The most common type of infection that Pneumocystis jirovecii causes is pneumocystis pneumonia (PCP). Pneumonia is an infection in one or both of the lungs. It causes the air sacs of the lungs to fill up with fluid or pus.

What are the symptoms of pneumocystis pneumonia (PCP)?

The symptoms of PCP can develop over several days or weeks. They may include:

• Fever
• Cough
• Trouble breathing
• Chest pain
• Chills
• Fatigue

Contact your healthcare provider if you have symptoms that you think are related to PCP. Since PCP can be life-threatening, it's important to get early treatment.

How is pneumocystis pneumonia (PCP) diagnosed?

To find out if you have PCP, your provider will take a sample of fluid or tissue from your lungs. You may cough up the sample (called sputum), have fluid collected during a bronchoalveolar lavage, or have tissue taken with a biopsy. They will send the sample to the lab to check for Pneumocystis.

What are the treatments for pneumocystis pneumonia (PCP)?

The treatment for PCP is with antibiotics, either by mouth or intravenously (by IV). You need to take them for about 3 weeks. If you have a severe case of PCP, you might need treatment in the hospital.

Can pneumocystis pneumonia (PCP) be prevented?

There is no vaccine to prevent PCP. Some people who are at high risk of getting PCP may need to take antibiotics to prevent it.

Centers for Disease Control and Prevention

Is it safe to take medicine during pregnancy?

Some medicines are safe to take during pregnancy, but many are not. If you're pregnant, check with your health care provider before taking any medicine. Some medicines can harm your developing fetus. This includes:

• Prescription drugs
• Over-the-counter medicines
• Herbs and supplements

Should I stop taking my medicine during pregnancy?

Always talk to your provider before you stop or start any medicine. You may take medicine to treat a health problem you had before pregnancy. Not using the medicine that you need may be more harmful to you and your fetus than using the medicine. For example, many pregnant women take prescription medicines for health problems like diabetes, asthma, seizures, and heartburn. The decision about whether to take a certain medicine should depend on the risks and benefits that go with it. You and your provider should make this choice together.

Can I take vitamins during pregnancy?

If you're pregnant, you shouldn't take regular vitamins. They may have too much or too little of the vitamins you need. For example, everyone needs folic acid, a type of B vitamin. But if you're trying to get pregnant, it's really important. Getting enough folic acid before and during pregnancy can prevent birth defects of the brain or spine. During your prenatal care visits, your provider will talk about prenatal vitamins. These are a special kind of vitamin to take during pregnancy.

Food and Drug Administration

You may need to take medicines while you are pregnant. But not all medicines are safe during pregnancy. Many medicines carry risks for you, your baby, or both. Opioids, especially when misused, can cause problems for you and your baby while you are pregnant.

What are opioids?

Opioids, sometimes called narcotics, are a type of drug. They include strong prescription pain relievers such as oxycodone, hydrocodone, fentanyl, and tramadol. The illegal drug heroin is also an opioid.

A health care provider may give you a prescription opioid to reduce pain after you have had a major injury or surgery. You may get them if you have severe pain from health conditions like cancer. Some providers prescribe them for chronic pain.

Prescription opioids used for pain relief are generally safe when taken for a short time and as prescribed by your provider. However, people who take opioids are at risk for opioid use disorder (OUD) and overdose. These risks increase when these medicines are misused. Misuse can include taking your opioid medicines in greater amounts or more often than you are supposed to, using them to get high, or taking someone else's opioids.

What are the risks of taking opioids during pregnancy?

Taking opioids during pregnancy can cause problems for you and your baby. The possible risks include:

• Neonatal abstinence syndrome (NAS) - withdrawal symptoms such as irritability, seizures, vomiting, diarrhea, fever, and poor feeding in newborns
• Neural tube defects - birth defects of the brain, spine, or spinal cord
• Congenital heart defects - problems with the structure of the baby's heart
• Gastroschisis - a birth defect of the baby's abdomen, where the intestines stick outside of the body through a hole beside the belly button
• Loss of the baby, either miscarriage (before 20 weeks of pregnancy) or stillbirth (after 20 or more weeks)
• Preterm delivery - a birth before 37 completed weeks of pregnancy
• Stunted growth, leading to low birthweight
• Problems with the placenta (the organ that brings oxygen and nutrients to the baby)

If your provider suggests that you take opioids during pregnancy, you should first discuss the risks and benefits. Then if you both decide that you need to take the opioids, you should work together to try to minimize the risks. Some of the ways to do this include:

• Taking them for the shortest time possible
• Taking the lowest dose that will help you
• Carefully following your provider's instructions for taking the medicines
• Contacting your provider if you have side effects
• Going to all your follow-up appointments

If I am already taking opioids and I become pregnant, what should I do?

If you have been taking opioids and you become pregnant, contact your provider. But don't stop taking the opioids on your own. If you suddenly stop taking opioids, it could cause severe health problems for you or your baby. In some cases, stopping suddenly during pregnancy may be more harmful than taking the medicines.

Can I breastfeed while taking opioids?

If you regularly take opioid medicines, you may be able to breastfeed. It depends on which medicine you are taking. But you should not breastfeed if you have HIV or take illegal drugs. Check with your provider before breastfeeding.

What is the treatments for opioid use disorder (OUD) in pregnancy?

If you are pregnant and have an opioid use disorder, do not stop taking opioids suddenly. Instead, see your provider so you can get help. The treatment for opioid use disorder (OUD) is called medication for opioid use disorder (MOUD). For MOUD during pregnancy, providers prescribe either buprenorphine or methadone. These medicines can reduce your cravings and help prevent withdrawal.

Counseling, including behavioral therapies, can also help you to change your attitudes and behaviors related to drug use and build healthy life skills.

What is primary ovarian insufficiency (POI)?

Primary ovarian insufficiency (POI) happens when your ovaries stop working normally before you are 40.

As you get older, fertility naturally decreases. This usually starts around age 40 or later. Menstrual periods may also become irregular as you transition to menopause. If you have POI, these changes happen earlier, before age 40. Sometimes POI can start as early as the teenage years.

POI is different from premature menopause. With premature menopause, your periods stop before age 40. You can no longer get pregnant. The cause can be natural or it can be a disease, surgery, chemotherapy, or radiation. With POI, some women still have occasional periods. They may even get pregnant. In most cases of POI, the cause is unknown.

What causes primary ovarian insufficiency (POI)?

In about 90% of cases, the exact cause of POI is unknown.

Research shows that POI is related to problems with the follicles. Follicles are small sacs in your ovaries where eggs grow and mature. One type of follicle problem is that you run out of working follicles earlier than normal. Another is that the follicles are not working properly. In most cases, the cause of the follicle problem is unknown. But sometimes the cause may be:

• Genetic disorders such as Fragile X syndrome and Turner syndrome
• A low number of follicles
• Autoimmune diseases, including thyroiditis and Addison disease
• Chemotherapy or radiation therapy
• Metabolic disorders
• Exposure to toxic substances, such as cigarette smoke, chemicals, and pesticides

Who is at risk for primary ovarian insufficiency (POI)?

Certain factors can raise your risk of POI:

• Family history. If you have a mother or sister with POI, you are more likely to have it.
• Genes. Some changes to genes and genetic conditions put you at higher risk for POI. For example, women with Fragile X syndrome or Turner syndrome are at higher risk.
• Certain diseases, such as autoimmune diseases and some viral infections.
• Cancer treatments, such as chemotherapy and radiation therapy.
• Age.You can get POI when you're young, but it becomes more common between the ages of 35 and 40.

What are the symptoms of primary ovarian insufficiency (POI)?

The first sign of POI is usually irregular or missed periods. Later symptoms may be like those of natural menopause, including:

• Hot flashes
• Night sweats
• Irritability
• Poor concentration
• Decreased sex drive
• Pain during sex
• Vaginal dryness

You may see a health care provider because of difficulty getting pregnant or trouble with infertility.

What other problems can primary ovarian insufficiency (POI) cause?

Since POI causes you to have lower levels of certain hormones, you are at greater risk for other health conditions, including:

• Anxiety and depression. Hormonal changes caused by POI can contribute to anxiety or lead to depression.
• Dry eye syndrome and eye surface disease. Some women with POI have one of these eye conditions. Both can cause discomfort and may lead to blurred vision. If not treated, these conditions can cause permanent eye damage.
• Heart disease. Lower levels of estrogen can affect the muscles lining the arteries and can increase the buildup of cholesterol. These factors increase your risk of atherosclerosis (hardening of the arteries).
• Infertility.
• Low thyroid function. This problem also is called hypothyroidism. The thyroid is a gland that makes hormones that control your body's metabolism and energy level. Low levels of thyroid hormones can affect your metabolism and can cause very low energy, mental sluggishness, and other symptoms.
• Osteoporosis. The hormone estrogen helps keep bones strong. Without enough estrogen, women with POI often develop osteoporosis. It is a bone disease that causes weak, brittle bones that are more likely to break.

How is primary ovarian insufficiency (POI) diagnosed?

To diagnose POI, your provider may do:

• A medical history, including asking whether you have relatives with POI
• A pregnancy test, to make sure that you are not pregnant
• A physical exam, to look for signs of other disorders that could be causing your symptoms
• Blood tests, to check for certain hormones. You may also have a blood test to do a chromosome analysis. A chromosome is the part of a cell that contains genetic information.
• A pelvic ultrasound, to see whether the ovaries are enlarged or have multiple follicles.

What are the treatments for primary ovarian insufficiency (POI)?

Currently, there is no proven treatment to restore normal function to the ovaries. But there are treatments for some of the symptoms of POI. There are also ways to lower your health risks and treat the conditions that POI can cause:

• Hormone therapy for menopause (sometimes called hormone replacement therapy or HRT). This is the most common treatment. It gives your body the estrogen and other hormones that your ovaries are not making. Hormone therapy for menopause improves sexual health and decreases the risks for heart disease and osteoporosis.
• Calcium and vitamin D supplements. Because women with POI are at higher risk for osteoporosis, you should take calcium and vitamin D every day.
• In vitro fertilization (IVF). If you have POI and you wish to become pregnant, you may consider trying IVF.
• Regular physical activity and a healthy body weight.Getting regular exercise and controlling your weight can lower your risk for osteoporosis and heart disease.
• Treatments for associated conditions. If you have a condition that is related to POI, it is important to treat that as well. Treatments may involve medicines and hormones.

NIH: National Institute of Child Health and Human Development

What is a pulmonary embolism (PE)?

A pulmonary embolism (PE) is a sudden blockage in a lung artery. It usually happens when a blood clot breaks loose and travels through the bloodstream to the lungs. PE is a serious condition that can cause:

• Permanent damage to the lungs
• Low oxygen levels in your blood
• Damage to other organs in your body from not getting enough oxygen

PE can be life-threatening, especially if a clot is large, or if there are many clots.

What causes a pulmonary embolism (PE)?

The cause is usually a blood clot that breaks loose and travels through the bloodstream to the lungs. The clot is usually a deep vein thrombosis (DVT), a clot in the leg. In rare cases, material such as air bubbles, clumps of fat, or parts of a tumor can block the lung artery and cause PE.

Who is more likely to develop a pulmonary embolism (PE)?

Anyone can get a pulmonary embolism (PE), but certain things can raise your risk of PE:

• Having surgery, especially joint replacement surgery.
• Certain medical conditions, including
• Cancers
• Heart diseases
• Lung diseases
• A broken hip or leg bone or other trauma
• Hormone-based medicines, such as birth control pills or hormone therapy for menopause.
• Pregnancy and childbirth. The risk is highest for about six weeks after childbirth.
• Not moving for long periods, such as being on bed rest, having a cast, or taking a long plane flight.
• Age. Your risk increases as you get older, especially after age 40.
• Family history and genetics. Certain genetic changes that can increase your risk of blood clots and PE.
• Obesity.

What are the symptoms of a pulmonary embolism (PE)?

Symptoms of PE include:

• Shortness of breath
• Rapid breathing
• Chest pain or discomfort, which usually gets worse when you cough or take a deep breath
• Increased heart rate
• Coughing up blood
• Very low blood pressure, lightheadedness, or fainting

Sometimes people with PE don't have any symptoms until they have serious complications, such as pulmonary hypertension (high blood pressure in the arteries to your lungs).

How is a pulmonary embolism (PE) diagnosed?

It can be difficult to diagnose PE. To find out if you have a PE, your health care provider will:

• Take your medical history, including asking about your symptoms and risk factors for PE
• Do a physical exam
• Likely order some tests, including various imaging and blood tests

What are the treatments for a pulmonary embolism (PE)?

If you have PE, you need medical treatment right away. The goal of treatment is to break up clots and help keep other clots from forming. Treatment options include medicines and procedures.

Medicines:

• Anticoagulants, or blood thinners, keep blood clots from getting larger and stop new clots from forming. You might get them as an injection, a pill, or through an I.V. (intravenous). They can cause bleeding, especially if you are taking other medicines that also thin your blood, such as aspirin.
• Thrombolytics are medicines to dissolve blood clots. You may get them if you have large clots that cause severe symptoms or other serious complications. Thrombolytics can cause sudden bleeding, so they are used if your PE is serious and may be life-threatening.

Procedures:

• Catheter-assisted thrombus removal uses a flexible tube to reach a blood clot in your lung. Your health care provider can insert a tool in the tube to break up the clot or to deliver medicine through the tube. Usually you will get medicine to put you to sleep for this procedure.
• A vena cava filter may be used in some people who cannot take blood thinners. Your health care provider inserts a filter inside a large vein called the vena cava. The filter catches blood clots before they travel to the lungs, which prevents pulmonary embolism. But the filter does not stop new blood clots from forming.

Can pulmonary embolism (PE) be prevented?

Preventing new blood clots can prevent PE. Prevention may include:

• Continuing to take blood thinners. It's also important to get regular checkups with your provider, to make sure that the dosage of your medicines is working to prevent blood clots but not causing bleeding.
• Heart-healthy lifestyle changes, such as heart-healthy eating, exercise, and, if you smoke, quitting smoking.
Using compression stockings to prevent deep vein thrombosis (DVT).
• Moving your legs when sitting for long periods of time (such as on long trips).
• Moving around as soon as possible after surgery or being confined to a bed.

NIH: National Heart, Lung, and Blood Institute