Pneumocystis jirovecii Infections Among COVID-19 Patients: A Case Series and Literature Review

Abstract

Background: Pneumocystis jirovecii pneumonia (PCP) is a serious, emerging complication of coronavirus disease 2019 (COVID-19).

Methods: We performed a systematic review of published cases. We describe 6 new cases of PCP/COVID-19 coinfection. Among our cases (n = 6) and those in the literature (n = 69) with available data, the median age (interquartile range [IQR]) was 59 (44-77) years (n = 38), 72% (47/65) were male, and the mortality rate was 30.9% (21/68).

Results: Long-term corticosteroid use was noted in 45.1% (23/51), advanced HIV infection (defined as a CD4 count <200 cells/μL) in 17.6% (9/51), and antineoplastic chemotherapy in 13.7% (7/51), consistent with known PCP risk factors. Notably, 56.7% (38/47) had verifiable risk factors for PCP (high-dose corticosteroids, immunosuppressive therapy, and HIV infection) before COVID-19 infection. A median absolute lymphocyte count (IQR) of 0.61 (0.28-0.92) ×10³ cells/mm³ (n = 23) and CD4 count (IQR) of 66 (33-291.5) cells/mm³ (n = 20) were also discovered among the study population.

Conclusions: These findings suggest a need for greater attention to PCP risk factors among COVID-19 patients and consideration of PCP prophylaxis in these high-risk populations.

Keywords: COVID-19; PCP; Pneumocystis jirovecii; coinfection; immunocompromised; invasive fungal infections; pneumocystis.

Figure 1.

Study inclusion procedures. Excluded Medline articles: Out of 95 articles, 33 articles were excluded because they were review or opinion articles, 3 articles were not in English or Spanish, and 32 articles were excluded because there was no description of PCP/COVID-19 co- or postinfections. Excluded Embase articles: Out of 91 articles, 40 were excluded due to duplication with the Medline database, 19 were excluded because they were review or opinion articles, and 28 were excluded because they contained no description of PCP/COVID-19 co- or postinfections. Included studies: Cohort, cross-sectional, case series, and case report studies that described concurrent or post-COVID-19 infections with PCP were included in the original screening [32]. Abbreviations: COVID-19, coronavirus disease 2019; PCP, Pneumocystis jirovecii pneumonia.