Concurrent COVID-19 and Pneumocystis jirovecii pneumonia in a severely immunocompromised 25-year-old patient

Bhat, Pavan; Noval, Mandee; Doub, James B.; Heil, Emily L.

doi:10.1016/j.ijid.2020.07.061

Cited by 33 publications

(31 citation statements)

References 4 publications

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“…COVID-19 patients mostly exhibited marked lymphopenia and alterations in lymphocyte functions, likely explaining the high-rate of P. jirovecii detection 36 . This association has been reported even in young severely ill patients 37 . Differentiating COVID-19 from pneumocystis jirovecii pneumonia is not usually possible from signs and symptoms.…”

Section: Fungal Co-infections In Covid-19mentioning

confidence: 51%

High mortality co-infections of COVID-19 patients: mucormycosis and other fungal infections

Bhatt

Agolli

Patel

et al. 2021

Discoveries (Craiova)

136

122

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Severe COVID-19 disease is associated with an increase in pro-inflammatory markers, such as IL-1, IL-6, and tumor necrosis alpha, less CD4 interferon-gamma expression, and fewer CD4 and CD8 cells, which increase the susceptibility to bacterial and fungal infections. One such opportunistic fungal infection is mucormycosis. Initially, it was debated whether a person taking immunosuppressants, such as corticosteroids, and monoclonal antibodies will be at higher risk for COVID-19 or whether the immunosuppresive state would cause a more severe COVID-19 disease. However, immunosuppressants are currently continued unless the patients are at greater risk of severe COVID-19 infection or are on high-dose corticosteroids therapy. As understood so far, COVID-19 infection may induce significant and persistent lymphopenia, which in turn increases the risk of opportunistic infections. It is also noted that 85% of the COVID-19 patients’ laboratory findings showed lymphopenia. This means that patients with severe COVID-19 have markedly lower absolute number of T lymphocytes, CD4+T and CD8+ T cells and, since the lymphocytes play a major role in maintaining the immune homeostasis, the patients with COVID-19 are highly susceptible to fungal co-infections. This report is intended to raise awareness of the importance of early detection and treatment of mucormycosis and other fungal diseases, such as candidiasis, SARS-CoV-2-associated pulmonary aspergillosis, pneumocystis pneumonia and cryptococcal disease, in COVID-19 patients, to reduce the risk of mortality.

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Section: Fungal Co-infections In Covid-19mentioning

confidence: 51%

High mortality co-infections of COVID-19 patients: mucormycosis and other fungal infections

Bhatt

Agolli

Patel

et al. 2021

Discoveries (Craiova)

136

122

View full text Add to dashboard Cite

show abstract

“…The mortality of patients admitted to the intensive care units reaches 40% [ 3 ]. The knowledge of coinfections associated with COVID-19 is relevant in reducing morbidity and mortality [ 4 , 5 ].…”

Section: Introductionmentioning

confidence: 99%

“…The occurrence of COVID-19 and Pneumocystis coinfection cases has previously been reported based on laboratory diagnosis [ 4 , 9 , 10 , 11 ] and seems to be underestimated in clinical practice [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

COVID-19 and Pneumocystis jirovecii Pulmonary Coinfection—The First Case Confirmed through Autopsy

Jeican

Inișca²,

Gheban

et al. 2021

Medicina

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Background: Establishing the diagnosis of COVID-19 and Pneumocystis jirovecii pulmonary coinfection is difficult due to clinical and radiological similarities that exist between the two disorders. For the moment, fungal coinfections are underestimated in COVID-19 patients. Case presentation: We report the case of a 52-year-old male patient, who presented to the emergency department for severe dyspnea and died 17 h later. The RT-PCR test performed at his admission was negative for SARS-CoV-2. Retesting of lung fragments collected during autopsy revealed a positive result for SARS-CoV-2. Histopathological examination showed preexisting lesions, due to comorbidities, as well as recent lesions: massive lung thromboses, alveolar exudate rich in foam cells, suprapleural and intra-alveolar Pneumocystis jirovecii cystic forms, and bilateral adrenal hemorrhage. The existing coinfection was identified after the autopsy. Establishing the diagnosis of this coinfection is difficult due to clinical and radiological similarities that exist between the two disorders. For the moment, fungal coinfections are underestimated in COVID-19 patients. Conclusion: COVID-19 and P. jirovecii coinfection should be considered, particularly in critically ill patients, and we recommend the systematic search for P. jirovecii in respiratory samples.

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“…Although it accounts for 7% of pulmonary coinfection in intensive care unit patients with influenza [5], only a few cases of Pneumocystis jirovecii pneumonia (PJP) has been reported in patients with SARS-CoV-2 pneumonia, so far, all of which as concurrent infections: a single case in an immunocompetent patient [6], four cases in HIV infected patients [7][8][9] and one in a kidney transplant recipient [10]; nonetheless, the proportion of patients admitted to intensive care unit with SARS-CoV-2 pneumonia with evidence of P. jirovecii colonization in respiratory tract has been estimated around 9%, suggesting that PJP can be more frequent than expected [11].…”

Section: Introductionmentioning

confidence: 99%

Pneumocystis jirovecii pneumonia in an immunocompetent patient recovered from COVID-19

Viceconte

Buonomo

Lanzardo

et al. 2021

Infectious Diseases

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Concurrent COVID-19 and Pneumocystis jirovecii pneumonia in a severely immunocompromised 25-year-old patient

Cited by 33 publications

References 4 publications

High mortality co-infections of COVID-19 patients: mucormycosis and other fungal infections

High mortality co-infections of COVID-19 patients: mucormycosis and other fungal infections

COVID-19 and Pneumocystis jirovecii Pulmonary Coinfection—The First Case Confirmed through Autopsy

Pneumocystis jirovecii pneumonia in an immunocompetent patient recovered from COVID-19

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