Coronavirus disease 2019 and Pneumocystis jirovecii pneumonia: a diagnostic dilemma in HIV

Pneumocystis pneumonia, a COVID-19 mimic, reminds us of the importance of HIV testing in COVID-19

“…Reports of missed or delayed treatment for conditions that imitate COVID-19 such as pneumonia caused by the fungus Pneumocystis jirovecii are emerging. 1,2 There is a risk that, without a high index of suspicion, alternative aetiologies may be overlooked while pursuing a diagnosis of COVID-19.…”

“…Perhaps more concerning, given recent case reports of co-infection with SARS-CoV-2 and Pneumocystis jirovecii, is that the rate was only 22% (15/69) in severe cases of PCR-confirmed COVID-19 requiring high-flow oxygen, non-invasive or invasive ventilation between 01 March 2020 and 18 May 2020. 1,2…”

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

“…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 ].…”

“…Clinically, COVID-19 infection and Pneumocystis pneumonia can share numerous common features [ 10 , 12 , 13 ]. Computed tomography (CT) of the chest shows bilateral symmetrical ground-glass opacities in both [ 12 , 14 ].…”

Reply to Blaize et al.: COVID-19–related Respiratory Failure and Lymphopenia Do Not Seem Associated with Pneumocystosis

“…Given the inherent risk of overextending conclusions from a single case, we were conservative in the interpretation of our case and suggested that it may be reasonable to consider additional diagnostic testing for P. jirovecii by assaying serum (1,3)-β- d -glucan in patients with COVID-19 if there are additional clinical findings, such as cystic findings on chest computed tomography or elevated lactate dehydrogenase that may support coinfection ( 1 ). This approach should be considered particularly in patients with classical P. jirovecii risk factors such as HIV, as coinfection with SARS-CoV-2 and P. jirovecii has been reported in both well-controlled ( 14 ) and severely immunocompromised patients with HIV ( 15 , 16 ). We commend the authors for their work and for expanding the COVID-19 evidence base by systematically testing the hypothesis generated by our initial clinical observation.…”