Analysis of fatal cases of pneumocystis pneumonia in HIV-infected patients with COVID-19

The aim: to determine the impact of a new coronavirus infection on the course of pneumocystis pneumonia in patients with HIV infection.

Materials and methods. A retrospective analysis of 45 medical records of patients who died in the intensive care unit of the S. P. Botkin Clinical Infectious Diseases Hospital between March 2020 and January 2023 was conducted. Of the 45 patients with Pneumocystis pneumonia, the new coronavirus infection was also verified in 26 patients. Anamnestic and clinical data, laboratory and instrumental research results, pathological findings were compared in groups of patients with Pneumocystis pneumonia with/without co-infection with COVID-19.

Results and discussion. The patient groups were comparable in terms of gender, age, duration of HIV infection, severity of immunodeficiency, and intensity of HIV viremia. The main clinical manifestations (fever level, cough, signs of respiratory failure, auscultatory picture in the lungs), as well as the indicators of routine laboratory tests (hemogram, concentration of LDH, CRP, ferritin, D-dimer) did not differ statistically in the groups. The radiological picture of changes in the lungs was similar, as well as the duration of hospital stay (bed days) in the groups did not differ. Analysis of the results of pathological reports showed that in most cases (²⁄3of patients), COVID-19 did not have a significant impact on the course and outcome of the disease, being a concomitant pathology. However, in every third patient, signs of viral pneumonia were postmortem along with specific Pneumocystis cystic lung damage.

Conclusion. COVID-19 coronavirus infection in patients with pneumocystosis does not significantly change the clinical picture, laboratory and radiological manifestations of pneumonia and in most cases does not affect its course and outcome. However, in a third of cases, coronavirus pneumonia was the cause of death along with pneumocystis.

1. Kaplan J.E., Benson C. et al. Guidelines for prevention and treatment of opportunistic infections in HIV-infected adults and adolescents: recommendations from CDC, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America // Centers for Disease Control and Prevention (CDC); National Institutes of Health; HIV Medicine Association of the Infectious Diseases Society of America. MMWR Recomm Rep. 2009. Apr. 10; Vol. 58 (RR-4). Р. 1–207; quiz CE1-4. PMID: 19357635.

2. Pokrovsky V.V., Ladnaya N.N. HIV infection, Bulletin. 2021, No. 46 (In Russ). http://www.hivrussia.info/wp-content/uploads/2022/05/Byulleten-46-VICH-infektsiya-za-2020-g-pdf.

3. Clinical management of COVID-19 cases. Variable recommendations, January 13, 2023 (In Russ) https://iris.who.int/bitstream/handle/10665/365580/WHO-2019-nCoV-clinical-2023.1-rus.pdf.

4. Nascimento I.J., Cacic N. et al. Novel coronavirus infection (COVID-19) in Humans: A scoping eview and meta-analysis // J. Clin. Med. 2020. Vol. 9. Р. 941. doi: 10.3390/jcm9040941.

5. Ilieva K., Karnaukhova E.Yu. et al. Clinical cases of pneumocystis pneumonia in patients with HIV infection on the background of COVID-19 // Journal of infectology (In Russ). doi: 10.22625/2072-6732-2022-14-4-126-131.

6. Liu K.-C., Xu P. et al. CT manifestations of coronavirus disease-2019: A retrospective analysis of 73 cases by disease severity // Eur. J. Radiol. 2020. Vol. 126. Р. 108941. doi: 10.1016/j.ejrad.2020.108941.

7. Lampejo Т. Pneumocystis pneumonia: An important consideration when investigating artificial intelligence-based methods in the radiological giagnosis of COVID-19 // Free PMC article. 2021. doi: 10.1016/j.clinimag.2021.02.044.

8. Chun-Jing Du, Jing-Yuan Liu et al. Differences and similarities of high-resolution computed tomography features between pneumocystis pneumonia and cytomegalovirus pneumonia in AIDS patients // J. Infectious Diseases of Poverty. 2020. Vol. 9. Р. 149. doi: 10.1186/s40249-020-00768-2.

9. Zhao X., Liu B. The characteristics and clinical value of chest CT images of novel coronavirus pneumonia // Clin. Free PMC article. 2020. doi:10.1016/j.crad.2020.03.002.

10. Zhou S., Wang Y. CT features of Coronavirus Disease 2019 (COVID-19) pneumonia in 62 patients in Wuhan, China // Am. J. Roentgenol. 2020. Vol. 215. Р. 1–8. doi: 10.2214/AJR.20.22975.

11. Hosseiny M., Kooraki S. et al. Radiology perspective of Coronavirus disease 2019 (COVID-19): lessons from severe acute respiratory syndrome and Middle East respiratory syndrome // Am. J. Roetgenol. 2020. Vol. 214, No. 5. Р. 1078–1082. doi: 10.2214/AJR.20.22969.

12. Huang L, Crothers K. HIV-associated opportunistic pneumonias // Respirology. 2009. Vol. 14, No. 4. Р. 474–485. doi: 10.1111/j.1440-1843.2009.01534.x.

13. Xu X., Yu C., Qu J. Imaging and clinical features of patients with 2019 novel coronavirus SARS-CoV-2 // Eur. J. Nucl. Mol. Imaging. 2020. Vol.47, No. 5. Р. 1275–1280. doi: 10.1007/s00259-020-04735-9.

14. Averyanov A.V., Sotnikova A.G. et al. Pneumocystis pneumonia mimicking COVID19 // Сlinical practice, 2020, Vol. 11, Nо. 2, рр. 87–92 (In Russ). doi: 10.17816/clinpract34995

15. Kelly S., Waters L et al. Pneumocystis pneumonia, a COVID-19 mimic, reminds us of the importance of HIV testing in COVID19 // Clin. Med. J. R. Coll Physicians Lond. 2020. Nov; Vol. 20, No. 6. Р. 590–592. doi: 10.7861/clinmed.2020-0565.

16. Moyano G.A.B., Ramos М.L. SARS-CoV-2 or Pnuemocystis jirovecii? A case report // Med. Intensiva 2020. doi: 10.1016/j.medin.2020.07.007.

17. Guo W., Wang M. et al. The diagnostic trap occurred in two COVID-19 cases combined Pneumocystis pneumonia in patient with AIDS // Free PMC article. doi: 10.21203/rs.3.rs-53350/v1.

18. Ovsyannikov N.V., Bilevich O.A., Pyannikova V.A. Clinical outcomes of COVID-19 among people living with the human immunodeficiency virus. Bulletin of Modern Clinical Medicine, 2022, Vol.15, No. 5, рр. 116–121 (In Russ). doi: 10.20969/VSKM.2022.15(5).116-121.

19. Chernozemova E.A., Makeeva N.V., Arkhipova L.I. et al. Features of the clinical course of COVID-19 in people living with HIV. Journal of Infectology, 2023, Vol. 15, No. 2, рр. 114–122 (In Russ). doi: 10.22625/2072-6732-2023-15-2-114-122.

20. Eremushkina Ya.M., Kuskova T.K., Filippov P.G. et al. Features of the course of COVID-19 and HIV co-infection. Doctor, 2022, Vol. 33, No. 5, рр. 18–23 (In Russ). doi: 10.29296/25877305-2022-05-04.

21. Vizcarra P., Perez-Elias M.J., Quereda C. et al. Description of COVID-19 in HIV-infected individuals: a single centre, prospective cohort // Lancet HIV. 2020. doi: 10.1016/S2352-3018(20)30164-8.

22. Long D.R., Gombar S., Hogan C.A. et al. Occurrence and Timing of Subsequent SARS-CoV-2 RT-PCR Positivity Among Initially Negative Patients. Free PMC article 2020. doi: 10.1093/cid/ciaa722.

23. Choy C.Y., Wong C.S. It’s not all about COVID-19: pneumocystis pneumonia in the era of a respiratory outbreak // Journal of the International AIDS Society. 2020. doi: 10.1002/jia2.25533.

24. Rubiano C., Tompkins K. et al. Pneumocystis and severe acute respiratory syndrome coronavirus 2 coinfection: a case report and review of an emerging diagnostic dilemma // Open Forum Infect Diseases. 2021. doi: 10.1093/ofid/ofaa633.

25. Coleman H., Snell L.B. et al. COVID-19 and Pneumocystis jirovecii pneumonia: a diagnostic dilemma in HIV // AIDS. 2020. Vol. 34, No. 8. Р.1258–1260. doi: 10.1097/QAD.0000000000002571.

26.