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

Menon, Aravind; Berg, David D.; Fredenburgh, Laura E.

doi:10.1164/rccm.202008-3174le

Cited by 5 publications

(4 citation statements)

References 16 publications

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“…Patients hospitalized in the ICU for COVID-19 might be at risk of PCP due to mechanical ventilation, use of corticosteroid therapy, or the existence of a cytokine storm leading to marked alveolar-interstitial pulmonary tissue [1]. However, there are radiological similarities between the two infections, the presence of cysts or fine reticular changes on CT scan being in favor of pneumocystosis, but similarities are not constant and are sometimes difficult to see [3,5,10]. The high sensitivity of PCR can lead to overdiagnosis of P. jirovecii infection in colonized patients, and the distinction between colonization and PCP can be difficult, especially in immunocompetent patients [5][6][7]10].…”

Section: Discussionmentioning

confidence: 99%

“…However, there are radiological similarities between the two infections, the presence of cysts or fine reticular changes on CT scan being in favor of pneumocystosis, but similarities are not constant and are sometimes difficult to see [3,5,10]. The high sensitivity of PCR can lead to overdiagnosis of P. jirovecii infection in colonized patients, and the distinction between colonization and PCP can be difficult, especially in immunocompetent patients [5][6][7]10]. Direct examination is usually not performed in COVID-19 patients.…”

Section: Discussionmentioning

confidence: 99%

“…Serum (1,3)-β-D-glucan assay might be used for its negative predictive value to rule out the diagnosis of infection [7]. Finally, the diagnosis of infection must therefore be based, in addition to the mycological criteria, on a set of arguments including clinical worsening, immunosuppression, deep lymphocytopenia, serum (1,3)-β-D-glucan, and LDH assays and response to treatment [10].…”

Section: Discussionmentioning

confidence: 99%

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Detection of Pneumocystis jirovecii in Patients with Severe COVID-19: Diagnostic and Therapeutic Challenges

Gerber

Ruch

Chamaraux-Tran

et al. 2021

JoF

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Detection of Pneumocystis jirovecii in Patients with Severe COVID-19: Diagnostic and Therapeutic Challenges

Gerber

Ruch

Chamaraux-Tran

et al. 2021

JoF

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“…In patients with active infection caused by pathogens (e.g., SARS CoV-2) an increased incidence of fungal infection (e.g. aspergillosis [11] , cryptococcosis, candidiasis [12] , [13] , Coccidioides [14] , Geotrichum [15] Fusarium [16] , Mucorales [17] Mucorales+Aspergillus [18] Pneumocystosis [19] , Mucormycosis, Histoplasmosis) was detected [20] . Finally it has been observed that excessive use of steroid drugs make patients susceptible to mucormycosis which can occur anytime during hospitalization or after hospitalization [21] .…”

Section: Introductionmentioning

confidence: 99%

Mucormycosis an added burden to Covid-19 Patients: An in-depth systematic review

Shah

Khan

Ahad

et al. 2022

Journal of Infection and Public Health

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

Cited by 5 publications

References 16 publications

Detection of Pneumocystis jirovecii in Patients with Severe COVID-19: Diagnostic and Therapeutic Challenges

Detection of Pneumocystis jirovecii in Patients with Severe COVID-19: Diagnostic and Therapeutic Challenges

Mucormycosis an added burden to Covid-19 Patients: An in-depth systematic review

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

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