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Trubiano JA, Chen S, Slavin MA. An Approach to a Pulmonary Infiltrate in Solid Organ Transplant Recipients. CURRENT FUNGAL INFECTION REPORTS 2015; 9:144-154. [PMID: 32218881 PMCID: PMC7091299 DOI: 10.1007/s12281-015-0229-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
The onset of a pulmonary infiltrate in a solid organ transplant (SOT) recipient is both a challenging diagnostic and therapeutic challenge. We outline the potential aetiologies of a pulmonary infiltrate in a SOT recipient, with particular attention paid to fungal pathogens. A diagnostic and empirical therapy approach to a pulmonary infiltrate, especially invasive fungal disease (IFD) in SOT recipients, is provided.
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Affiliation(s)
- Jason A. Trubiano
- Infectious Diseases, Peter MacCallum Cancer Centre, East Melbourne, VIC Australia
- Infectious Diseases, Austin Health, Melbourne, VIC Australia
- Peter MacCallum Cancer Centre, 2 St Andrews Place, East Melbourne, VIC 3002 Australia
| | - Sharon Chen
- Centre for Infectious Diseases and Microbiology Laboratory Services, ICPMR-Pathology West, Westmead Hospital, Sydney, Australia
| | - Monica A. Slavin
- Infectious Diseases, Peter MacCallum Cancer Centre, East Melbourne, VIC Australia
- Infectious Diseases, Royal Melbourne Hospital, Melbourne, VIC Australia
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Could Histoplasma capsulatum Be Related to Healthcare-Associated Infections? BIOMED RESEARCH INTERNATIONAL 2015; 2015:982429. [PMID: 26106622 PMCID: PMC4461736 DOI: 10.1155/2015/982429] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Revised: 05/12/2015] [Accepted: 05/12/2015] [Indexed: 02/07/2023]
Abstract
Healthcare-associated infections (HAI) are described in diverse settings. The main etiologic agents of HAI are bacteria (85%) and fungi (13%). Some factors increase the risk for HAI, particularly the use of medical devices; patients with severe cuts, wounds, and burns; stays in the intensive care unit, surgery, and hospital reconstruction works. Several fungal HAI are caused by Candida spp., usually from an endogenous source; however, cross-transmission via the hands of healthcare workers or contaminated devices can occur. Although other medically important fungi, such as Blastomyces dermatitidis, Paracoccidioides brasiliensis, and Histoplasma capsulatum, have never been considered nosocomial pathogens, there are some factors that point out the pros and cons for this possibility. Among these fungi, H. capsulatum infection has been linked to different medical devices and surgery implants. The filamentous form of H. capsulatum may be present in hospital settings, as this fungus adapts to different types of climates and has great dispersion ability. Although conventional pathogen identification techniques have never identified H. capsulatum in the hospital environment, molecular biology procedures could be useful in this setting. More research on H. capsulatum as a HAI etiologic agent is needed, since it causes a severe and often fatal disease in immunocompromised patients.
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Gits-Muselli M, Peraldi MN, de Castro N, Delcey V, Menotti J, Guigue N, Hamane S, Raffoux E, Bergeron A, Valade S, Molina JM, Bretagne S, Alanio A. New Short Tandem Repeat-Based Molecular Typing Method for Pneumocystis jirovecii Reveals Intrahospital Transmission between Patients from Different Wards. PLoS One 2015; 10:e0125763. [PMID: 25933203 PMCID: PMC4416908 DOI: 10.1371/journal.pone.0125763] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Accepted: 03/26/2015] [Indexed: 12/26/2022] Open
Abstract
Pneumocystis pneumonia is a severe opportunistic infection in immunocompromised patients caused by the unusual fungus Pneumocystis jirovecii. Transmission is airborne, with both immunocompromised and immunocompetent individuals acting as a reservoir for the fungus. Numerous reports of outbreaks in renal transplant units demonstrate the need for valid genotyping methods to detect transmission of a given genotype. Here, we developed a short tandem repeat (STR)-based molecular typing method for P. jirovecii. We analyzed the P. jirovecii genome and selected six genomic STR markers located on different contigs of the genome. We then tested these markers in 106 P. jirovecii PCR-positive respiratory samples collected between October 2010 and November 2013 from 91 patients with various underlying medical conditions. Unique (one allele per marker) and multiple (more than one allele per marker) genotypes were observed in 34 (32%) and 72 (68%) samples, respectively. A genotype could be assigned to 55 samples (54 patients) and 61 different genotypes were identified in total with a discriminatory power of 0.992. Analysis of the allelic distribution of the six markers and minimum spanning tree analysis of the 61 genotypes identified a specific genotype (Gt21) in our hospital, which may have been transmitted between 10 patients including six renal transplant recipients. Our STR-based molecular typing method is a quick, cheap and reliable approach to genotype Pneumocystis jirovecii in hospital settings and is sensitive enough to detect minor genotypes, thus enabling the study of the transmission and pathophysiology of Pneumocystis pneumonia.
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Affiliation(s)
- Maud Gits-Muselli
- Laboratoire de Parasitologie-Mycologie, AP-HP, Groupe Hospitalier Saint-Louis-Lariboisière-Fernand-Widal, Paris, France
| | - Marie-Noelle Peraldi
- Service de transplantation rénale, AP-HP, Groupe Hospitalier Saint-Louis-Lariboisière-Fernand-Widal, Paris, France
- Université Paris-Diderot, Sorbonne Cité, Paris, France
| | - Nathalie de Castro
- Service de Maladie Infectieuses et tropicales, AP-HP, Groupe Hospitalier Saint-Louis-Lariboisière-Fernand-Widal, Paris, France
| | - Véronique Delcey
- Service de Médecine interne, AP-HP, Groupe Hospitalier Saint-Louis-Lariboisière-Fernand-Widal, Hôpital Lariboisière, Paris, France
| | - Jean Menotti
- Laboratoire de Parasitologie-Mycologie, AP-HP, Groupe Hospitalier Saint-Louis-Lariboisière-Fernand-Widal, Paris, France
- Université Paris-Diderot, Sorbonne Cité, Paris, France
- Institut Pasteur, Unité de Mycologie Moléculaire, Centre National de Référence Mycoses invasives et Antifongiques, Paris, France
- CNRS URA3012, Paris, France
| | - Nicolas Guigue
- Laboratoire de Parasitologie-Mycologie, AP-HP, Groupe Hospitalier Saint-Louis-Lariboisière-Fernand-Widal, Paris, France
- Université Paris-Diderot, Sorbonne Cité, Paris, France
| | - Samia Hamane
- Laboratoire de Parasitologie-Mycologie, AP-HP, Groupe Hospitalier Saint-Louis-Lariboisière-Fernand-Widal, Paris, France
| | - Emmanuel Raffoux
- Service d’Hématologie adulte, AP-HP, Groupe Hospitalier Saint-Louis-Lariboisière-Fernand-Widal, Paris, France
| | - Anne Bergeron
- Université Paris-Diderot, Sorbonne Cité, Paris, France
- Service de Pneumologie, AP-HP, Groupe Hospitalier Saint-Louis-Lariboisière-Fernand-Widal, Paris, France
| | - Sandrine Valade
- Service de Réanimation, AP-HP, Groupe Hospitalier Saint-Louis-Lariboisière-Fernand-Widal, Paris, France
| | - Jean-Michel Molina
- Université Paris-Diderot, Sorbonne Cité, Paris, France
- Service de Maladie Infectieuses et tropicales, AP-HP, Groupe Hospitalier Saint-Louis-Lariboisière-Fernand-Widal, Paris, France
| | - Stéphane Bretagne
- Laboratoire de Parasitologie-Mycologie, AP-HP, Groupe Hospitalier Saint-Louis-Lariboisière-Fernand-Widal, Paris, France
- Université Paris-Diderot, Sorbonne Cité, Paris, France
- Institut Pasteur, Unité de Mycologie Moléculaire, Centre National de Référence Mycoses invasives et Antifongiques, Paris, France
- CNRS URA3012, Paris, France
| | - Alexandre Alanio
- Laboratoire de Parasitologie-Mycologie, AP-HP, Groupe Hospitalier Saint-Louis-Lariboisière-Fernand-Widal, Paris, France
- Université Paris-Diderot, Sorbonne Cité, Paris, France
- Institut Pasteur, Unité de Mycologie Moléculaire, Centre National de Référence Mycoses invasives et Antifongiques, Paris, France
- CNRS URA3012, Paris, France
- * E-mail:
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Ralph E, Reppas G, Halliday C, Krockenberger M, Malik R. Pneumocystis canis pneumonia in dogs. MICROBIOLOGY AUSTRALIA 2015. [DOI: 10.1071/ma15026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Iriart X, Challan Belval T, Fillaux J, Esposito L, Lavergne RA, Cardeau-Desangles I, Roques O, Del Bello A, Cointault O, Lavayssière L, Chauvin P, Menard S, Magnaval JF, Cassaing S, Rostaing L, Kamar N, Berry A. Risk factors of Pneumocystis pneumonia in solid organ recipients in the era of the common use of posttransplantation prophylaxis. Am J Transplant 2015; 15:190-9. [PMID: 25496195 DOI: 10.1111/ajt.12947] [Citation(s) in RCA: 100] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Revised: 07/21/2014] [Accepted: 07/22/2014] [Indexed: 01/25/2023]
Abstract
Pneumocystis pneumonia (PCP) in solid organ transplant (SOT) recipients becomes rare in the immediate posttransplantation period thanks to generalized prophylaxis. We aimed to identify the predictive factors for PCP in the era of universal prophylaxis and to propose a strategy for preventing PCP beyond the first year after transplantation. In a retrospective case-control study, 33 SOT cases with PCP diagnosed between 2004 and 2010 were matched with two controls each to identify risk factors for PCP by uni- and multivariate analysis. All the patients benefited from 6 months of posttransplantation trimethoprim-sulfamethoxazole prophylaxis. Most PCP in SOT patients occurred during the second year posttransplantation (33%). By univariate analysis, age, nonuse of tacrolimus, total and CD4 lymphocyte counts, gamma-globulin concentration and cytomegalovirus (CMV) infection appeared to be PCP risk factors. In the final multivariate analysis, age (adjusted odds ratio [OR] 3.7, 95% confidence interval [CI]: 1.3-10.4), CMV infection (OR: 5.2, 95% CI: 1.8-14.7) and total lymphocyte count (OR: 3.9, 95% CI: 1.4-10.7) were found to be independently associated with PCP. The second year posttransplantation appeared to be the new period of highest risk of PCP. Age, CMV viremia and lymphocytes were the most pertinent predictive criteria to evaluate the risk of PCP in clinical practice.
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Affiliation(s)
- X Iriart
- Department of Parasitology-Mycology, CHU Toulouse, Toulouse, France; INSERM U1043, Toulouse, France; CNRS UMR5282, Toulouse, France; Centre de Physiopathiologie de Toulouse Purpan (CPTP), UPS, Université de Toulouse, Toulouse, France
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Malasingam R, Ranganathan D, Jeyaseelan L, Ramanathan K, Jacks M, Owens J, John GT. An Audit of Dapsone-associated Methaemoglobinaemia in Renal Transplant Recipients. Nephrology (Carlton) 2014; 19:594-5. [DOI: 10.1111/nep.12291] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2014] [Indexed: 12/01/2022]
Affiliation(s)
- Roshini Malasingam
- Department of Nephrology; The Royal Brisbane and Women's Hospital; Brisbane Queensland Australia
| | | | | | - Kavitha Ramanathan
- Department of Nephrology; The Royal Brisbane and Women's Hospital; Brisbane Queensland Australia
| | - Margaret Jacks
- Department of Nephrology; The Royal Brisbane and Women's Hospital; Brisbane Queensland Australia
| | - Julie Owens
- Department of Nephrology; The Royal Brisbane and Women's Hospital; Brisbane Queensland Australia
| | - George T. John
- Department of Nephrology; The Royal Brisbane and Women's Hospital; Brisbane Queensland Australia
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Weissenbacher-Lang C, Nedorost N, Weissenböck H. Finding your way through Pneumocystis sequences in the NCBI gene database. J Eukaryot Microbiol 2014; 61:537-55. [PMID: 24966006 DOI: 10.1111/jeu.12132] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Revised: 01/16/2014] [Accepted: 04/02/2014] [Indexed: 11/30/2022]
Abstract
Pneumocystis sequences can be downloaded from GenBank for purposes as primer/probe design or phylogenetic studies. Due to changes in nomenclature and assignment, available sequences are presented with a variety of inhomogeneous information, which renders practical utilization difficult. The aim of this study was the descriptive evaluation of different parameters of 532 Pneumocystis sequences of mitochondrial and ribosomal origin downloaded from GenBank with regard to completeness and information content. Pneumocystis sequences were characterized by up to four different names. Official changes in nomenclature have only been partly implemented and the usage of the "forma specialis", a special feature of Pneumocystis, has only been established fragmentary in the database. Hints for a mitochondrial or ribosomal genomic origin could be found, but can easily be overlooked, which renders the download of wrong reference material possible. The specification of the host was either not available or variable regarding the used language and the localization of this information in the title or several subtitles, which limits their applicability in phylogenetic studies. Declaration of products and geographic origin was incomplete. The print version of this manuscript is completed by an online database which contains detailed information to every accession number included in the meta-analysis.
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Affiliation(s)
- Christiane Weissenbacher-Lang
- Institute of Pathology and Forensic Veterinary Medicine, University of Veterinary Medicine, Veterinärplatz 1, 1210, Vienna, Austria
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Chen S, Nankivell B, Firacative C, Kable K, Marriott D, MacDonald P, Meyer W, Chapman J. Hospital-acquired Pneumocystis pneumonia: a renewed concern? MICROBIOLOGY AUSTRALIA 2014. [DOI: 10.1071/ma14016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
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Outbreak of pneumocystis pneumonia in renal and liver transplant patients caused by genotypically distinct strains of Pneumocystis jirovecii. Transplantation 2013; 96:834-42. [PMID: 23903011 DOI: 10.1097/tp.0b013e3182a1618c] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND An outbreak of 29 cases of Pneumocystis jirovecii pneumonia (PCP) occurred among renal and liver transplant recipients (RTR and LTR) in the largest Danish transplantation centre between 2007 and 2010, when routine PCP prophylaxis was not used. METHODS P. jirovecii isolates from 22 transplant cases, 2 colonized RTRs, and 19 Pneumocystis control samples were genotyped by restriction fragment length polymorphism and multilocus sequence typing analysis. Contact tracing was used to investigate transmission. Potential risk factors were compared between PCP cases and matched non-PCP transplant patients. RESULTS Three unique Pneumocystis genotypes were shared among 19 of the RTRs, LTRs, and a colonized RTR in three distinct clusters, two of which overlapped temporally. In contrast, Pneumocystis control samples harbored a wide range of genotypes. Evidence of possible nosocomial transmission was observed. Among several potential risk factors, only cytomegalovirus viremia was consistently associated with PCP (P=0.03; P=0.009). Mycophenolate mofetil was associated with PCP risk only in the RTR population (P=0.04). CONCLUSION We identified three large groups infected with unique strains of Pneumocystis and provide evidence of an outbreak profile and nosocomial transmission. LTRs may be infected in PCP outbreaks simultaneously with RTRs and by the same strains, most likely by interhuman transmission. Patients are at risk several years after transplantation, but the risk is highest during the first 6 months after transplantation. Because patients at risk cannot be identified clinically and outbreaks cannot be predicted, 6 months of PCP chemoprophylaxis should be considered for all RTRs and LTRs.
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Prevalence and genotype distribution of Pneumocystis jirovecii in Cuban infants and toddlers with whooping cough. J Clin Microbiol 2013; 52:45-51. [PMID: 24131683 DOI: 10.1128/jcm.02381-13] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
This study describes the prevalence and genotype distribution of Pneumocystis jirovecii obtained from nasopharyngeal (NP) swabs from immunocompetent Cuban infants and toddlers with whooping cough (WC). A total of 163 NP swabs from 163 young Cuban children with WC who were admitted to the respiratory care units at two pediatric centers were studied. The prevalence of the organism was determined by a quantitative PCR (qPCR) assay targeting the P. jirovecii mitochondrial large subunit (mtLSU) rRNA gene. Genotypes were identified by direct sequencing of mtLSU ribosomal DNA (rDNA) and restriction fragment length polymorphism (RFLP) analysis of the dihydropteroate synthase (DHPS) gene amplicons. qPCR detected P. jirovecii DNA in 48/163 (29.4%) samples. mtLSU rDNA sequence analysis revealed the presence of three different genotypes in the population. Genotype 2 was most common (48%), followed in prevalence by genotypes 1 (23%) and 3 (19%); mixed-genotype infections were seen in 10% of the cases. RFLP analysis of DHPS PCR products revealed four genotypes, 18% of which were associated with resistance to sulfa drugs. Only contact with coughers (prevalence ratio [PR], 3.51 [95% confidence interval {CI}, 1.79 to 6.87]; P = 0.000) and exposure to tobacco smoke (PR, 1.82 [95% CI, 1.14 to 2.92]; P = 0.009) were statistically associated with being colonized by P. jirovecii. The prevalence of P. jirovecii in infants and toddlers with WC and the genotyping results provide evidence that this population represents a potential reservoir and transmission source of P. jirovecii.
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Post-transplant Pneumocystis jirovecii pneumonia—a re-emerged public health problem? Kidney Int 2013; 84:240-3. [DOI: 10.1038/ki.2013.212] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2012] [Revised: 02/26/2013] [Accepted: 03/07/2013] [Indexed: 11/09/2022]
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Nankivell BJ, Firacative C, Kable K, Chen SCA, Meyer W. Molecular Epidemiology Linking Multihospital Clusters of Opportunistic Pneumocystis jirovecii Pneumonia. Clin Infect Dis 2013; 57:1058-9. [DOI: 10.1093/cid/cit413] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Multilocus sequence typing of Pneumocystis jirovecii from clinical samples: how many and which loci should be used? J Clin Microbiol 2013; 51:2843-9. [PMID: 23784120 DOI: 10.1128/jcm.01073-13] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Pneumocystis jirovecii pneumonia (PCP) is an opportunistic infection with airborne transmission and remains a major cause of respiratory illness among immunocompromised individuals. In recent years, several outbreaks of PCP, occurring mostly in kidney transplant recipients, have been reported. Currently, multilocus sequence typing (MLST) performed on clinical samples is considered to be the gold standard for epidemiological investigations of nosocomial clusters of PCP. However, until now, no MLST consensus scheme has emerged. The aim of this study was to evaluate the discriminatory power of eight distinct loci previously used for the molecular typing of P. jirovecii (internal transcribed spacer 1 [ITS1], cytochrome b [CYB], mitochondrial rRNA gene [mt26S], large subunit of the rRNA gene [26S], superoxide dismutase [SOD], β-tubulin [β-TUB], dihydropteroate synthase [DHPS], and dihydrofolate reductase [DHFR]) using a cohort of 33 epidemiologically unrelated patients having respiratory samples that were positive for P. jirovecii and who were admitted to our hospital between 2006 and 2011. Our results highlight that the choice of loci for MLST is crucial, as the discriminatory power of the method was highly variable from locus to locus. In all, the eight-locus-based scheme we used displayed a high discriminatory power (Hunter [H] index, 0.996). Based on our findings, a simple and alternative MLST scheme relying on three loci only (mt26S, CYB, and SOD) provides enough discriminatory power (H-index, 0.987) to be used for preliminary investigations of nosocomial clusters of PCP.
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Fritzsche C, Riebold D, Fuehrer A, Mitzner A, Klammt S, Mueller-Hilke B, Reisinger EC. Pneumocystis jiroveciicolonization among renal transplant recipients. Nephrology (Carlton) 2013; 18:382-7. [DOI: 10.1111/nep.12054] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2013] [Indexed: 11/26/2022]
Affiliation(s)
- Carlos Fritzsche
- Division of Tropical Medicine and Infectious Diseases; Department of Medicine; University of Rostock; Rostock; Germany
| | - Diana Riebold
- Division of Tropical Medicine and Infectious Diseases; Department of Medicine; University of Rostock; Rostock; Germany
| | - Andreas Fuehrer
- Division of Nephrology; Department of Medicine; University of Rostock; Rostock; Germany
| | - Andrea Mitzner
- Division of Nephrology; Department of Medicine; University of Rostock; Rostock; Germany
| | - Sebastian Klammt
- Division of Tropical Medicine and Infectious Diseases; Department of Medicine; University of Rostock; Rostock; Germany
| | | | - Emil C Reisinger
- Division of Tropical Medicine and Infectious Diseases; Department of Medicine; University of Rostock; Rostock; Germany
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Abstract
OBJECTIVES Patients with inflammatory bowel disease (IBD) may be at increased risk for pneumocystis jiroveci pneumonia (PCP). Our aims were (1) to determine the incidence and relative risk of PCP in IBD and (2) to describe medication exposures in patients with IBD with PCP. METHODS We performed a retrospective cohort study and a case series using administrative data from IMS Health Inc, LifeLink Health Plan Claims Database. In the cohort, patients with IBD were matched to 4 individuals with no IBD claims. PCP risk was evaluated by incidence rate ratio and adjusted Cox proportional hazards modeling. The demographics and medication histories of the 38 cases of PCP in patients with IBD were extracted. RESULTS The cohort included 50,932 patients with Crohn's disease, 56,403 patients with ulcerative colitis, and 1269 patients with unspecified IBD; matched to 434,416 individuals without IBD. The crude incidence of PCP was higher in the IBD cohort (10.6/100,000) than in the non-IBD cohort (3.0/100,000). In the adjusted analyses, PCP risk was higher in the IBD versus non-IBD cohort (hazard ratio, 2.96; 95% confidence interval, 1.75-4.29), with the greatest risk in Crohn's disease compared with non-IBD (hazard ratio, 4.01; 95% confidence interval, 1.88-8.56). In the IBD case series of PCP cases (n = 38), the median age was 49 (interquartile range, 43-57). A total of 20 individuals (53%) were on corticosteroids alone or in combination with other immunosuppression. CONCLUSIONS Although the overall incidence of PCP is low, patients with IBD are at increased risk. Patients with IBD with PCP are predominantly on corticosteroids alone or in combination before PCP diagnosis.
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Maini R, Henderson KL, Sheridan EA, Lamagni T, Nichols G, Delpech V, Phin N. Increasing Pneumocystis pneumonia, England, UK, 2000-2010. Emerg Infect Dis 2013; 19:386-92. [PMID: 23622345 PMCID: PMC3647665 DOI: 10.3201/eid1903.121151] [Citation(s) in RCA: 119] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
After an increase in the number of reported cases of Pneumocystis jirovecii pneumonia in England, we investigated data from 2000-2010 to verify the increase. We analyzed national databases for microbiological and clinical diagnoses of P. jirovecii pneumonia and associated deaths. We found that laboratory-confirmed cases in England had increased an average of 7% per year and that death certifications and hospital admissions also increased. Hospital admissions indicated increased P. jirovecii pneumonia diagnoses among patients not infected with HIV, particularly among those who had received a transplant or had a hematologic malignancy. A new risk was identified: preexisting lung disease. Infection rates among HIV-positive adults decreased. The results confirm that diagnoses of potentially preventable P. jirovecii pneumonia among persons outside the known risk group of persons with HIV infection have increased. This finding warrants further characterization of risk groups and a review of P. jirovecii pneumonia prevention strategies.
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Mori S, Sugimoto M. Pneumocystis jirovecii infection: an emerging threat to patients with rheumatoid arthritis. Rheumatology (Oxford) 2012; 51:2120-30. [PMID: 23001613 PMCID: PMC3510430 DOI: 10.1093/rheumatology/kes244] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2012] [Revised: 07/31/2012] [Indexed: 01/15/2023] Open
Abstract
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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Affiliation(s)
- Shunsuke Mori
- Department of Rheumatology, Clinical Research Center for Rheumatic Disease, NHO Kumamoto Saishunsou National Hospital, 2659 Suya, Kohshi, Kumamoto 861-1196, Japan.
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Parize P, Rammaert B, Lortholary O. Emerging invasive fungal diseases in transplantation. Curr Infect Dis Rep 2012; 14:668-75. [PMID: 23065419 DOI: 10.1007/s11908-012-0296-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Invasive fungal infections continue to be a major cause of morbidity and mortality in severely immunocompromised transplant patients. Although Candida spp. and Aspergillus spp. represent the majority of identified pathogens, other fungi have become increasingly prevalent among this patient population. Diagnosis and treatment of invasive fungal infections remain a challenge in transplant medicine despite recent major advances. In this review, we will emphasize emerging topics in invasive fungal infections in transplantations that occurred in 2011-2012. The current literature was reviewed to synthesize new trends in epidemiology, recent outbreaks, clinical findings, and advances in diagnostic and therapeutic resources.
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Affiliation(s)
- Perrine Parize
- Université Paris-Descartes, Sorbonne Paris Cité, Hôpital Necker-Enfants Malades, Service des Maladies Infectieuses et Tropicales, APHP, Centre d'Infectiologie Necker-Pasteur, Institut Hospitalo-Universitaire Imagine, 149, rue de Sèvres, 75743, Paris Cedex 15, France
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Brunot V, Pernin V, Chartier C, Garrigue V, Vetromile F, Szwarc I, Delmas S, Portalès P, Basset D, Mourad G. An Epidemic of Pneumocystis Jiroveci Pneumonia in a Renal Transplantation Center: Role of T-Cell Lymphopenia. Transplant Proc 2012; 44:2818-20. [DOI: 10.1016/j.transproceed.2012.09.089] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Li MC, Lee NY, Lee CC, Lee HC, Chang CM, Ko WC. Pneumocystis jiroveci pneumonia in immunocompromised patients: delayed diagnosis and poor outcomes in non-HIV-infected individuals. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2012; 47:42-7. [PMID: 23063081 DOI: 10.1016/j.jmii.2012.08.024] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2012] [Revised: 07/17/2012] [Accepted: 08/24/2012] [Indexed: 01/24/2023]
Abstract
BACKGROUND Pneumocystis jiroveci pneumonia (PJP) is a life-threatening disease in immunocompromised patients. Improved knowledge about the varied characteristics and management in different populations may guide treatment. METHODS We evaluated the clinical characteristics, management, and outcomes of patients with PJP diagnosed by nested polymerase chain reaction at a medical center in southern Taiwan from 2008 to 2011. The risk factors of mortality among non-human immunodeficiency virus (HIV)-infected patients were analyzed. RESULTS During the study period, there were 43 cases of PJP, and the common underlying diseases were HIV infection (23 patients, median CD4 count: 19/μl) and malignancy. The HIV-infected patients had a younger age (36.9 ± 13.7 vs. 50.2 ± 16.2 years, p = 0.006), a lower body mass index (19.9 ± 2.3 vs. 22.0 ± 3.7 kg/m(2), p = 0.035), a longer duration of symptoms before admission (24 ± 29 vs. 7 ± 15 days, p = 0.035), and a lower pneumonia severity index (56 ± 25 vs. 99 ± 35, p < 0.001) than non-HIV-infected patients. A delay between admission and starting antimicrobial therapy for PJP (10 ± 10 days vs. 1 ± 3 days, p = 0.004) and a high crude mortality (12/20, 60% vs. 2/23, 9%, p = 0.001) were noted in non-HIV-infected patients. In the univariate analysis, the risk factors for mortality were a low lymphocyte count (p < 0.05) and shock during hospitalization (p = 0.004). CONCLUSION A delay in the initiation of antimicrobial therapy for PJP and severe pneumonia were more common in the non-HIV-infected patients and were most likely related to the poor prognosis. The utilization of sensitive diagnostic tools to facilitate early diagnosis and treatment may improve the clinical outcomes of non-HIV-infected patients with PJP.
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Affiliation(s)
- Ming-Chi Li
- Department of Internal Medicine, National Cheng Kung University, College of Medicine and Hospital, Tainan, Taiwan
| | - Nan-Yao Lee
- Department of Internal Medicine, National Cheng Kung University, College of Medicine and Hospital, Tainan, Taiwan
| | - Ching-Chi Lee
- Department of Internal Medicine, National Cheng Kung University, College of Medicine and Hospital, Tainan, Taiwan
| | - Hsin-Chun Lee
- Department of Internal Medicine, National Cheng Kung University, College of Medicine and Hospital, Tainan, Taiwan
| | - Chia-Ming Chang
- Department of Internal Medicine, National Cheng Kung University, College of Medicine and Hospital, Tainan, Taiwan
| | - Wen-Chien Ko
- Department of Internal Medicine, National Cheng Kung University, College of Medicine and Hospital, Tainan, Taiwan.
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Sassi M, Ripamonti C, Mueller NJ, Yazaki H, Kutty G, Ma L, Huber C, Gogineni E, Oka S, Goto N, Fehr T, Gianella S, Konrad R, Sing A, Kovacs JA. Outbreaks of Pneumocystis pneumonia in 2 renal transplant centers linked to a single strain of Pneumocystis: implications for transmission and virulence. Clin Infect Dis 2012; 54:1437-44. [PMID: 22431811 DOI: 10.1093/cid/cis217] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND There have been numerous reports of clustered outbreaks of Pneumocystis pneumonia (PCP) at renal transplant centers over the past 2 decades. It has been unclear whether these outbreaks were linked epidemiologically to 1 or several unique strains, which could have implications for transmission patterns or strain virulence. METHODS Restriction fragment length polymorphism (RFLP) analysis was used to compare Pneumocystis isolates from 3 outbreaks of PCP in renal transplant patients in Germany, Switzerland, and Japan, as well as nontransplant isolates from both human immunodeficiency virus (HIV)-infected and uninfected patients. RESULTS Based on RFLP analysis, a single Pneumocystis strain caused pneumonia in transplant patients in Switzerland (7 patients) and Germany (14 patients). This strain was different from the strain that caused an outbreak in transplant patients in Japan, as well as strains causing sporadic cases of PCP in nontransplant patients with or without HIV infection. CONCLUSIONS Two geographically distinct clusters of PCP in Europe were due to a single strain of Pneumocystis. This suggests either enhanced virulence of this strain in transplant patients or a common, but unidentified, source of transmission. Outbreaks of PCP can be better understood by enhanced knowledge of transmission patterns and strain variation.
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Affiliation(s)
- Monica Sassi
- Critical Care Medicine Department, National Institutes of Health Clinical Center, Bethesda, Maryland 20892-1662, USA
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Pliquett RU, Asbe-Vollkopf A, Hauser PM, Presti LL, Hunfeld KP, Berger A, Scheuermann EH, Jung O, Geiger H, Hauser IA. A Pneumocystis jirovecii pneumonia outbreak in a single kidney-transplant center: role of cytomegalovirus co-infection. Eur J Clin Microbiol Infect Dis 2012; 31:2429-37. [DOI: 10.1007/s10096-012-1586-x] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2012] [Accepted: 02/08/2012] [Indexed: 11/30/2022]
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