Detection of <i>Pneumocystis jirovecii</i> in Patients with Severe COVID-19: Diagnostic and Therapeutic Challenges

• Main Authors: Victor Gerber, Yvon Ruch, Thiên-Nga Chamaraux-Tran, Walid Oulehri, Francis Schneider, Veronique Lindner, Valentin Greigert, Julie Denis, Julie Brunet, François Danion
• Format: Article
• Language: English
• Published: MDPI AG 2021-07-01
• Series: Journal of Fungi
• Subjects: pneumocystosis; <i>Pneumocystis jirovecii</i>; COVID-19; SARS-CoV-2; fungi
• Online Access: https://www.mdpi.com/2309-608X/7/8/585

Cases of <i>Pneumocystis jirovecii</i> pneumonia (PCP) in patients suffering from COVID-19 were described in patients with various comorbidities and outcomes. The diagnosis of PCP in these patients is difficult due to clinical and radiological similarities. We carried out this study in order to better describe potentially at-risk patients and their outcomes. We retrospectively analyzed all patients with a <i>P. jirovecii</i> PCR performed in bronchoalveolar lavage fluid, tracheal aspirate, or sputum within a month after the COVID-19 diagnosis. Fifty-seven patients with COVID-19 infection were tested for <i>P. jirovecii</i>. Among 57 patients with COVID-19, four patients had a concomitant positive <i>P. jirovecii</i> PCR. These four patients were elderly with a mean age of 78. Two patients were immunocompromised, and the two others presented only diabetes mellitus. Three patients presented an ARDS requiring transfer to the ICU and mechanical ventilation. All patients presented lymphocytopenia. Three patients had probable PCP, and one had proven PCP. All patients died within two months after hospital admission. These co-infections are rare but severe, therefore, PCP should be considered in case of worsening of the condition of patients with severe COVID-19.