Risk Factors for Pneumocystis jirovecii Pneumonia in Non-HIV Patients Hospitalized for COVID-19: A Case-Control Study

Version 1 : Received: 15 June 2023 / Approved: 16 June 2023 / Online: 16 June 2023 (05:00:56 CEST)
Version 2 : Received: 5 August 2023 / Approved: 7 August 2023 / Online: 7 August 2023 (07:27:55 CEST)

A peer-reviewed article of this Preprint also exists.

Viceconte, G.; Buonomo, A.R.; D’Agostino, A.; Foggia, M.; Di Fusco, A.; Pinchera, B.; Scotto, R.; Iacovazzo, C.; Fanasca, L.; Messina, G.; Cacciatore, F.; Salvatore, P.; Gentile, I.; on behalf of the Federico II COVID Team. Risk Factors for Pneumocystis jirovecii Pneumonia in Non-HIV Patients Hospitalized for COVID-19: A Case-Control Study. J. Fungi 2023, 9, 838. Viceconte, G.; Buonomo, A.R.; D’Agostino, A.; Foggia, M.; Di Fusco, A.; Pinchera, B.; Scotto, R.; Iacovazzo, C.; Fanasca, L.; Messina, G.; Cacciatore, F.; Salvatore, P.; Gentile, I.; on behalf of the Federico II COVID Team. Risk Factors for Pneumocystis jirovecii Pneumonia in Non-HIV Patients Hospitalized for COVID-19: A Case-Control Study. J. Fungi 2023, 9, 838.

Abstract

Background Very few cases of Pneumocystis jirovecii pneumonia (PCP) have been reported in COVID-19 so far, mostly in patients with concomitant HIV infection or in solid organ transplant recipients. Despite COVID-19 is associated with lymphopenia and use of steroids, there are no studies specifically aimed to investigate risk factors for PCP in COVID-19 Methods retrospective case-control study in a cohort of patients with confirmed COVID-19. Direct immunofluorescence assay on respiratory samples was used to diagnose PCP. Results We enrolled 54 patients. Patients with PCP had significant lower median lymphocyte values (p=0.033), longer COVID-19 disease duration (p=0.014), higher cumulative dose of steroid received (p=0.026), higher CRP values (p=0.005) and lower SARS-CoV-2 vaccination rate than controls (p=0.029). Cumulative steroid dose (p=0.042) and the highest CRP value during the stay (p=0.012) were identified as risk factor for PCP, while SARS-CoV-2 vaccination with one (p=0.029) and two doses (p=0.049) as a protective factor for PCP, although not independently associated. Conclusions PCP develops in COVID-19 patients regardless of immunosuppressive conditions. However, a higher rate of PCP is significantly associated with the cumulative steroidal dose, high CRP values and lack of vaccination.

Keywords

COVID-19; Pneumocystis jirovecii; SARS-CoV-2; immunocompromised; pneumonia.

Subject

Biology and Life Sciences, Virology

Copyright: This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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