Sulfa or Sulfone Prophylaxis and Geographic Region Predict Mutations in the<i>Pneumocystis carinii</i>Dihydropteroate Synthase Gene

Huang, Laurence; Beard, Charles B.; Creasman, Jennifer M.; Levy, Deborah A.; Duchin, Jeffrey S.; Lee, Sherline; Pieniążek, Norman J.; Carter, Jane L.; Rı́o, Carlos del; Rimland, David; Navin, Thomas R.

doi:10.1086/315824

Cited by 140 publications

(135 citation statements)

References 30 publications

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“…Recent studies investigating mutations in the gene encoding dihydropteroate synthase have shown a correlation not only with prior sulfur prophylaxis or treatment but also with geographical location, indicating transmission either directly or through a common environmental source (3,12). In addition, in a study examining P. carinii transmission, P. carinii DNA was found in nasopharyngeal samples from the mother, doctor, and nurse caring for an HIV-negative child with P. carinii pneumonia but not in 30 control hospital staff members who did not have contact with the infected patient (37).…”

Section: Discussionmentioning

confidence: 99%

Pneumocystis carinii f. sp. hominis DNA in Immunocompetent Health Care Workers in Contact with Patients with P. carinii Pneumonia

2001

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The possible transmission of Pneumocystis carinii f. sp. hominis from patients with P. carinii pneumonia to asymptomatic health care workers (HCW), with or without occupational exposure to human immunodeficiency virus (HIV)-infected patients with P. carinii pneumonia, was examined. HCW in a specialist inpatient HIV-AIDS facility and a control group in the general medical-respiratory service in the same hospital provided induced sputum and/or nasal rinse samples, which were analyzed for the presence of P. carinii f. sp. hominis DNA by using DNA amplification (at the gene encoding the mitochondrial large subunit rRNA [mt LSU rRNA]). P. carinii f. sp. hominis DNA was detected in some HCW samples; those with the closest occupational contact were more likely to have detectable P. carinii DNA. P. carinii DNA was detected in one HCW who carried out bronchoscopy over a 2-year period. P. carinii-positive samples were genotyped by using DNA sequence variations at the internal transcribed spacer (ITS) regions of the nuclear rRNA operon, along with bronchoalveolar lavage samples from patients with P. carinii pneumonia hospitalized at the same time. Genotyping identified 31 different P. carinii f. sp. hominis ITS genotypes, 26 of which were found in the patient samples. Five of the eight ITS genotypes detected in HCW samples were not observed in the patient samples. The results suggested that HCW in close occupational contact with patients who had P. carinii pneumonia may have become colonized with P. carinii. Carriage was asymptomatic and did not result in the development of clinical disease.The fungal pathogen Pneumocystis carinii f. sp. hominis is primarily associated with pneumonia in the profoundly immunocompromised, e.g., those with human immunodeficiency virus (HIV) infection, and also in patients undergoing organ transplantation or chemotherapy for malignant disease. Recent data suggest that exposure to P. carinii f. sp. hominis is frequent and that reinfection with different isolates of P. carinii f. sp. hominis commonly occurs (14,15,17,35). Little is known about the life cycle of the fungus; the reservoir of infectious P. carinii f. sp. hominis has not yet been elucidated nor have the modes of transmission of the infection.It is now widely accepted that the P. carinii organisms that infect each mammalian species are host specific and that the infection in humans is not acquired from an animal reservoir (32, 39). Airborne acquisition of P. carinii infection has been demonstrated by using the rat model (13). The existence of airborne P. carinii organisms has been supported by the identification of P. carinii DNA in samples of airborne spores from rural environments (38), from animal facilities housing immunosuppressed rats with P. carinii pneumonia, and in hospital inpatient and outpatient rooms used for treating patients with P. carinii pneumonia (1, 2, 16, 29).P. carinii has been found in low numbers in the lungs of patients who did not have pneumonia, both HIV-infected individuals and patients who were only mildl...

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Section: Discussionmentioning

confidence: 99%

Pneumocystis carinii f. sp. hominis DNA in Immunocompetent Health Care Workers in Contact with Patients with P. carinii Pneumonia

2001

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“…Prior exposure to sulfonamide drugs has been identified as a predictor of mutant genotypes (reviewed in Totet et al, 2004). In addition the city in which a patient resides has also been identified as an independent risk factor (Huang et al, 2000;Kazanjian et al, 2000), a factor that supports the hypothesis that P. jirovecii is transmitted from infected treated patients to susceptible untreated patients, either directly or through a common envi-ronmental source. Totet and colleagues identified P. jirovecii genotypes at the DHPS locus in immunocomptetent infants with primary infection and immunosuppressed adults with PCP (Totet et al, 2004).…”

Section: Transmission Of Possible Resistant P Jirovecii Organisms Inmentioning

confidence: 99%

NosocomialPneumocystis jiroveciiinfections

et al. 2008

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Summary :Airborne transmission of Pneumocystis sp. from host to host has been demonstrated in rodent models and several observations suggest that interindividual transmission occurs in humans. Moreover, it is accepted that the Pneumocystis organisms infecting each mammalian species are host specific and that the hypothesis of an animal reservoir for Pneumocystis jirovecii (P. jirovecii), the human-specific Pneumocystis species, can be excluded. An exosaprophytic form of the fungus cannot be strictly ruled out. However, these data point toward the potential for the specific host to serve as its own reservoir and for Pneumocystis infection in humans as an anthroponosis with humans as a reservoir for P. jirovecii. This review highlights the main data on host-to-host transmission of Pneumocystis in rodent models and in humans by the airborne route and provides a rationale for considering the occurrence of nosocomial infections and measures for their prevention KEY WORDS : Pneumocystis jirovecii, nosocomial infections, genotyping.

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“…As PCR assay is infrequently applied as a diagnostic method for PCP on respiratory samples, colonised patients with P. carinii may be missed [8]. Huang et al [9] have recently reported that a high proportion of mutant genotypes of P. carinii among HIV-infected individuals in a localised region provides the evidence of person-to-person transmission of the organism either directly or through a common environmental source. Transmission of P. carinii DNA from a patient with PCP to immunocompetent contact health-care workers has also been described [10].…”

Section: Introductionmentioning

confidence: 99%

Pneumocystis carinii carriage in immunocompromised patients with and without human immunodeficiency virus infection

Takahashi¹,

Goto²,

Endo³

et al. 2002

Journal of Medical Microbiology

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Eighty-one bronchoalveolar lavage (BAL) specimens obtained from 26 HIV-infected, 45 non-HIV immunosuppressed and 10 immunocompetent patients with primary pulmonary diseases were analysed for the presence of Pneumocystis carinii by staining and by P. carinii 5S rDNA determined by PCR. P. carinii was observed by staining of BAL specimens from HIV-infected patients significantly more frequently than those from immunocompromised hosts without HIV infection (57.7% versus 20.0%, respectively). P. carinii 5S rDNA was detected by PCR assay in seven (26.9%) HIV-infected individuals, which was significantly more frequent than for four (8.9%) immunosuppressed patients without HIV infection, for whom staining was negative. None of these patients developed P. carinii pneumonia (PCP) within the follow-up period. BAL specimens from 10 immunocompetent patients with pulmonary disorders were negative for PCP by both staining and PCR assay.

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Sulfa or Sulfone Prophylaxis and Geographic Region Predict Mutations in thePneumocystis cariniiDihydropteroate Synthase Gene

Cited by 140 publications

References 30 publications

Pneumocystis carinii f. sp. hominis DNA in Immunocompetent Health Care Workers in Contact with Patients with P. carinii Pneumonia

Pneumocystis carinii f. sp. hominis DNA in Immunocompetent Health Care Workers in Contact with Patients with P. carinii Pneumonia

NosocomialPneumocystis jiroveciiinfections

Pneumocystis carinii carriage in immunocompromised patients with and without human immunodeficiency virus infection

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