Narrative review of the relationship between COVID-19 and PJP: does it represent coinfection or colonization?

• Published in: Infection 2021-12, Vol.49 (6), p.1079-1090
• Main Authors: Chong, Woon H., Saha, Biplab K., Chopra, Amit
• Format: Article
• Language: English
• Subjects: Case reports; CD4 antigen; Coinfection - epidemiology; Colonization; Coronaviruses; Corticoids; Corticosteroids; COVID-19; Diagnosis; Family Medicine; General Practice; Glucan; HIV; Human immunodeficiency virus; Humans; Immunosuppressive agents; Infectious Diseases; Internal Medicine; L-Lactate dehydrogenase; Lactate dehydrogenase; Lactic acid; Lymphocytes; Lymphocytes T; Lymphopenia; Mechanical ventilation; Medicine; Medicine & Public Health; Pneumocystis carinii; Pneumonia, Pneumocystis - diagnosis; Pneumonia, Pneumocystis - drug therapy; Pneumonia, Pneumocystis - epidemiology; Respiratory tract; Review; Risk analysis; Risk factors; SARS-CoV-2; Severe acute respiratory syndrome coronavirus 2; Steroids; Sulfamethoxazole; Trimethoprim; β-Glucan
• ISSN: 0300-8126; 1439-0973
• DOI: 10.1007/s15010-021-01630-9

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.