Concurrent Infection with SARS-CoV-2 and Pneumocystis jirovecii in Immunocompromised and Immunocompetent Individuals.
Francesca GioiaHanan AlbasataSeyed M Hosseini-MoghaddamPublished in: Journal of fungi (Basel, Switzerland) (2022)
Coronavirus disease 2019 (COVID-19) may occur with concurrent infections caused by bacterial and fungal microorganisms. This systematic review evaluated studies reporting concomitant COVID-19 and Pneumocystis jirovecii pneumonia (PJP). We found 39 patients (74% male, median age: 56.8 (range: 11-83) years), including 66% immunosuppressed individuals (23% HIV-infected and 41% on long-term corticosteroid therapy). Patients were characteristically severely ill (mechanical ventilation: 70%), associated with 41% mortality. The median lymphocyte count was 527 cells/mm 3 (range: 110-2200), and the median CD4+ T cell count was 206 cells/mm 3 (range: 8-1021). We identified three patterns of concurrent COVID-19 and P. jirovecii infection. The first pattern (airway colonization with a low burden of P. jirovecii ) does not seem to modify the COVID-19 course of illness. However, P. jirovecii superinfection, typically occurring weeks after COVID-19 diagnosis as a biphasic illness, and P. jirovecii coinfection characteristically results in progressive multilobar pneumonia, which is associated with poor outcomes. To support this categorization, we reported three patients with concurrent PJP and COVID-19 identified in our institution, presenting these clinical scenarios. The diagnosis of PJP requires a high index of suspicion, since clinical and radiological characteristics overlap with COVID-19. Observational studies are necessary to determine the PJP burden in patients with COVID-19 requiring hospitalization.
Keyphrases
- coronavirus disease
- sars cov
- respiratory syndrome coronavirus
- systematic review
- mechanical ventilation
- hiv infected
- ejection fraction
- end stage renal disease
- newly diagnosed
- induced apoptosis
- intensive care unit
- locally advanced
- multiple sclerosis
- stem cells
- type diabetes
- skeletal muscle
- squamous cell carcinoma
- respiratory failure
- risk factors
- cardiovascular disease
- acute respiratory distress syndrome
- climate change
- antiretroviral therapy
- radiation therapy
- metabolic syndrome
- hepatitis c virus
- patient reported outcomes
- human immunodeficiency virus
- electronic health record
- patient reported
- extracorporeal membrane oxygenation
- signaling pathway