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. 2021 Oct 29;18(21):11399.
doi: 10.3390/ijerph182111399.

Pneumocystis jirovecii Pneumonia in Non-HIV Patients Recovering from COVID-19: A Single-Center Experience

Ivan Gentile  1 , Giulio Viceconte  1 , Amedeo Lanzardo  1 , Irene Zotta  1 , Emanuela Zappulo  1 , Biagio Pinchera  1 , Riccardo Scotto  1 , Nicola Schiano Moriello  1 , Maria Foggia  1 , Agnese Giaccone  1 , Gaetana Messina  2 , Paola Salvatore  3 , Antonio Riccardo Buonomo  1 , Federico Ii Covid-Team
Affiliations

Pneumocystis jirovecii Pneumonia in Non-HIV Patients Recovering from COVID-19: A Single-Center Experience

Ivan Gentile et al. Int J Environ Res Public Health. .

Abstract

Objective: to describe a single-center experience of Pneumocystis jirovecii pneumonia (PJP) in non-HIV patients recovering from COVID-19.

Methods: We report the cases of five non-HIV patients with COVID-19 who also developed PJP at a University Hospital.

Results: With the exception of one subject, who experienced an atypical and prolonged course of COVID-19, all the patients developed PJP after the clinical resolution of COVID-19 pneumonia. All but one patient had no pre-existing immunosuppressive conditions or other risk factors for PJP development at COVID-19 diagnosis. Nonetheless, following the course of COVID-19 infection, all the patients fulfilled at least one host factor for PJP; indeed, all the patients had received at least 2 weeks of high-dose steroids and three out of five had a CD4+ cell count <200/mm3.

Conclusions: The use of corticosteroids for COVID-19 respiratory impairment seems to be the most common risk factor for PJP, together with viral-induced and iatrogenic lymphopenia. The worsening in respiratory function and the characteristic radiological picture during or after COVID-19 pneumonia should raise the suspicion of PJP, even in immunocompetent patients. PJP primary chemoprophylaxis can be considered in selected high-risk COVID-19 patients, but further studies are needed.

Keywords: COVID-19; Pneumocystis jirovecii; corticosteroids; invasive fungal infections; lymphopenia.

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Conflict of interest statement

The authors have no conflict of interest to disclose.

Figures

Figure 1
Figure 1
Radiological characteristics of the patients. Patient 2 (P.2): (A) HRCT at PJP diagnosis; (B) HRCT after CTX therapy, 21 days after PJP diagnosis. Patient 3 (P.3): (C) HRCT at PJP diagnosis; (D) HRCT after CTX therapy, 30 days after PJP diagnosis. Patient 4 (P.4): (E) HRCT at PJP diagnosis; (F) HRCT after CTX therapy, 20 days after PJP diagnosis. Patient 5 (P.5): (G) HRCT at PJP diagnosis; (H) HRCT after CTX therapy, 26 days after PJP diagnosis. HRCT = high-resolution CT-scan; PJP = Pneumocystis jirovecii pneumonia; CTX = trimethoprim-sulfamethoxazole.
See this image and copyright information in PMC

References

    1. Wang D., Hu B., Hu C., Zhu F., Liu X., Zhang J., Wang B., Xiang H., Cheng Z., Xiong Y., et al. Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus–Infected Pneumonia in Wuhan, China. JAMA. 2020;323:1061. doi: 10.1001/jama.2020.1585. - DOI - PMC - PubMed
    1. Koehler P., Bassetti M., Chakrabarti A., Chen S.C.A., Colombo A.L., Hoenigl M., Klimko N., Lass-Flörl C., Oladele R.O., Vinh D.C., et al. Defining and managing COVID-19-associated pulmonary aspergillosis: The 2020 ECMM/ISHAM consensus criteria for research and clinical guidance. Lancet Infect. Dis. 2020;21:e149–e162. doi: 10.1016/S1473-3099(20)30847-1. - DOI - PMC - PubMed
    1. Alanio A., Dellière S., Voicu S., Bretagne S., Mégarbane B. The presence of Pneumocystis jirovecii in critically ill patients with COVID-19. J. Infect. 2020;82:84–123. doi: 10.1016/j.jinf.2020.10.034. - DOI - PMC - PubMed
    1. Coleman H., Snell L.B., Simons R., Douthwaite S.T., Lee M.J. Coronavirus disease 2019 and Pneumocystis jirovecii pneumonia: A diagnostic dilemma in HIV. AIDS. 2020;34:1258–1260. doi: 10.1097/QAD.0000000000002571. - DOI - PMC - PubMed
    1. Donnelly J.P., Chen S.C., Kauffman C.A., Steinbach W.J., Baddley J.W., Verweij P., Clancy C.J., Wingard J.R., Lockhart S.R., Groll A.H., et al. Revision and Update of the Consensus Definitions of Invasive Fungal Disease From the European Organization for Research and Treatment of Cancer and the Mycoses Study Group Education and Research Consortium. Clin. Infect. Dis. 2019;71:1367–1376. doi: 10.1093/cid/ciz1008. - DOI - PMC - PubMed