Department of Nephrology, Nanjing Yimin Hospital, Nanjing, 211100, China.
National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, 200016, China.
BMC Pulm Med. 2023 Nov 21;23(1):458. doi: 10.1186/s12890-023-02764-2.
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.
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.
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.
卡氏肺孢子虫肺炎（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，这一脆弱人群中 PCP 的发病率不断上升，导致移植物丢失和死亡率增加。肾移植受者的免疫抑制是必不可少的，但会增加病毒和机会性感染的易感性，从而加大临床挑战。与此同时，由严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）引起的 2019 年冠状病毒病（COVID-19）在全球范围内造成了深远影响。肾移植受者感染 SARS-CoV-2 后往往会出现严重后果，经常需要重症监护。在这种情况下，COVID-19 和 PCP 的合并感染代表了一种复杂的临床情况，需要精确的管理策略，即在免疫抑制和免疫激活之间取得微妙的平衡。尽管已经有关于肾移植受者 COVID-19 和 PCP 管理的病例报告，但关于同时发生这些感染时如何处理的指南仍然有限。
我们遇到了 4 例同时患有 COVID-19 和 PCP 感染的肾移植受者。这些患者接受了综合治疗，包括调整维持性免疫抑制方案、抗卡氏肺孢子虫治疗、COVID-19 和其他感染的治疗以及对症和支持性治疗。经过这种多方面的治疗策略，所有这些患者都显著改善，结果良好。
我们成功地管理了 4 例同时感染 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，但 COVID-19 患者中的发病率凸显了双重感染的复杂性。我们的发现表明，个体化的免疫抑制方案，加上抗病毒和抗菌治疗，可以使此类病例的临床状况得到改善。需要进一步研究来完善风险评估和治疗策略，这将最终改善这一脆弱人群的护理。
