Possible Nosocomial Transmission of<i>Pneumocystis jirovecii</i>

Damiani, Céline; Choukri, F.; Gal, Solène Le; Menotti, Jean; Sarfati, Claudine; Nevez, Gilles; Derouin, Francis; Totet, Anne

doi:10.3201/eid1805.111432

Cited by 25 publications

(19 citation statements)

References 8 publications

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“…Choukri et al [77] indicated that detection rates of P. jirovecii in air samples decrease with increasing distance from hospitalized patients with PCP and thereby proposed a possible risk of direct airborne transmission of P. jirovecii from close contact with PCP patients. In each PCP patient reported in that study, P. jirovecii genotypes in surrounding air samples closely matched those in pulmonary specimens, confirming that P. jirovecii organisms in the air of hospital rooms were exhaled by PCP patients [78]. Animal models also indicate a direct airborne transmission route of Pneumocystis species among immunosuppressed mice, from immunocompetent mice to highly susceptible mice, and among healthy mice [79–81].…”

Section: Establishing the Major Route For Infection: A Common Environsupporting

confidence: 54%

Pneumocystis jirovecii infection: an emerging threat to patients with rheumatoid arthritis

Mori¹,

Sugimoto²

2012

Rheumatology

103

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Accompanying the increased use of biologic and non-biologic antirheumatic agents, patients with RA have been exposed to an increased risk of Pneumocystis jirovecii infection, which causes acute fulminant P. jirovecii pneumonia (PCP). Mortality in this population is higher than in HIV-infected individuals. Several guidelines and recommendations for HIV-infected individuals are available; however, such guidelines for RA patients remain less clear. Between 2006 and 2008 we encountered a clustering event of P. jirovecii infection among RA outpatients. Through our experience with this outbreak and a review of the recent medical literature regarding asymptomatic colonization and its clinical significance, transmission modes of infection and prophylaxis of PCP, we have learned the following lessons: PCP outbreaks among RA patients can occur through person-to-person transmission in outpatient facilities; asymptomatic carriers serve as reservoirs and sources of infection; and short-term prophylaxis for eradication of P. jirovecii is effective in controlling PCP outbreaks among RA outpatients.

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Section: Establishing the Major Route For Infection: A Common Environsupporting

confidence: 54%

Pneumocystis jirovecii infection: an emerging threat to patients with rheumatoid arthritis

Mori¹,

Sugimoto²

2012

Rheumatology

103

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“…It has been proposed that patients with inflammatory rheumatic diseases or systemic autoimmune diseases should be screened for P. jirovecii colonization and treated prior to the prescription of immunosuppressive therapy (25,26). Moreover, independently of the potential selfbenefit of co-trimoxazole treatment for patients with P. jirovecii detection, a growing number of studies have stressed the risk of colonized patients infecting other immunocompromised patients during hospital care or consultations, as recently shown in renal transplant patients (5,27) (28,29). Therefore, future strategies could also consider treatment, at least in targeted patients or hospital care units, to prevent airborne dissemination (14,30).…”

Section: Discussionmentioning

confidence: 99%

Diagnosis of Pneumocystis jirovecii Pneumonia in Immunocompromised Patients by Real-Time PCR: a 4-Year Prospective Study

et al. 2014

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Pneumocystis jirovecii pneumonia (PCP) is a life-threatening infection in immunocompromised patients. Quantitative real-time PCR (qPCR) is more sensitive than microscopic examination for the detection of P. jirovecii but also detects colonized patients. Hence, its positive predictive value (PPV) needs evaluation. In this 4-year prospective observational study, all immunocompromised patients with acute respiratory symptoms who were investigated for PCP were included, totaling 659 patients (814 bronchoalveolar lavage fluid samples). Patients with negative microscopy but positive qPCR were classified through medical chart review as having retained PCP, possible PCP, or colonization, and their clinical outcomes were compared to those of patients with microscopically proven PCP. Overall, 119 patients were included for analysis, of whom 35, 41, and 43 were classified as having retained PCP, possible PCP, and colonization, respectively. The 35 patients with retained PCP had clinical findings similar to those with microscopically proven PCP but lower fungal loads (P < 0.001) and were mainly non-HIV-infected patients (P < 0.05). Although the mean amplification threshold was higher in colonized patients, it was not possible to determine a discriminant qPCR cutoff. The PPV of qPCR in patients with negative microscopy were 29.4% and 63.8% when considering retained PCP and retained plus possible PCP, respectively. Patients with possible PCP had a higher mortality rate than patients with retained PCP or colonization (63% versus 3% and 16%, respectively); patients who died had not received co-trimoxazole. In conclusion, qPCR is a useful tool to diagnose PCP in non-HIV patients, and treatment might be better targeted through a multicomponent algorithm including both clinical/radiological parameters and qPCR results.

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“…79 Increasing evidence suggests that aerosolization of the fungus can occur from infected patients and may play a role in nosocomial transmission. 80 …”

Section: Pneumocystis Pneumoniamentioning

confidence: 99%

Update on Opportunistic Infections in the Era of Effective Antiretroviral Therapy

Zanoni¹,

Gandhi²

2014

Infectious Disease Clinics of North America

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Possible Nosocomial Transmission ofPneumocystis jirovecii

Cited by 25 publications

References 8 publications

Pneumocystis jirovecii infection: an emerging threat to patients with rheumatoid arthritis

Pneumocystis jirovecii infection: an emerging threat to patients with rheumatoid arthritis

Diagnosis of Pneumocystis jirovecii Pneumonia in Immunocompromised Patients by Real-Time PCR: a 4-Year Prospective Study

Update on Opportunistic Infections in the Era of Effective Antiretroviral Therapy

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