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

Abstract

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.

Risk Factors for Pneumocystis jirovecii Pneumonia in Non-HIV Patients Hospitalized for COVID-19: A Case-Control Study

“…One of these elements could be the presence of the prior colonization of the respiratory tract by Pneumocystis jirovecii spores before hospitalization, or the airborne transmission from infected patients to susceptible ones, as occurred in the past with PJP outbreaks in transplantation hospital units [ 29 , 30 ]. The clustering transmission of Pneumocystis jirovecii in the hospital setting can explain why the reports of PJP cases are so heterogeneous in the literature, with some centers such as ours reporting higher numbers of cases than others, but such a hypothesis must be confirmed with ad hoc studies.…”

Trends in the Epidemiology of Pneumocystis Pneumonia in Immunocompromised Patients without HIV Infection

“…Over the past two decades, there is an increasing trend of PCP outbreaks in immunocompromised patients without HIV/AIDS, particularly in transplant recipients, as recently reviewed by Delliere et al [ 309 ]. The largest number of cases involved in PCP outbreaks was reported in France (150 cases), followed by Australia (97 cases) and the UK (58 cases) ( Figure 4 , Table S4 [ 58 , 77 , 107 , 310 , 311 , 312 , 313 , 314 , 315 , 316 , 317 , 318 , 319 , 320 , 321 , 322 , 323 , 324 , 325 , 326 , 327 , 328 , 329 , 330 , 331 , 332 , 333 , 334 , 335 , 336 , 337 , 338 , 339 , 340 , 341 , 342 , 343 ]).…”