Molecular Evidence of Nosocomial Pneumocystis jirovecii Transmission among 16 Patients after Kidney Transplantation

Abstract

In recent years, clusters of Pneumocystis jirovecii (formerly Pneumocystis carinii) pneumonia (PCP) among immunocompromised individuals have been reported. Mostly, the source of infections was suspected to be within the clinical settings when transplant recipients and PCP patients shared hospital facilities. We report on a cluster of 16 renal transplant recipients positive for P. jirovecii. None of them received anti-Pneumocystis prophylaxis prior to P. jirovecii detection. Epidemiological studies revealed that 15 of them had received kidney transplants at a German university hospital and attended the same inpatient and outpatient clinic from January through September 2006. Multilocus sequence typing (MLST) was performed on the following genes: ITS1, ␤-tub, 26S, and mt26S. P. jirovecii DNA was available from 14 patients and showed identical MLST types among these renal transplant recipients. Surprisingly, one patient who was treated at a different nephrological center and reported no personal contact with patients from the renal transplantation cluster harbored an identical P. jirovecii MLST type. Three HIV-positive patients and one bone-marrow-transplanted hematologic malignancy patient-treated at different medical centers-were used as controls, and different MLST types were revealed. Interestingly, in three of the four previously described regions, new alleles were detected, and one new polymorphism was observed in the mt26S region. The epidemiological data and the genotyping results strongly suggest a nosocomial patient-to-patient transmission of P. jirovecii as the predominant transmission route. Therefore, strict segregation and isolation of P. jirovecii-positive/ suspected patients in clinical settings seems warranted.

Investigation of Pneumocystis jirovecii Pneumonia and Colonization in Iatrogenically Immunosuppressed and Immunocompetent Patients

“…Ancak son yıllarda mikofenolat mofetil gibi yeni anti-rejeksiyon ajanlarının kullanıma girmesiyle böbrek tx yapılan hastalarda salgınlar şeklinde PCP enfeksiyonları rapor edilmiştir 21,22 . Bizim de, böbrek tx sonrası altı ay profi laksi almasına rağmen PCP gelişen bir olgu raporumuz mevcuttur 19 .…”

Epidemiological Outbreaks of Pneumocystis jirovecii Pneumonia Are Not Limited to Kidney Transplant Recipients: Genotyping Confirms Common Source of Transmission in a Liver Transplantation Unit

“…In such health care settings, trimethoprim-sulfamethoxazole remains the drug of choice (80 to 160/400 to 800 mg orally daily or three times weekly [grade I] for at least 6 to 12 months posttransplantation [grade III]) (26). Some authors also recommend strict hospital segregation of immunocompromised individuals with PCP (patients at risk of PCP should not share a hospital room with a patient with PCP) and the systematic use of face-mask filtering to prevent airborne P. jirovecii transmission among infected patients (18). Nevertheless, clinical data to support this recommendation in practice are insufficient (27), and consequently the issue is still the subject of debate.…”

“…Nucleotide sequencing was achieved using a BigDye Terminator, version 1.1, kit (Life Technologies SAS, Saint-Aubin, France), the primers indicated above, and an ABI-3130XL genetic analyzer (Life Technologies SAS, Saint-Aubin, France). Nucleotide sequences were analyzed using CodonCode Aligner 5.1.5 software (CodonCode Corporation, Centerville, MA) (11,18). The NCBI GenBank accession numbers for the reference sequences are as follows: AF146753 for SOD, M58605 for mt26S, and AF320344 for CYB.…”

A Cluster ofPneumocystis jiroveciiInfection Among Outpatients with Rheumatoid Arthritis: Figure 1.

“…The Journal of on May 7, 2018 -Published by www.jrheum.org Downloaded from compromised individuals, some groups proposed the possible role of person-to-person transmission [4][5][6] , while others suggested it may occur but does not constitute the major route of transmission 7,8 . The members of the cluster described here regularly visited the outpatient facility in our hospital.…”