Investigation of nosocomial pneumocystis infections: usefulness of longitudinal screening of epidemic and post-epidemic pneumocystis genotypes

Nevez, Gilles; Gal, Solène Le; Noël, Natacha; Wynckel, Alain; Huguenin, A; Govic, Yohann Le; Pougnet, Laurence; Virmaux, Michèle; Toubas, D.; Bajolet, Odile

doi:10.1016/j.jhin.2017.09.015

Cited by 12 publications

(10 citation statements)

References 41 publications

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“…The actual challenge for PCP diagnosis relies on the discrimination between PCP and colonization among patients with a positive PCR result, which was the specific question addressed in the present study. Other roles of PCP PCR, for instance as a screening tool in the setting of nosocomial PCP outbreaks, could also be investigated in the future [ 20, 21 ].…”

Section: Discussionmentioning

confidence: 99%

Ability of quantitative PCR to discriminate Pneumocystis jirovecii pneumonia from colonization

Perret

Kritikos

Hauser

et al. 2020

Journal of Medical Microbiology

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Introduction. Pneumocystis jirovecii pneumonia (PCP) is a severe disease affecting immunocompromised patients. Diagnosis is difficult due to the low sensitivity of direct examination and inability to grow the pathogen in culture. Quantitative PCR in bronchoalveolar lavage fluid (BAL) has high sensitivity, but limited specificity for distinguishing PCP from colonization. Aim. To assess the performance of an in-house quantitative PCR to discriminate between PCP and colonization. Methodology. This was a single-centre retrospective study including all patients with a positive PCR result for P. jirovecii in BAL between 2009 and 2017. Irrespective of PCR results, PCP was defined as the presence of host factors and clinical/radiological criteria consistent with PCP and (i) the presence of asci at direct examination of respiratory sample or (ii) anti-PCP treatment initiated with clinical response and absence of alternative diagnosis. Colonization was considered for cases who did not receive anti-PCP therapy with a favourable outcome or an alternative diagnosis. Cases who did not meet the above mentioned criteria were classified as ‘undetermined’. Results. Seventy-one patients with positive P. jirovecii PCR were included (90 % non-HIV patients). Cases were classified as follows: 37 PCP, 22 colonization and 12 undetermined. Quantitative PCR values in BAL were significantly higher in patients with PCP versus colonization or undetermined ( P <0.0001). The cut-off of 5×10 3 copies/ml was able to discriminate PCP cases from colonization with 97 % sensitivity, 82 % specificity, 90 % positive predictive value and 95 % negative predictive value. Conclusions. Our quantitative PCR for P. jirovecii in BAL was reliable to distinguish PCP cases from colonization in this predominantly non-HIV population.

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Section: Discussionmentioning

confidence: 99%

Ability of quantitative PCR to discriminate Pneumocystis jirovecii pneumonia from colonization

Perret

Kritikos

Hauser

et al. 2020

Journal of Medical Microbiology

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“…In 2012, Le Gal and colleagues showed that both PCP patients and P. jirovecii colonized patients may be possible infectious sources of the fungus [23]. These results were confirmed by two other investigations on P. jirovecii outbreaks, one in renal transplant recipients and another in heart transplant recipients [29,32]. Interestingly, during the course of the latter outbreak, a P. jirovecii cytochrome b mutant was observed exclusively in the heart transplant recipients and not in the control patients; the mutation may provide putative resistance to atovaquone, an anti-infectious agent targeting the cytochrome b [28].…”

Section: Transmission Of Pneumocystis Jirovecii In Hospitalsmentioning

confidence: 85%

“…PCP outbreaks occurring in hospitals over the past 60 years favor the hypothesis of interindividual transmission of P. jirovecii. Between 1968 and 2019, almost 60 outbreaks were described worldwide, mainly in renal transplant recipients as well as in HIV-infected and cancer patients [22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41]. Although interindividual transmission of P. jirovecii was suggested, it remained hypothetical until 1998 due to the absence of genotyping methods.…”

Section: Transmission Of Pneumocystis Jirovecii In Hospitalsmentioning

confidence: 99%

“…The application of droplet precautions was proposed in France in the late nineties [53,54]. However, these recommendations have been poorly applied and at least 10 clusters of PCP cases occurred in France over the past two decades [23,29,30,32,33,35,40,41,55,56]. Since the exhalation of P. jirovecii by infected patients can be observed beyond 1 m distance [45,47,48], airborne precautions may be more suitable.…”

Section: Prevention Of Pneumocystis Jirovecii Transmission In Hospitalsmentioning

confidence: 99%

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Airborne Interindividual Transmission of Pneumocystis jirovecii

Pougnet¹,

Nevez²,

Gal³

2018

obm genet

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Pneumocystis pneumonia (PCP) is the most frequent AIDS-defining disease among HIVinfected individuals in developed countries, and also affects immunocompromised non-HIV patients. Experimental studies on rodent models carried out in the early eighties have shown that Pneumocystis spp. can be transmitted via the airborne route. Unfortunately, this mode of acquisition and transmission has long been overlooked by physicians because PCP in immunosuppressed patients was considered to result from reactivation of a latent endogenous infection. This hypothesis was further investigated and, at present, PCP is considered to frequently result from the de novo acquisition of the fungus. This paradigm shift is correlated with the development of highly sensitive detection techniques and molecular characterization of Pneumocystis spp. in animal models and humans. This review article describes the milestones that have been achieved on the knowledge on the airborne interindividual transmission of Pneumocystis jirovecii.

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“…However, this potential weakness of our method should not question our analysis based on major genotypes. Moreover, the method we used is suitable for examining samples with low fungal loads (Vindrios et al, 2017;Nevez et al, 2018Nevez et al, , 2020.…”

Section: Discussionmentioning

confidence: 99%

Pneumocystis jirovecii Diversity in Réunion, an Overseas French Island in Indian Ocean

Gal

Hoarau²,

Bertolotti³

et al. 2020

Front. Microbiol.

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Data on Pneumocystis jirovecii characteristics from the overseas French territories are still scarce whereas numerous data on P. jirovecii genotypes are available for metropolitan France. The main objective of the present study was to identify P. jirovecii multilocus genotypes in patients living in Réunion and to compare them with those identified using the same method in metropolitan France and in French Guiana. Archival P. jirovecii specimens from immunosuppressed patients, 16 living in Réunion (a French island of the Indian ocean), six living in French Guiana (a South-American French territory), and 24 living in Brest (Brittany, metropolitan France) were examined at the large subunit rRNA (mtLSUrRNA) genes, cytochrome b (CYB), and superoxide dismutase (SOD) genes using PCR assays and direct sequencing. A total of 23 multi-locus genotypes (MLG) were identified combining mtLSUrRNA, CYB, and SOD alleles, i.e., six in Reunionese patients, three in Guianese patients, and 15 in Brest patients. Only one MLG (mtLSU1-CYB1-SOD2) was shared by Reunionese and Guianese patients (one patient from each region) whereas none of the 22 remaining MLG were shared by the 3 patient groups. A total of eight MLG were newly identified, three in Réunion and five in Brest. These results that were obtained through a retrospective investigation of a relatively low number of P. jirovecii specimens, provides original and first data on genetic diversity of P. jirovecii in Réunion island. The results suggest that P. jirovecii organisms from Réunion present specific characteristics compared to other P. jirovecii organisms from metropolitan France and French Guiana.

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Investigation of nosocomial pneumocystis infections: usefulness of longitudinal screening of epidemic and post-epidemic pneumocystis genotypes

Cited by 12 publications

References 41 publications

Ability of quantitative PCR to discriminate Pneumocystis jirovecii pneumonia from colonization

Ability of quantitative PCR to discriminate Pneumocystis jirovecii pneumonia from colonization

Airborne Interindividual Transmission of Pneumocystis jirovecii

Pneumocystis jirovecii Diversity in Réunion, an Overseas French Island in Indian Ocean

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