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

Kelly, Sophie; Waters, Laura; Çevik, Müge; Collins, Simon; Lewis, Jessica; Wu, Meng; Blanchard, Tom; Geretti, Anna María

doi:10.7861/clinmed.2020-0565

Cited by 36 publications

(36 citation statements)

References 3 publications

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“…In fact, some clinical conditions related to both HIV and COVID-19 maybe intertwined. For instance, clinical and radiological picture of interstitial pneumonia could be referred to Pneumocystis pneumonia as well as COVID-19 10,11 and perhaps, thank to this, we observed an increase in PCP diagnosis in 2020. However, the total number of patients diagnosed during hospitalization slightly decrease in 2020 compared to 2019; as a matter of fact, in particular during the first pandemic wave, patients with symptoms not clearly related to COVID-19 did not often consider access to hospital care necessary.…”

Section: Discussionmentioning

confidence: 58%

Decrease in New Diagnosis of HIV/AIDS in the Two Years Period 2019-2020: Impact of COVID-19 Pandemic

Quiros-Roldan

Izzo

Carriero

et al. 2022

Journal of Public Health Research

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The emergence SARS-CoV-2 in late 2019 and early 2020 has caused a pandemic of unprecedented proportions. Management of COVID-19 became emergent public health priorities, and the impact on other public health initiatives, such as expanded HIV screening and linkage to care, remain largely unknown. In this Single-Center retrospective observational study, we describe the characteristics and circumstance of the new HIV cases during 2020 compared to 2019. We observed a decrease of HIV diagnosis during this period. Interestingly, median age at HIV diagnosis decreased of one decade and percentage of female patients was higher. In addition, more patients received diagnosis during hospitalization and more AIDS-defining conditions, such as Pneumocystis pneumonia, were detected. We express our concern that HIV new diagnoses will increase as a result of people's inability to get tested or treated in this period. More efforts are needed to improve local screening programs both during and after COVID-19 pandemic.

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Section: Discussionmentioning

confidence: 58%

Decrease in New Diagnosis of HIV/AIDS in the Two Years Period 2019-2020: Impact of COVID-19 Pandemic

Quiros-Roldan

Izzo

Carriero

et al. 2022

Journal of Public Health Research

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“…In all these studies, the degree of lymphocytopenia and corticosteroids administration was significantly higher in the critically ill/non-survivor group than in other groups. Furthermore, although the nadir CD4 + T-cell count was less than 200 cells/10 6 L in the majority of case reports/ series describing PJP among HIV patients co-infected with COVID-19 [19][20][21], a case report by Menon et al described a hospitalized COVID-19 patient diagnosed with PJP despite the absence of HIV infection. Though her nadir CD4 + T-cell count was 291 cells/10 6 L and she was on chronic oral budesonide for her ulcerative colitis, the improvement with trimethoprim-sulfamethoxazole supported the diagnosis of secondary PJP infection [18].…”

Section: Discussionmentioning

confidence: 99%

“…The most common bacterial microorganisms identified in the respiratory tract cultures among the nine observational studies (Table 2 [17]. Other rare opportunistic fungal infections such as Pneumocystis jirovecii (PJP) had been observed in four case reports/series included in our review [18][19][20][21].…”

Section: Microbiology Of Secondary Pulmonary Infectionsmentioning

confidence: 96%

State-of-the-art review of secondary pulmonary infections in patients with COVID-19 pneumonia

et al. 2021

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Background The incidence of secondary pulmonary infections is not well described in hospitalized COVID-19 patients. Understanding the incidence of secondary pulmonary infections and the associated bacterial and fungal microorganisms identified can improve patient outcomes. Objective This narrative review aims to determine the incidence of secondary bacterial and fungal pulmonary infections in hospitalized COVID-19 patients, and describe the bacterial and fungal microorganisms identified. Method We perform a literature search and select articles with confirmed diagnoses of secondary bacterial and fungal pulmonary infections that occur 48 h after admission, using respiratory tract cultures in hospitalized adult COVID-19 patients. We exclude articles involving co-infections defined as infections diagnosed at the time of admission by non-SARS-CoV-2 viruses, bacteria, and fungal microorganisms. Results The incidence of secondary pulmonary infections is low at 16% (4.8-42.8%) for bacterial infections and lower for fungal infections at 6.3% (0.9-33.3%) in hospitalized COVID-19 patients. Secondary pulmonary infections are predominantly seen in critically ill hospitalized COVID-19 patients. The most common bacterial microorganisms identified in the respiratory tract cultures are Pseudomonas aeruginosa, Klebsiella species, Staphylococcus aureus, Escherichia coli, and Stenotrophomonas maltophilia. Aspergillus fumigatus is the most common microorganism identified to cause secondary fungal pulmonary infections. Other rare opportunistic infection reported such as PJP is mostly confined to small case series and case reports. The overall time to diagnose secondary bacterial and fungal pulmonary infections is 10 days (2-21 days) from initial hospitalization and 9 days (4-18 days) after ICU admission. The use of antibiotics is high at 60-100% involving the studies included in our review. Conclusion The widespread use of empirical antibiotics during the current pandemic may contribute to the development of multidrug-resistant microorganisms, and antimicrobial stewardship programs are required for minimizing and de-escalating antibiotics. Due to the variation in definition across most studies, a large, well-designed study is required to determine the incidence, risk factors, and outcomes of secondary pulmonary infections in hospitalized COVID-19 patients.

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“…Although the distribution of lung involvement is often described as more peripheral in SARS-CoV-2 infection compared to in Pneumocystis jirovecii infection [ 3 ] differentiating between the two infections radiologically can be a challenge. This is supported by the fact that during the coronavirus disease 2019 (COVID-19) pandemic there have been multiple reports of patients with a delayed diagnosis of Pneumocystis pneumonia (particularly in patients with previously undiagnosed immunosuppression[both HIV and non-HIV]) due to misdiagnosis as SARS-CoV-2 infection [ [4] , [5] , [6] , [7] , [8] ]. Furthermore, as we know that throat swab sensitivity for SARS-CoV-2 infection is in the region of 70% [ 9 ] , many patients with a negative SARS-CoV-2 swab result will still be treated as having a SARS-CoV-2 infection based on imaging findings.…”

mentioning

confidence: 99%

Pneumocystis pneumonia: An important consideration when investigating artificial intelligence-based methods in the radiological diagnosis of COVID-19

Lampejo

2022

Clinical Imaging

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

Cited by 36 publications

References 3 publications

Decrease in New Diagnosis of HIV/AIDS in the Two Years Period 2019-2020: Impact of COVID-19 Pandemic

Decrease in New Diagnosis of HIV/AIDS in the Two Years Period 2019-2020: Impact of COVID-19 Pandemic

State-of-the-art review of secondary pulmonary infections in patients with COVID-19 pneumonia

Pneumocystis pneumonia: An important consideration when investigating artificial intelligence-based methods in the radiological diagnosis of COVID-19

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