PDF(Pubmed)
Abstract：
BACKGROUND: Pneumocystis pneumonia (PCP) is a life-threatening pulmonary fungal infection that predominantly affects immunocompromised individuals, including kidney transplant recipients. Recent years have witnessed a rising incidence of PCP in this vulnerable population, leading to graft loss and increased mortality. Immunosuppression, which is essential in transplant recipients, heightens susceptibility to viral and opportunistic infections, magnifying the clinical challenge. Concurrently, the global impact of coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has been profound. Kidney transplant recipients have faced severe outcomes when infected with SARS-CoV-2, often requiring intensive care. Co-infection with COVID-19 and PCP in this context represents a complex clinical scenario that requires precise management strategies, involving a delicate balance between immunosuppression and immune activation. Although there have been case reports on management of COVID-19 and PCP in kidney transplant recipients, guidance on how to tackle these infections when they occur concurrently remains limited.
METHODS: We have encountered four kidney transplant recipients with concurrent COVID-19 and PCP infection. These patients received comprehensive treatment that included adjustment of their maintenance immunosuppressive regimen, anti-pneumocystis therapy, treatment for COVID-19 and other infections, and symptomatic and supportive care. After this multifaceted treatment strategy, all of these patients improved significantly and had favorable outcomes.
CONCLUSIONS: We have successfully managed four kidney transplant recipients co-infected with COVID-19 and PCP. While PCP is a known complication of immunosuppressive therapy, its incidence in patients with COVID-19 highlights the complexity of dual infections. Our findings suggest that tailored immunosuppressive regimens, coupled with antiviral and antimicrobial therapies, can lead to clinical improvement in such cases. Further research is needed to refine risk assessment and therapeutic strategies, which will ultimately enhance the care of this vulnerable population.
METHODS: We have encountered four kidney transplant recipients with concurrent COVID-19 and PCP infection. These patients received comprehensive treatment that included adjustment of their maintenance immunosuppressive regimen, anti-pneumocystis therapy, treatment for COVID-19 and other infections, and symptomatic and supportive care. After this multifaceted treatment strategy, all of these patients improved significantly and had favorable outcomes.
CONCLUSIONS: We have successfully managed four kidney transplant recipients co-infected with COVID-19 and PCP. While PCP is a known complication of immunosuppressive therapy, its incidence in patients with COVID-19 highlights the complexity of dual infections. Our findings suggest that tailored immunosuppressive regimens, coupled with antiviral and antimicrobial therapies, can lead to clinical improvement in such cases. Further research is needed to refine risk assessment and therapeutic strategies, which will ultimately enhance the care of this vulnerable population.
摘要：
背景：肺孢子菌肺炎（PCP）是一种危及生命的肺部真菌感染，主要影响免疫功能低下的个体，包括肾移植受者.近年来，在这一弱势群体中，PCP的发病率不断上升，导致移植物丢失和死亡率增加。免疫抑制,这对移植接受者来说是必不可少的，增加对病毒和机会性感染的易感性，放大临床挑战。同时,2019年冠状病毒病的全球影响（COVID-19），由严重急性呼吸综合征冠状病毒2（SARS-CoV-2）引起，已经深刻了。肾移植受者在感染SARS-CoV-2时面临严重的后果，通常需要重症监护。在这种情况下，COVID-19和PCP的共感染代表了一种复杂的临床情况，需要精确的管理策略，涉及免疫抑制和免疫激活之间的微妙平衡。尽管有肾移植受者COVID-19和PCP管理的病例报告，关于如何解决这些感染同时发生时的指导仍然有限。
方法：我们遇到了4例肾移植患者并发COVID-19和PCP感染。这些患者接受综合治疗，包括调整其维持免疫抑制方案，抗肺囊虫病治疗，治疗COVID-19和其他感染，以及对症和支持性治疗。经过这种多方面的治疗策略，所有这些患者均有显著改善,且结局良好.
结论：我们已经成功地治疗了4名同时感染COVID-19和PCP的肾移植受者。虽然PCP是免疫抑制治疗的已知并发症，其在COVID-19患者中的发病率突出了双重感染的复杂性。我们的研究结果表明，定制的免疫抑制方案，加上抗病毒和抗菌治疗，在这种情况下可以导致临床改善。需要进一步的研究来完善风险评估和治疗策略，这将最终加强对这一弱势群体的照顾。
方法：我们遇到了4例肾移植患者并发COVID-19和PCP感染。这些患者接受综合治疗，包括调整其维持免疫抑制方案，抗肺囊虫病治疗，治疗COVID-19和其他感染，以及对症和支持性治疗。经过这种多方面的治疗策略，所有这些患者均有显著改善,且结局良好.
结论：我们已经成功地治疗了4名同时感染COVID-19和PCP的肾移植受者。虽然PCP是免疫抑制治疗的已知并发症，其在COVID-19患者中的发病率突出了双重感染的复杂性。我们的研究结果表明，定制的免疫抑制方案，加上抗病毒和抗菌治疗，在这种情况下可以导致临床改善。需要进一步的研究来完善风险评估和治疗策略，这将最终加强对这一弱势群体的照顾。
