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

Ivan Gentile, Giulio Viceconte, Amedeo Lanzardo, Irene Zotta, Emanuela Zappulo, Biagio Pinchera, Riccardo Scotto, Nicola Schiano Moriello, Maria Foggia, Agnese Giaccone, Gaetana Messina, Paola Salvatore, Antonio Riccardo Buonomo and Federico II COVID-19 Team
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Ivan Gentile: Department of Clinical Medicine and Surgery, Section of Infectious Disease, University of Naples “Federico II”, 80131 Naples, Italy
Giulio Viceconte: Department of Clinical Medicine and Surgery, Section of Infectious Disease, University of Naples “Federico II”, 80131 Naples, Italy
Amedeo Lanzardo: Department of Clinical Medicine and Surgery, Section of Infectious Disease, University of Naples “Federico II”, 80131 Naples, Italy
Irene Zotta: Department of Clinical Medicine and Surgery, Section of Infectious Disease, University of Naples “Federico II”, 80131 Naples, Italy
Emanuela Zappulo: Department of Clinical Medicine and Surgery, Section of Infectious Disease, University of Naples “Federico II”, 80131 Naples, Italy
Biagio Pinchera: Department of Clinical Medicine and Surgery, Section of Infectious Disease, University of Naples “Federico II”, 80131 Naples, Italy
Riccardo Scotto: Department of Clinical Medicine and Surgery, Section of Infectious Disease, University of Naples “Federico II”, 80131 Naples, Italy
Nicola Schiano Moriello: Department of Clinical Medicine and Surgery, Section of Infectious Disease, University of Naples “Federico II”, 80131 Naples, Italy
Maria Foggia: Department of Clinical Medicine and Surgery, Section of Infectious Disease, University of Naples “Federico II”, 80131 Naples, Italy
Agnese Giaccone: Department of Clinical Medicine and Surgery, Section of Infectious Disease, University of Naples “Federico II”, 80131 Naples, Italy
Gaetana Messina: Toracic Surgery Unit, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
Paola Salvatore: Department of Molecular Medicine and Medical Biotechnology, University of Naples “Federico II”, 80131 Naples, Italy
Antonio Riccardo Buonomo: Department of Clinical Medicine and Surgery, Section of Infectious Disease, University of Naples “Federico II”, 80131 Naples, Italy
Federico II COVID-19 Team: Membership of the Federico II COVID-19 team is provided in the Acknowledgments.

IJERPH, 2021, vol. 18, issue 21, 1-7

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/mm 3 . 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.

Keywords: COVID-19; Pneumocystis jirovecii; invasive fungal infections; corticosteroids; lymphopenia (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2021
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