The diagnostic challenge of pneumocystis pneumonia and COVID‐19 co‐infection in HIV

Abstract

Coronavirus disease 2019 (COVID‐19) and pneumocystis pneumonia (PCP) share many overlapping features and may be clinically indistinguishable on initial presentation in people living with HIV. We present the case of co‐infection with COVID‐19 and PCP in a patient with progressive respiratory failure admitted to our intensive care unit where the dominant disease was uncertain. This case highlights the difficulty in differentiating between the two diseases, especially in a high HIV prevalence setting where PCP is frequently diagnosed using case definitions and clinical experience due to limited access to bronchoscopy, appropriate laboratory testing, and computed tomography scans. In addition, diagnostic testing may yield false‐negative results in both diseases, and clinician awareness to the overlap and pitfalls is essential if COVID‐19 becomes endemic in such settings.

Invasive Fungal Infections Complicating COVID-19: A Narrative Review

“…Twenty-five studies (20 case reports/case series and five observational studies) describe uncommon IFIs in COVID-19 patients [30,45,61,110,137,148,[178][179][180][181][182][183][184][185][186][187][188][189][190][191][192][193][194][195][196] (Table 8). Most are from non-European countries (seven from South America, 28%; six from the USA, 24%; single reports from Canada, China, and Qatar).…”

“…The diagnosis of PCP was established mainly on the basis of P. jirovecii PCR in respiratory samples (80%); histopathological evidence was rare (one autoptic diagnosis, one direct examination of sputum) [183,187]. More than half of the patients received specific treatment (65%), and eight deaths were reported [178][179][180][181][182][183][184][185][186][187][188].…”

“…It is worth noting that 10 patients had a history of immunosuppression (one with chronic hemolytic anemia, one who had undergone a solid organ transplantation, and eight with AIDS) [178][179][180][181]186,[188][189][190]192,194,195].…”

The role of SARS-CoV-2 immunosuppression and the therapy used to manage COVID-19 disease in the emergence of opportunistic fungal infections: A review

“…These two case reports that along with COVID-19 clinicians should also be wary about pathogens that mimic COVID-19 such as P. jirovecii . Two fatalities were reported, one with HIV infection and another with Anti-melanoma differentiation-associated gene 5 juvenile dermatomyositis, who had a simultaneous diagnosis of SARS-CoV-2 and P. jirovecii ( Broadhurst et al, 2021 , Quintana-Ortega et al, 2021 ). Both these patients died because of respiratory failure and the contribution of these infections to disease severity was unclear ( Broadhurst et al, 2021 , Quintana-Ortega et al, 2021 ).…”

“…Two fatalities were reported, one with HIV infection and another with Anti-melanoma differentiation-associated gene 5 juvenile dermatomyositis, who had a simultaneous diagnosis of SARS-CoV-2 and P. jirovecii ( Broadhurst et al, 2021 , Quintana-Ortega et al, 2021 ). Both these patients died because of respiratory failure and the contribution of these infections to disease severity was unclear ( Broadhurst et al, 2021 , Quintana-Ortega et al, 2021 ). The case reports reviewed in this section suggest in patients with HIV infection who present with pneumonia-like symptoms ; the clinicians should test for both P. jirovecii and SARS-CoV-2 infections as these patients are more prone to these infections because of their weakened immunity.…”