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Concurrent Infection with SARS-CoV-2 and Pneumocystis jirovecii in Immunocompromised and Immunocompetent Individuals
Francesca Gioia1, Hanan Albasata1, Seyed M Hosseini-Moghaddam1
1Transplant Infectious Diseases Program, Ajmera Transplant Centre, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON M5G 2N2, Canada.
Abstract:
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/mm3 (range: 110-2200), and the median CD4+ T cell count was 206 cells/mm3 (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.
Insights
Concurrent Pneumocystis jirovecii pneumonia (PJP) with COVID-19 is associated with severe illness and high mortality, particularly in immunosuppressed patients. Early diagnosis and further research are crucial for managing this dual infection.
Area of Science:
- Infectious Diseases
- Pulmonology
- Critical Care Medicine
Background:
- Concurrent bacterial and fungal infections can complicate Coronavirus disease 2019 (COVID-19).
- Pneumocystis jirovecii pneumonia (PJP) is a significant opportunistic infection, especially in immunocompromised individuals.
Purpose of the Study:
- To systematically review studies on concomitant COVID-19 and PJP.
- To identify patterns and outcomes of dual COVID-19 and PJP infections.
- To highlight the diagnostic challenges and need for further research.
Main Methods:
- Systematic review of studies reporting COVID-19 and PJP.
- Analysis of patient demographics, clinical characteristics, and outcomes.
- Case series of three patients with concurrent PJP and COVID-19.
Main Results:
- 39 patients with COVID-19 and PJP identified; 74% male, median age 56.8 years.
- 66% were immunosuppressed (23% HIV, 41% on corticosteroids); 70% required mechanical ventilation.
- 41% mortality; three patterns of PJP involvement identified, with superinfection/coinfection leading to poor outcomes.
Conclusions:
- Concurrent PJP in COVID-19 patients, especially those with immunosuppression, is linked to severe disease and high mortality.
- Distinguishing PJP from COVID-19 is challenging due to overlapping symptoms and imaging findings.
- Further observational studies are needed to understand the burden of PJP in hospitalized COVID-19 patients.
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