The diagnostic challenge of pneumocystis pneumonia and COVID-19 co-infection in HIV.
Alistair G B BroadhurstUsha LallaJantjie J TaljaardElizabeth H LouwCoenraad F N KoegelenbergBrian W AllwoodPublished in: Respirology case reports (2021)
Coronavirus disease 2019 (COVID-19) and pneumocystis pneumonia (PCP) share many overlapping features and may be clinically indistinguishable on initial presentation in people living with HIV. We present the case of co-infection with COVID-19 and PCP in a patient with progressive respiratory failure admitted to our intensive care unit where the dominant disease was uncertain. This case highlights the difficulty in differentiating between the two diseases, especially in a high HIV prevalence setting where PCP is frequently diagnosed using case definitions and clinical experience due to limited access to bronchoscopy, appropriate laboratory testing, and computed tomography scans. In addition, diagnostic testing may yield false-negative results in both diseases, and clinician awareness to the overlap and pitfalls is essential if COVID-19 becomes endemic in such settings.
Keyphrases
- coronavirus disease
- respiratory failure
- sars cov
- computed tomography
- intensive care unit
- antiretroviral therapy
- respiratory syndrome coronavirus
- hiv infected
- hiv positive
- human immunodeficiency virus
- mechanical ventilation
- hepatitis c virus
- hiv testing
- hiv aids
- magnetic resonance imaging
- case report
- risk factors
- contrast enhanced
- extracorporeal membrane oxygenation
- positron emission tomography
- magnetic resonance
- south africa