COVID-19 and Pneumocystis jiroveci Pneumonia
Open Forum Infectious Diseases
; 8(SUPPL 1):S272, 2021.
Article
in English
| EMBASE | ID: covidwho-1746658
ABSTRACT
Background. More accounts of opportunistic infection in COVID-19 patients are emerging. At our institution, we identified 2 COVID-19 patients with Pneumocystis jiroveci pneumonia (PJP) opportunistic infection. This prompted a review of the literature to identify trends in patient characteristics, risk factors, and outcomes in this population. Methods. A literature review was conducted using PubMed that identified 13 other patients with both COVID-19 and PJP infection. Age, gender, human immunodeficiency virus (HIV) status, other immunocompromised states, time between COVID-19 and PJP diagnosis, and clinical outcomes were captured for analysis. Results. Eleven patients were male. The average age was 56 years. All but 2 patients were immunocompromised. At time of PJP diagnosis, seven patients had newly diagnosed HIV and one had known, well-controlled HIV. One patient had rheumatoid arthritis receiving leflunomide, 1 had ulcerative colitis receiving budesonide and sulfasalazine, 2 patients had multiple myeloma whereby both were on lenalidomide, 1 patient was a renal transplant recipient immunosuppressed on tacrolimus, mycophenolate, and methylprednisolone, and 1 patient had chronic lymphocytic leukemia getting fludarabine, cyclophosphamide, and rituximab. Nine patients had positive COVID-19 and PJP tests performed within 7 days of one another. One patient tested positive for PJP 54 days into admission for COVID-19. This patient received high dose steroids and tocilizumab for initial COVID-19 infection. Three patients were re-hospitalized with PJP after a recent admission for COVID-19 pneumonia, with a mean time to readmission of 25 days. One of these 3 patients had no treatment for COVID-19, while 2 received steroids. Five of the total 15 patients (33%) died. Conclusion. COVID-19 treatments with high dose steroids and tocilizumab can make patients vulnerable for opportunistic infection with PJP. Furthermore, COVID-19 is known to cause lymphopenia which may further increase this risk. A diagnosis of concomitant PJP can be especially challenging due to nearly identical radiographical findings. Serum beta-D glucan and HIV testing can be especially helpful in this situation, and there should be a low threshold for performing bronchoalveolar lavage.
budesonide; cyclophosphamide; fludarabine; leflunomide; lenalidomide; methylprednisolone; mycophenolic acid; rituximab; salazosulfapyridine; tacrolimus; tocilizumab; adult; cancer patient; chronic lymphatic leukemia; clinical outcome; conference abstract; coronavirus disease 2019; diagnosis; drug combination; drug megadose; drug therapy; female; gender; HIV test; hospital readmission; human; human tissue; kidney graft; lung lavage; lymphocytopenia; male; Medline; middle aged; multiple myeloma; opportunistic infection; outcome assessment; Pneumocystis pneumonia; rheumatoid arthritis; risk factor; surgery; systematic review; ulcerative colitis
Full text:
Available
Collection:
Databases of international organizations
Database:
EMBASE
Language:
English
Journal:
Open Forum Infectious Diseases
Year:
2021
Document Type:
Article
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