Pneumocystis jiroveciiInfections Among COVID-19 Patients: A Case Series and Literature Review

Abstract

Pneumocystis jiroveciipneumonia (PCP) is a serious, emerging complication of coronavirus disease 2019 (COVID-19). We describe six new cases of PCP/COVID-19 co-infection and performed a systematic review of published cases. Among our cases (n=6) and those in the literature (n=69) with available data, median age was 59 [IQR: 44-77, n=38] years, 72% (47/65) were male, and the mortality rate was 30.9% (21/68). Long-term corticosteroid use was noted in 45.1% (23/51), advanced human immunodeficiency virus (HIV) infection (defined as a CD4 count less than 200 cells per microliter (cells/mm³)) in 17.6% (9/51), and antineoplastic chemotherapy in 13.7% (7/51); consistent with known PCP risk factors. Notably, 56.7% (38/47) had verifiable risk factors for PCP (high-dose corticosteroids, immunosuppressive therapy, and HIV infection) prior to COVID-19 infection. A median absolute lymphocyte count of 0.61 x 10³ cells/mm³[0.28-0.92, n=23] and a CD4 count 66 cells/mm³ [33-291.5, n=20] were also discovered among the study population. These findings suggest a need for greater attention to PCP risk factors among COVID-19 patients and consideration of PCP prophylaxis in these high-risk populations.