COVID-19–related Respiratory Failure and Lymphopenia Do Not Seem Associated with Pneumocystosis

Blaize, Marion; Mayaux, Julien; Luyt, Charles Edouard; Lampros, Alexandre; Fekkar, Arnaud

doi:10.1164/rccm.202007-2938le

Cited by 28 publications

(44 citation statements)

References 7 publications

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“…Like many patients without HIV, the diagnosis of PJP becomes challenging, in whom the burden of PJP is generally lower and limits the sensitivity of microscopy [ 9 ]. Given the high sensitivity of P. jirovecii PCR in detecting low fungal loads, even in non-HIV patients, the distinction between actual infection and colonization is a common problem [ 54 , 55 ]. PCR has 87.2% sensitivity and 92.2% specificity; 51.5% positive predictive value and 98.7% negative predictive value for diagnosing PJP [ 56 ].…”

Section: Discussionmentioning

confidence: 99%

“…When clinical suspicion for PJP is high, treatment can be initiated even before making a definitive diagnosis because P. jirovecii persists in respiratory specimens for up to 3 weeks after adequate treatment is initiated [ 65 ]. Clinical improvement with anti-PJP therapy can be expected around 4–8 days [ 9 , 55 ]. Serum BDG, despite being a reliable, adjunct diagnostic marker, may indicate favorable treatment response with decreasing levels but does not always reflect the severity and prognosis in PJP patients [ 66 – 68 ].…”

Section: Discussionmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

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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“…Some of the results of this study have been previously briefly reported or discussed in the form of case report ( 10 , 18 ) or letter ( 19 , 20 ).…”

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confidence: 99%

Occurrence of Invasive Pulmonary Fungal Infections in Patients with Severe COVID-19 Admitted to the ICU

Fekkar

Lampros²,

Mayaux

et al. 2021

Am J Respir Crit Care Med

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151

183

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AF designed the study, participated in data collection and analysis, performed statistical analysis and wrote the paper. AL participates in study design, data collection and analysis, performed statistical analysis and participated in writing. JM, SD, JMC, AM and CEL participated in patients' care and clinical data collection and analysis. CP participated in study design, data collection and analysis. AGM performed virology analysis. MB participated in study design, data collection and analysis and writing. All authors contributed to writing of the paper.

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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%

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–related Respiratory Failure and Lymphopenia Do Not Seem Associated with Pneumocystosis

Cited by 28 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?

Occurrence of Invasive Pulmonary Fungal Infections in Patients with Severe COVID-19 Admitted to the ICU

Epidemiology of Systemic Mycoses in the COVID-19 Pandemic

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