Abstract
Cases of Pneumocystis jirovecii pneumonia (PCP) in patients suffering from COVID-19 were described in patients with various comorbidities and outcomes. The diagnosis of PCP in these patients is difficult due to clinical and radiological similarities. We carried out this study in order to better describe potentially at-risk patients and their outcomes. We retrospectively analyzed all patients with a P. jirovecii PCR performed in bronchoalveolar lavage fluid, tracheal aspirate, or sputum within a month after the COVID-19 diagnosis. Fifty-seven patients with COVID-19 infection were tested for P. jirovecii. Among 57 patients with COVID-19, four patients had a concomitant positive P. jirovecii PCR. These four patients were elderly with a mean age of 78. Two patients were immunocompromised, and the two others presented only diabetes mellitus. Three patients presented an ARDS requiring transfer to the ICU and mechanical ventilation. All patients presented lymphocytopenia. Three patients had probable PCP, and one had proven PCP. All patients died within two months after hospital admission. These co-infections are rare but severe, therefore, PCP should be considered in case of worsening of the condition of patients with severe COVID-19.
Highlights
Among adult patients with confirmed SARS-CoV-2 infection between 1 March 2020 and 1 February 2021, hospitalized in Strasbourg University Hospital, we retrospectively analyzed all patients with a P. jirovecii polymerase chain reaction (PCR) performed in bronchoalveolar lavage (BAL) fluid, tracheal aspirate, or sputum
Two patients were immunocompromised and at risk of Pneumocystis jirovecii pneumonia (PCP) before the occurrence of COVID-19, one with rheumatoid arthritis treated by steroid therapy and one with history of hematopoietic stem cell transplantation and with an Ewing’s sarcoma metastasized to the lung and treated by cyclophosphamide (Sandoz, Levallois-Perret, France) and doxorubicine (Accord-healthcare, Lille, France)
We identified four cases of PCP among 57 COVID-19 patients screened for P. jirovecii using in BAL, tracheal or sputum
Summary
COVID-19 causes a wide spectrum of symptoms ranging from asymptomatic disease to life-threatening severe acute respiratory distress syndrome (ARDS) and death [1]. This disease can be complicated with fungal superinfection, aspergillosis [2]. A study found that two among 145 patients (1.4%) with severe COVID-19 had a positive polymerase chain reaction (PCR) for Pneumocystis jirovecii [6]
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