COVID-19 and Pneumocystis jirovecii pneumonia: Back to the basics

Mouren, D.; Catherinot, Émilie; Givel, C.; Chabrol, A.; Tchérakian, Colas; Longchampt, Élisabeth; Vargaftig, Jacques; Farfour, Éric; Couderc, Louis‐Jean; Salvator, Hélène

doi:10.1016/j.resmer.2021.100814

Cited by 20 publications

(23 citation statements)

References 7 publications

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“…BAL cell differentials are often non-specific in patients with COVID-19 pneumonia; however, BAL cell counts that are predominant lymphocytosis (13% <) with flow cytometry showing high levels of CD8 + T cells (30% <) and cell viability (80% <) but low CD4 + T cells (50% >) and CD4 + /CD8 + T cell ratio (2.5 >) are suggestive of PJP coinfection [ 48 ]. Mouren et al was the only case report reporting BAL findings in COVID-19 patients with PJP coinfection, demonstrating a total white cell count of 468 × 10 3 cells/mm 3 and 38% lymphocytes [ 49 ]. Nevertheless, the significance of low levels of PJP detected by PCR and BAL cell count differentials need to be interpreted in conjunction with clinical context.…”

Section: Discussionmentioning

confidence: 99%

Narrative review of the relationship between COVID-19 and PJP: does it represent coinfection or colonization?

2021

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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.

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Section: Discussionmentioning

confidence: 99%

Narrative review of the relationship between COVID-19 and PJP: does it represent coinfection or colonization?

2021

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“…Differentiating COVID-19 from pneumocystis jirovecii pneumonia is not usually possible from signs and symptoms. Sputum culture, RT-PCR, CT chest are recommended to diagnose on time and do a differential between COVID-19 and P. jirovecii 38 .…”

Section: Fungal Co-infections In Covid-19mentioning

confidence: 99%

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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“…During the COVID-19 pandemic, 13 publications have reported a total of 24 confirmed cases of co-infection with SARS-CoV-2 and P. jirovecii ( Table 1 ). This co-infection has occurred in both men and women, in the age range of 11–83 years, predominantly in males over 40 years of age [ 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 ]. The main risk factor for developing co-infection with Pneumocystis was HIV infection with low CD4+ count, followed by immunosuppressive treatments, lymphopenia, and autoimmune disease (anti-melanoma differentiation-associated gene 5 juvenile dermatomyositis) [ 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 ].…”

Section: Pneumonia By Pneumocystis Jirovecii and Covid-19mentioning

confidence: 99%

“…The fungal presence was confirmed in 22 cases through different methods, such as PCR, high-performance sequencing, detection of β-D-glucan in serum, and staining techniques (Grocott and direct fluorescent antibody stain) [ 20 , 21 , 22 , 23 , 24 , 25 , 27 , 28 , 29 , 30 , 31 , 32 ]. Treatment of pneumocystosis in COVID-19 patients was trimethoprim-sulfamethoxazole [ 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 ]. However, one patient presented intolerance to this medication, so he was treated with clindamycin [ 26 ].…”

Section: Pneumonia By Pneumocystis Jirovecii and Covid-19mentioning

confidence: 99%

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Epidemiology of Systemic Mycoses in the COVID-19 Pandemic

Frías-De-León

Pinto‐Almazán

Hernández‐Castro

et al. 2021

JoF

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The physiopathologic characteristics of COVID-19 (high levels of inflammatory cytokines and T-cell reduction) promote fungal colonization and infection, which can go unnoticed because the symptoms in both diseases are very similar. The objective of this work was to study the current epidemiology of systemic mycosis in COVID-19 times. A literature search on the subject (January 2020–February 2021) was performed in PubMed, Embase, Cochrane Library, and LILACS without language restrictions. Demographic data, etiological agent, risk factors, diagnostic methods, antifungal treatment, and fatality rate were considered. Eighty nine publications were found on co-infection by COVID-19 and pneumocystosis, candidiasis, aspergillosis, mucormycosis, coccidioidomycosis, or histoplasmosis. In general, the co-infections occurred in males over the age of 40 with immunosuppression caused by various conditions. Several species were identified in candidiasis and aspergillosis co-infections. For diagnosis, diverse methods were used, from microbiological to molecular. Most patients received antifungals; however, the fatality rates were 11–100%. The latter may result because the clinical picture is usually attributed exclusively to SARS-CoV-2, preventing a clinical suspicion for mycosis. Diagnostic tests also have limitations beginning with sampling. Therefore, in the remainder of the pandemic, these diagnostic limitations must be overcome to achieve a better patient prognosis.

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COVID-19 and Pneumocystis jirovecii pneumonia: Back to the basics

Cited by 20 publications

References 7 publications

Narrative review of the relationship between COVID-19 and PJP: does it represent coinfection or colonization?

Narrative review of the relationship between COVID-19 and PJP: does it represent coinfection or colonization?

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

Epidemiology of Systemic Mycoses in the COVID-19 Pandemic

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