Pneumocystis pneumonia in the COVID-19 pandemic era: similarities and challenges

Abstract

The clinical picture of the fungal disease, Pneumocystis pneumonia, resembles the course of coronavirus disease 2019 (COVID-19), presenting a diagnostic challenge in the pandemic era. We discuss the concern of Pneumocystis jirovecii and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) coinfection, their similarities, and the impact of immunosuppression, with a suggested diagnostic pathway for their suspected coinfection.

Keywords: COVID-19; Pneumocystis jirovecii; SARS-CoV-2; pneumonia.

Figure 1

Proposed diagnostic pathway for suspected SARS-CoV-2 and Pneumocystis jirovecii coinfection. ^⁎Additional testing for P. jirovecii should be considered especially in less common risk groups (e.g., patients with mild immunosuppression) or those with SARS-CoV-2-related lymphopenia. ^⁎⁎In view of various factors associated with the intensive care unit (ICU) setting (e.g., host proinflammatory responses, drug administration, blood transfusion, or application of blood products), consider false-positive (1,3)-β-d-glucan (BDG) results. ^⁎⁎⁎Of note, P. jirovecii pneumonia (PCP) in non-HIV-infected immunocompromised individuals may be associated with low and moderate fungal burdens; also, false-negative BDG results (e.g., due to treatment with antifungal agents) may be considered. Abbreviations: COVID-19, coronavirus disease 2019; PCR, polymerase chain reaction; qPCR, quantitative PCR; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2.