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Narrative review of the relationship between COVID-19 and PJP: does it represent coinfection or colonization?
Chong, Woon H; Saha, Biplab K; Chopra, Amit.
  • Chong WH; Department of Pulmonary and Critical Care Medicine, Albany Medical Center, 43 New Scotland Avenue, Albany, NY, USA. chongw@amc.edu.
  • Saha BK; Department of Pulmonary and Critical Care, Ozarks Medical Center, West Plains, MO, USA.
  • Chopra A; Department of Pulmonary and Critical Care Medicine, Albany Medical Center, 43 New Scotland Avenue, Albany, NY, USA.
Infection ; 49(6): 1079-1090, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1248754
ABSTRACT

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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Full text: Available Collection: International databases Database: MEDLINE Main subject: Pneumonia, Pneumocystis / Pneumocystis carinii / Coinfection / COVID-19 Type of study: Diagnostic study / Etiology study / Experimental Studies / Observational study / Prognostic study / Randomized controlled trials / Reviews Topics: Long Covid Limits: Humans Language: English Journal: Infection Year: 2021 Document Type: Article Affiliation country: S15010-021-01630-9

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Pneumonia, Pneumocystis / Pneumocystis carinii / Coinfection / COVID-19 Type of study: Diagnostic study / Etiology study / Experimental Studies / Observational study / Prognostic study / Randomized controlled trials / Reviews Topics: Long Covid Limits: Humans Language: English Journal: Infection Year: 2021 Document Type: Article Affiliation country: S15010-021-01630-9