Narrative review of the relationship between COVID-19 and PJP: does it represent coinfection or colonization?
Woon H Chong1, Biplab K Saha2, Amit Chopra3
1Department of Pulmonary and Critical Care Medicine, Albany Medical Center, 43 New Scotland Avenue, Albany, NY, USA. chongw@amc.edu.
Background:
Pneumocystis jirovecii (P. jirovecii) is increasingly identified on lower respiratory tract specimens of COVID-19 patients. Our narrative review aims to determine whether the diagnosis of pneumocystis jirovecii pneumonia (PJP) in COVID-19 patients represents coinfection or colonization based on the evidence available in the literature. We also discuss the decision to treat COVID-19 patients with coinfection by PJP.
Methods:
A literature search was performed through the Pubmed and Web of Science databases from inception to March 10, 2021.
Results:
We identified 12 COVID-19 patients suspected to have PJP coinfection. All patients were critically ill and required mechanical ventilation. Many were immunosuppressed from HIV or long-term corticosteroids and other immunosuppressive agents. In both the HIV and non-HIV groups, severe lymphocytopenia was encountered with absolute lymphocyte and CD4+T cell count less than 900 and 200 cells/mm, respectively. The time to PJP diagnosis from the initial presentation was 7.8 (range 2-21) days. Serum lactate dehydrogenase and beta-D-glucan were elevated in those coinfected with PJP. All patients were treated with anti-PJP therapy, predominantly sulfamethoxazole-trimethoprim with corticosteroids. The overall mortality rate was 41.6%, and comparable for both HIV and non-HIV groups.
Conclusion:
As the current evidence is restricted to case reports, the true incidence, risk factors, and prognosis of COVID-19 patients with PJP coinfections cannot be accurately determined. Comorbidities of poorly controlled HIV with lymphocytopenia and multiple immunosuppressive therapies are likely predisposing factors for PJP coinfection.
Insights
Pneumocystis jirovecii pneumonia (PJP) coinfection in COVID-19 patients is associated with severe illness and immunosuppression. Treatment with sulfamethoxazole-trimethoprim and corticosteroids showed a 41.6% mortality rate, highlighting the need for further research.
Area of Science:
- Medical Mycology
- Infectious Diseases
- Pulmonology
Background:
- Pneumocystis jirovecii (P. jirovecii) is increasingly detected in COVID-19 patients.
- Distinguishing P. jirovecii pneumonia (PJP) coinfection from colonization in COVID-19 is crucial.
Purpose of the Study:
- To review the literature on PJP coinfection in COVID-19 patients.
- To determine if PJP in COVID-19 patients is coinfection or colonization.
- To discuss treatment strategies for PJP coinfection in COVID-19.
Main Methods:
- A comprehensive literature search was conducted using PubMed and Web of Science databases.
- The search covered studies from database inception to March 10, 2021.
Main Results:
- Twelve critically ill COVID-19 patients with suspected PJP coinfection requiring mechanical ventilation were identified.
- Patients often had immunosuppression (HIV, corticosteroids), severe lymphocytopenia, and elevated serum lactate dehydrogenase and beta-D-glucan.
- Treatment with sulfamethoxazole-trimethoprim and corticosteroids resulted in a 41.6% mortality rate, similar in HIV and non-HIV groups.
Conclusions:
- Current evidence is limited to case reports, hindering accurate determination of PJP coinfection incidence, risk factors, and prognosis in COVID-19.
- Poorly controlled HIV with lymphocytopenia and extensive immunosuppressive therapies are probable risk factors for PJP coinfection in COVID-19 patients.
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