Table 2.
Patients | 1 | 2 | 3 | 4 | 5 | 6 | Median [IQR] or No. (%) | |
---|---|---|---|---|---|---|---|---|
Demographics | Age, y | 84 | 49 | 58 | 61 | 69 | 66 | 63.5 [58–69] |
… | Sex | Female | Female | Male | Female | Male | Male | 3/6 (50) female |
… | Mortality at hospital dischargea | Living | Deceased | Living | Living | Living | Living | 1/6 (16.7) deceased |
COVID-19 | Risk factors at PCP diagnosis | HTN, CAD, asthma, IgM deficiency | DM2, HTN, CAD, obese, S/P SOT (tacrolimus, corticosteroids, mycophenolate) | MM II, S/P ASCT long-term corticosteroids | CKD, DLBL IV | Obese, methotrexate for RA | HTN | 5/6 (83.3) had PCP risk factors before COVID-19 |
… | Treatment | Remdesivir, dexamethasone | Remdesivir, dexamethasone | Remdesivir, dexamethasone, bamlanivimab-etesevimab | Dexamethasone, baricitinib, casirivimab- imdevimab | Remdesivir, CP, dexamethasone | Remdesivir, dexamethasone | … |
… | Prednisone-equivalent steroid administration,b mg | 400 | 660 + 5 daily for SOT | 240 + 130 weekly for MM/ASCT | 1310 | 400 | 930 | 530 [400–930] |
Pneumocystis | Status | Probable | Probable | Probable | Probable | Probable | Probable | 6/6 (100) |
… | Diagnosis method | BAL PCR, β−D-Glucan | β−D-Glucan, LDH, clinical picture | BAL PCR, β−D-Glucan | BAL PCR, β−D-Glucan | Sputum PCR, clinical picture | BAL PCR, β−D-Glucan | … |
… | Risk factors at PCP diagnosis | Corticosteroids | Immune compromised, corticosteroids | Immune compromised, corticosteroids, | Immune compromised, corticosteroids | Immune compromised, corticosteroids | Corticosteroids | 6/6 (100) corticosteroids |
… | Treatment | TMP-SMX, then atovaquone | TMP-SMX | TMP-SMX, then atovaquone, prednisone | TMP-SMX, prednisone | TMP-SMX, then atovaquone | TMP-SMX, then atovaquone, prednisone | … |
… | Time of PCP diagnosis, d from COVID-19 diagnosis | 39 | 19 | 58 | 199 | 16 | 43 | 41 [19–58] |
Laboratory findings | β−D-Glucan [<80], pg/mL | 191 | 137 | >500 | >500 | 31 | 292 | 241.5 [137–>500] |
… | LDH [91–180], units/L | 303 | 536 | 204 | 320 | 398 | 428 | 359 [303–428] |
… | ALC [1.0–4.8], K/mm3 | … | 0.54 | 1.56 | 0.61 | 0.64 | 0.97 | 0.64 [0.58–1.27] |
… | CD4 count [>200], cells/mm3 | 34 | … | 243 | 382 | 56 | … | 200 [56–382] |
… | Lowest PaO2, mmHg | 78 | 45 | 72 | 52 | 58 | 45 | 55 [45–72] |
Imagining findings | CT chest | Bilateral infiltrates and diffuse ground glass opacitiesc | Bilateral nodules and diffuse ground glass opacities | Diffuse ground glass opacities with new, focal nodular opacities | Diffuse ground glass opacities | New peripheral infiltrates | Diffuse ground glass opacities and prominent mediastinal lymph nodes | … |
Hospital stay | ICU stay | Yes | Yes | No | Yes | Yes | No | 4/6 (66.7) ICU admission |
… | ICU days | 10 | 13 | N/A | 27 | 7 | N/A | 10 [4.5–20] |
… | Mechanical ventilation | Yes | Yes | No | Yes | No | No | 3/6 (50) MV |
Roman numerals indicate stage of malignancy.
Abbreviations: ALC, absolute lymphocyte count; ASCT, autologous hematopoietic stem cell transplant; BAL, bronchoalveolar lavage; CAD, coronary artery disease; CKD, chronic kidney disease; CP, convalescent plasma; CT, computed tomography; DLBL, diffuse large B-cell lymphoma; DM2, type 2 diabetes mellitus; HM, hematogenic malignancy; HSCT, nonautologous hematopoietic stem cell transplant; HTN, hypertension; ICU, intensive care unit; IgM, immunoglobulin M; IQR, interquartile range; LDH, lactate dehydrogenase; MDS, myelodysplastic syndrome; MM, multiple myeloma; PaO2, partial pressure of arterial oxygen; PCP, Pneumocystis jirovecii pneumonia; PCR, polymerase chain reaction; RA, rheumatoid arthritis; S/P, status post; SOT, solid organ transplant; TMP-SMX, trimethoprim-sulfamethoxazole.
From hospitalization with PCP diagnosis.
Prednisone-equivalent dosing from time of COVID-19 diagnosis until PCP diagnosis. Daily or weekly administration of steroids for existing conditions is in addition to administration during hospital admittance for at least 6 months before hospitalization.
Imaging findings at time of diagnosis only available on PA and lateral chest x-ray, but improving and comparable findings were found on CT chest at 1-month follow up.