Do COVID-19 patients admitted to the ICU require anti-Pneumocystis jirovecii prophylaxis?

  1. Alexandre Alanio
  2. Sebastian Voicu
  3. sarah Delliere
  4. Bruno Megarbane
  5. Stephane Bretagne

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Abstract

We are currently facing a frightening increase in COVID-19 patients admitted to the ICU. Aiming at screening for secondary pneumonia, we collected the data of our first twelve ICU patients who underwent bronchoalveolar lavage (BAL). Surprisingly, four were detected with Pneumocystis jirovecii (Pj) DNA and RNA, resulting in Pj prevalence of 17%. Pj is a ubiquitous ascomycetes fungus that thrives at the surface of type-I pneumocytes, specifically in human alveoli, leading to pneumocystosis in immunocompromised patients. Interestingly, none of our patients was immunocompromised per se before admission, while all presented the recognized risk factors for life-threatening COVID-19 infection. Observing such high prevalence in COVID-infected patients was unexpected. Almost all patients developed ARDS and received high-dose steroids to prevent worsening, as suggested by reports from China. In Pj-positive patients requiring steroids, prophylaxis was given to avoid the risk of pneumocystosis and increased lung inflammation that may compromise the outcome. We are strongly convinced that testing deep lung specimens for Pj in severe COVID-19 patients should be recommended and Pj-positive patients treated with steroids, and given anti-Pj prophylaxis. This message is important, given the high mortality rate of COVID-19 patients in the ICU.

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  1. ScreenIT

    SciScore for 10.1101/2020.05.18.20105296: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementIRB: Our institutional ethics committee approved the study (IDRCB, 2020-A00256-33; CPP, 11-20 20.02.04.68737).
    Consent: When possible, signed informed consent was obtained from the patients or the next of kin.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Our study limitations include the relatively small number of patients, the single-center setting, and the short study period. However, to the best of our knowledge, this is the first study evaluating the prevalence of P. jirovecii in COVID-19 patients. Because we focused on critically ill COVID-19 patients, prevalence of P. jirovecii in less severe patients remains to be determined. In conclusion, based on our findings, we advocate systematically searching for P. jirovecii in deep respiratory specimens in critically ill COVID-19 patients. We believe that this strategy may be useful in limiting enhanced inflammation due to the presence of P. jirovecii in the lung and avoiding inter-patient P. jirovecii transmission.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

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  2. Version published to 10.1101/2020.05.18.20105296v1 on medRxiv