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Gentile, Ivan; Viceconte, Giulio; Lanzardo, Amedeo; Zotta, Irene; Zappulo, Emanuela; Pinchera, Biagio; Scotto, Riccardo; Schiano Moriello, Nicola; Foggia, Maria; Giaccone, Agnese; Messina, Gaetana; Salvatore, Paola; Buonomo, Antonio Riccardo
International journal of environmental research and public health, 10/2021, Volume: 18, Issue: 21Journal Article
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/mm3. 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.
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