A Multicenter Case-control Study of the Effect of Acute Rejection and Cytomegalovirus Infection on Pneumocystis Pneumonia in Solid Organ Transplant Recipients

Hosseini-Moghaddam, Seyed M; Shokoohi, Mostafa; Singh, Gagandeep; Dufresne, Simon F.; Boucher, Anne; Jevnikar, Anthony M.; Prasad, G. V. Ramesh; Shoker, Ahmed; Kabbani, Dima; Hébert, Marie‐Josée; Cardinal, Héloïse; Houde, Isabelle; Humar, Atul; Kumar, Deepali

doi:10.1093/cid/ciy682

Cited by 51 publications

(54 citation statements)

References 34 publications

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“…This type of PCP is considered as late‐onset PCP occurring beyond complete course of 12 months prophylaxis 32 . In a recent study, we showed epidemiological transition of post‐transplant PCP to a late‐onset disease in most Canadian transplantation centers 33 . This phenomenon is likely secondary to PCP prophylaxis in initial months after transplantation.…”

Section: Discussionmentioning

confidence: 93%

Long‐lasting cluster of nosocomial pneumonia with a single Pneumocystis jirovecii genotype involving different organ allograft recipients

Hosseini-Moghaddam

Dufresne

Gutierrez

et al. 2020

Clinical Transplantation

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Pneumocystis pneumonia (PCP) outbreaks may occur in solid organ transplant (SOT) patients. Transmissibility of Pneumocystis jirovecii among SOT and non-SOT patients has not been investigated. Ten SOT (ie, 4 heart, 4 kidney, 2 liver allograft recipients) and 11 non-SOT (ie, 7 HIV-infected, 3 hematologic malignancies, and 1 stem cell transplant) patients with PCP were admitted to London Health Sciences Center (LHSC) from October 2014 to August 2016. We investigated the course of illness and outcome of PCP in SOT and non-SOT patients. Post-transplant PCP was frequently an acute-onset disease (90% vs. 18.2%, p = .01) requiring ICU admission (70% vs. 20%, p = .03) and hemodialysis (60% vs. 0, p = .003). Mortality was more frequent in SOT patients (40% vs. 18.1%, p = .36). Multilocus sequence typing (MLST) demonstrated circulation of a single genotype of P. jirovecii among SOT patients. However, 8 different genotypes were detected from non-SOT patients. Reinstitution of prophylaxis successfully controlled post-transplant cluster until end of observation period in October 2019. No transmission was detected from non-SOT patients to SOT recipients. Detection of a single P. jirovecii genotype from all SOT recipients highlights the likelihood of nosocomial transmission. No source control method is recommended by current guidelines. Improvement of preventive strategies is required.

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Section: Discussionmentioning

confidence: 93%

Long‐lasting cluster of nosocomial pneumonia with a single Pneumocystis jirovecii genotype involving different organ allograft recipients

Hosseini-Moghaddam

Dufresne

Gutierrez

et al. 2020

Clinical Transplantation

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“…Additional risk factors for infection can be more challenging to implement as part of prophylaxis protocol but are nonetheless important. These include older age, CMV infection, lymphopenia (especially absolute lymphocyte count <500), prolonged neutropenia, low CD4+ count, multiple episodes of rejection, and receipt of rituximab [21,26,[28][29][30][31][32][33]. Newer data suggest considering PJP prophylaxis in patients with active CMV viremia/disease [34][35][36].…”

Section: Epidemiology and Prevention (Tables 1 And 2)mentioning

confidence: 99%

Pneumocystis jiroveci in Transplant: Recognizing Risk, Understanding Prevention, and Implementing Treatment

Shoham

Dioverti

2020

Emerging Transplant Infections

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“…CMV infection, directly and indirectly, increases the risk of Pneumocystis jirovecii pneumonia (PJP). The association between CMV infection and post-transplant PJP is biologically plausible considering the immunomodulatory effect of this viral infection [5]. Gram-negative bacilli, particularly Pseudomonas aeruginosae, continue to cause most early (< 1 month) infections [6].…”

Section: Introductionmentioning

confidence: 99%

Cytomegalovirus associated severe pneumonia in three liver transplant recipients

Kose

Yalçınsoy

Şamdancı

et al. 2020

J Infect Dev Ctries

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Introduction: Cytomegalovirus (CMV), is the most common opportunistic infection, remains a cause of life-threatening disease and allograft rejection in liver transplant (LT) recipients. The purpose of this case series is to state that CMV may lead to severe pneumonia along with other bacteria. Methodology: CMV pneumonia was diagnosed with the thoracic computed tomography (CT) scan findings, bronchoscopic biopsy, real time quantitative Polymerase Chain Reaction (qPCR) and clinical symptoms. For extraction of CMV DNA from the clinical sample, EZ1 Virus Mini Kit v2.0 (Qiagen, Germany) was used, and aplification was performed with CMV QS-RGQ Kit (Qiagen, Germany) on Rotor Gene Q 5 Plex HMR (Qiagen, Germany) device. Results: All recipients had severe pneumonia, leukopenia, thrombocytopenia and at least two-fold increase in transaminases on seventh, twenty-eighth and twenty-second days after surgery, respectively. Thoracic CT scan revealed as diffuse interstitial infiltration in the lung parenchyma. Bronchoscopy, Gram-staining and culture from bronchoalveolar lavage (BAL) fluid were performed in all of them. During bronchoscopy, a bronchial biopsy was administered to two recipients. One recipient could not be performed procedure because of deep thrombocytopenia. PCR results were positive from serum and BAL fluid. Bronchial biopsy was compatible with CMV pneumonia. However, Pseudomonas aeruginosae was found in two cases and Klebsiella pneumoniae in one case BAL fluid cultures. Conclusions: CMV pneumonia can be seen simultaneously with bacterial agents due to the indirect effects of the CMV. It should be kept in mind that CMV pneumonia may cause severe clinical courses and can be mortal.

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A Multicenter Case-control Study of the Effect of Acute Rejection and Cytomegalovirus Infection on Pneumocystis Pneumonia in Solid Organ Transplant Recipients

Cited by 51 publications

References 34 publications

Long‐lasting cluster of nosocomial pneumonia with a single Pneumocystis jirovecii genotype involving different organ allograft recipients

Long‐lasting cluster of nosocomial pneumonia with a single Pneumocystis jirovecii genotype involving different organ allograft recipients

Pneumocystis jiroveci in Transplant: Recognizing Risk, Understanding Prevention, and Implementing Treatment

Cytomegalovirus associated severe pneumonia in three liver transplant recipients

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