Pneumocystis jirovecii Pneumonia in Non-HIV Patients Recovering from COVID-19: A Single-Center Experience

Abstract

Objective: to describe a single-center experience of Pneumocystis jirovecii pneumonia (PJP) in non-HIV patients recovering from COVID-19. Methods: We report the cases of five non-HIV patients with COVID-19 who also developed PJP at a University Hospital. Results: With the exception of one subject, who experienced an atypical and prolonged course of COVID-19, all the patients developed PJP after the clinical resolution of COVID-19 pneumonia. All but one patient had no pre-existing immunosuppressive conditions or other risk factors for PJP development at COVID-19 diagnosis. Nonetheless, following the course of COVID-19 infection, all the patients fulfilled at least one host factor for PJP; indeed, all the patients had received at least 2 weeks of high-dose steroids and three out of five had a CD4+ cell count <200/mm3. Conclusions: The use of corticosteroids for COVID-19 respiratory impairment seems to be the most common risk factor for PJP, together with viral-induced and iatrogenic lymphopenia. The worsening in respiratory function and the characteristic radiological picture during or after COVID-19 pneumonia should raise the suspicion of PJP, even in immunocompetent patients. PJP primary chemoprophylaxis can be considered in selected high-risk COVID-19 patients, but further studies are needed.

Concurrent Infection with SARS-CoV-2 and Pneumocystis jirovecii in Immunocompromised and Immunocompetent Individuals

“…The second pattern of PJP is superinfection, occurring days or weeks after COVID-19 symptom onset as a biphasic illness. This presentation is well described by Gentile et al [ 42 ]. All patients in this cohort developed PJP after clinical resolution of COVID-19 pneumonia, and the median time between COVID-19 symptoms and PJP diagnosis was 40 days.…”

Neumonía por Pneumocystis jirovecii posterior a COVID-19 en un paciente sin infección por VIH

“…Gentile y cols. describen una serie de casos similares al presentado, donde ponen de manifiesto estas características 7 .…”

Fungal Infections Other Than Invasive Aspergillosis in COVID-19 Patients

“…Antifungal therapy should follow a similar approach to patients without COVID-19 [87]. Trimethoprim-sulfamethoxazole often in conjunction with corticosteroids remains the preferred first-line treatment of PCP [87,88], although there is debate as to whether to treat patients coinfected with COVID-19 or not, as some patients have improved without treatment [81][82][83]. When there is a high clinical suspicion for PCP, treatment can be initiated before making a definitive diagnosis, and clinical improvement can be expected within 4-8 days [77].…”