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Ma L, Lin I, Hunter ST, Blasi B, Danesi P, Weissenbacher-Lang C, Cisse OH, Rothenburger JL, Kovacs JA. Development of Highly Efficient Universal Pneumocystis Primers and Their Application in Investigating the Prevalence and Genetic Diversity of Pneumocystis in Wild Hares and Rabbits. J Fungi (Basel) 2024; 10:355. [PMID: 38786710 PMCID: PMC11121927 DOI: 10.3390/jof10050355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Revised: 05/10/2024] [Accepted: 05/13/2024] [Indexed: 05/25/2024] Open
Abstract
Despite its ubiquitous infectivity to mammals with strong host specificity, our current knowledge about Pneumocystis has originated from studies of merely 4% of extant mammalian species. Further studies of Pneumocystis epidemiology across a broader range of animal species require the use of assays with high sensitivity and specificity. To this end, we have developed multiple universal Pneumocystis primers targeting different genetic loci with high amplification efficiency. Application of these primers to PCR investigation of Pneumocystis in free-living hares (Lepus townsendii, n = 130) and rabbits (Oryctolagus cuniculus, n = 8) in Canada revealed a prevalence of 81% (105/130) and 25% (2/8), respectively. Genotyping analysis identified five and two variants of Pneumocystis from hares and rabbits, respectively, with significant sequence divergence between the variants from hares. Based on phylogenetic analysis using nearly full-length sequences of the mitochondrial genome, nuclear rRNA operon and dihydropteroate synthase gene for the two most common variants, Pneumocystis in hares and rabbits are more closely related to each other than either are to Pneumocystis in other mammals. Furthermore, Pneumocystis in both hares and rabbits are more closely related to Pneumocystis in primates and dogs than to Pneumocystis in rodents. The high prevalence of Pneumocystis in hares (P. sp. 'townsendii') suggests its widespread transmissibility in the natural environment, similar to P. oryctolagi in rabbits. The presence of multiple distinct Pneumocystis populations in hares contrasts with the lack of apparent intra-species heterogeneity in P. oryctolagi, implying a unique evolution history of P. sp. 'townsendii' in hares.
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Affiliation(s)
- Liang Ma
- Critical Care Medicine Department, National Institutes of Health Clinical Center, Bethesda, MD 20892, USA; (I.L.); (O.H.C.); (J.A.K.)
| | - Isabella Lin
- Critical Care Medicine Department, National Institutes of Health Clinical Center, Bethesda, MD 20892, USA; (I.L.); (O.H.C.); (J.A.K.)
| | - Summer T. Hunter
- Faculty of Veterinary Medicine, University of Calgary, Canadian Wildlife Health Cooperative (Alberta Region), Calgary, AB T2N 1N4, Canada; (S.T.H.); (J.L.R.)
| | - Barbara Blasi
- Department of Biological Sciences and Pathobiology, Institute of Pathology, University of Veterinary Medicine Vienna, 1210 Wien, Austria; (B.B.); (C.W.-L.)
| | - Patrizia Danesi
- Laboratory of Parasitology, Mycology and Medical Enthomology, Istituto Zooprofilattico delle Venezie, 35020 Legnaro, Italy;
| | - Christiane Weissenbacher-Lang
- Department of Biological Sciences and Pathobiology, Institute of Pathology, University of Veterinary Medicine Vienna, 1210 Wien, Austria; (B.B.); (C.W.-L.)
| | - Ousmane H. Cisse
- Critical Care Medicine Department, National Institutes of Health Clinical Center, Bethesda, MD 20892, USA; (I.L.); (O.H.C.); (J.A.K.)
| | - Jamie L. Rothenburger
- Faculty of Veterinary Medicine, University of Calgary, Canadian Wildlife Health Cooperative (Alberta Region), Calgary, AB T2N 1N4, Canada; (S.T.H.); (J.L.R.)
| | - Joseph A. Kovacs
- Critical Care Medicine Department, National Institutes of Health Clinical Center, Bethesda, MD 20892, USA; (I.L.); (O.H.C.); (J.A.K.)
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Douglas AP, Stewart AG, Halliday CL, Chen SCA. Outbreaks of Fungal Infections in Hospitals: Epidemiology, Detection, and Management. J Fungi (Basel) 2023; 9:1059. [PMID: 37998865 PMCID: PMC10672668 DOI: 10.3390/jof9111059] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 10/17/2023] [Accepted: 10/26/2023] [Indexed: 11/25/2023] Open
Abstract
Nosocomial clusters of fungal infections, whilst uncommon, cannot be predicted and are associated with significant morbidity and mortality. Here, we review reports of nosocomial outbreaks of invasive fungal disease to glean insight into their epidemiology, risks for infection, methods employed in outbreak detection including genomic testing to confirm the outbreak, and approaches to clinical and infection control management. Both yeasts and filamentous fungi cause outbreaks, with each having general and specific risks. The early detection and confirmation of the outbreak are essential for diagnosis, treatment of affected patients, and termination of the outbreak. Environmental sampling, including the air in mould outbreaks, for the pathogen may be indicated. The genetic analysis of epidemiologically linked isolates is strongly recommended through a sufficiently discriminatory approach such as whole genome sequencing or a method that is acceptably discriminatory for that pathogen. An analysis of both linked isolates and epidemiologically unrelated strains is required to enable genetic similarity comparisons. The management of the outbreak encompasses input from a multi-disciplinary team with epidemiological investigation and infection control measures, including screening for additional cases, patient cohorting, and strict hygiene and cleaning procedures. Automated methods for fungal infection surveillance would greatly aid earlier outbreak detection and should be a focus of research.
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Affiliation(s)
- Abby P. Douglas
- National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, VIC 3000, Australia
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, VIC 3000, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC 3000, Australia
- Department of Infectious Diseases, Austin Health, Heidelberg, VIC 3084, Australia
| | - Adam G. Stewart
- Centre for Clinical Research, Faculty of Medicine, Royal Brisbane and Women’s Hospital Campus, The University of Queensland, Herston, QLD 4006, Australia;
| | - Catriona L. Halliday
- Centre for Infectious Diseases and Microbiology Laboratory Services, Institute of Clinical Pathology and Medical Research, New South Wales Health Pathology, Westmead Hospital, Sydney, NSW 2145, Australia; (C.L.H.); (S.C.-A.C.)
| | - Sharon C.-A. Chen
- Centre for Infectious Diseases and Microbiology Laboratory Services, Institute of Clinical Pathology and Medical Research, New South Wales Health Pathology, Westmead Hospital, Sydney, NSW 2145, Australia; (C.L.H.); (S.C.-A.C.)
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2050, Australia
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Abdulwhhab MT, Holmes CW, Mutuyimana J, Koo SSF, Wisniewska A, Auty J, Perera N, Barer MR. Exhaled Pneumocystis jirovecii output and detection of asymptomatic exhalation by facemask sampling in HIV-uninfected, immunocompromised patients. J Hosp Infect 2023; 132:20-27. [PMID: 36521583 DOI: 10.1016/j.jhin.2022.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 12/07/2022] [Accepted: 12/07/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Pneumocystis jirovecii pneumonia (PJP) transmission is poorly defined. Previous studies have sampled air of rooms occupied by HIV-infected patients with PJP, while natural and direct exhalations of HIV-uninfected subjects remain under-investigated. Here, clinical facemasks were used to examine and quantify potential P. jirovecii exhalations from HIV-uninfected patients with suspected PJP and to determine whether pathogen exhalation was definable clinically or radiologically. METHODS Forty-five patients in Leicester (England), highly suspected of having PJP based on European Conference on Infections in Leukaemia (ECIL-5) guidelines, each wore one facemask carrying a gelatine/PVA sampling matrix for 1 h while respiring normally. Mask contamination with P. jirovecii was assessed using a modified quantitative polymerase chain reaction targeting mitochondrial large subunit (MtLSU). Radiological findings on chest X-ray (CXR) and computed tomography (CT) were graded and analysed for correlation with P. jirovecii signals alongside relevant clinical and laboratory findings. RESULTS P. jirovecii was detected in seven of 20 patients diagnosed with PJP and three of 19 patients with suspected but undiagnosed PJP. The median captured signal was 8.59 × 104 MtLSU copies/mask (interquartile range (IQR) = 3.01 × 105-1.81 × 104). Blood β-D-glucan test results correlated with the mask detection data (r = 0.65; P<0.0001) but other clinical indices and radiological features did not. Five of the 10 P. jirovecii-exhalers exhibited normal CXR with a median exhalation burden 1.28 × 105 copies/mask (IQR = 1.51 × 105-2.27 × 104). Two P. jirovecii-exhalers (7.64 × 104 copies/mask) were asymptomatic. CONCLUSION P. jirovecii was exhaled sufficiently during normal respiration to be detectable in facemasks worn by HIV-uninfected patients. Neither clinical nor radiological features correlated with P. jirovecii exhalation.
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Affiliation(s)
- M T Abdulwhhab
- Department of Respiratory Sciences, University of Leicester, Leicester, UK; Leicester Tuberculosis Research Group (LTBRG), Leicester, UK.
| | - C W Holmes
- Department of Respiratory Sciences, University of Leicester, Leicester, UK; Department of Clinical Microbiology, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - J Mutuyimana
- Department of Clinical Microbiology, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - S S F Koo
- Department of Clinical Microbiology, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - A Wisniewska
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
| | - J Auty
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
| | - N Perera
- Leicester Tuberculosis Research Group (LTBRG), Leicester, UK; Department of Clinical Microbiology, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - M R Barer
- Department of Respiratory Sciences, University of Leicester, Leicester, UK; Leicester Tuberculosis Research Group (LTBRG), Leicester, UK; Department of Clinical Microbiology, University Hospitals of Leicester NHS Trust, Leicester, UK
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Xue T, Du WQ, Dai WJ, Li YS, Wang SF, Wang JL, Zhang XR. Genetic Polymorphisms of Pneumocystis jirovecii in HIV-Positive and HIV-Negative Patients in Northern China. Pol J Microbiol 2022; 71:27-34. [PMID: 35635165 PMCID: PMC9152919 DOI: 10.33073/pjm-2022-002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 12/15/2021] [Indexed: 11/25/2022] Open
Abstract
Pneumocystis jirovecii is an opportunistic fungus that can cause severe and potentially fatal Pneumocystis pneumonia (PCP) in immunodeficient patients. In this study, we investigated the genetic polymorphisms of P. jirovecii at eight different loci, including six nuclear genes (ITS, 26S rRNA, sod, dhps, dhfr and β-Tub) and two mitochondrial genes (mtLSU-rRNA and cyb) in three PCP cases, including two patients with HIV infection and one without HIV infection in Shanxi Province, P.R. China. The gene targets were amplified by PCR followed by sequencing of plasmid clones. The HIV-negative patient showed a coinfection with two genotypes of P. jirovecii at six of the eight loci sequenced. Of the two HIV-positive patients, one showed a coinfection with two genotypes of P. jirovecii at the same two of the six loci as in the HIV-negative patient, while the other showed a single infection at all eight loci sequenced. None of the three drug target genes (dhfr, dhps and cyb) showed mutations known to be potentially associated with drug resistance. This is the first report of genetic polymorphisms of P. jirovecii in PCP patients in Shanxi Province, China. Our findings expand our understanding of the genetic diversity of P. jirovecii in China. ![]()
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Affiliation(s)
- Ting Xue
- NHC Key Laboratory of Pneumoconiosis, Key Laboratory of Prophylaxis and Treatment and Basic Research of Respiratory Diseases of Shanxi Province , Department of Respiratory and Critical Care Medicine , First Affiliated Hospital of Shanxi Medical University , Taiyuan , P.R. China
| | - Wei-Qin Du
- Department of clinical inspection , Eleventh Affiliated Hospital of Shanxi Medical University , Lvliang , P.R. China
| | - Wen-Juan Dai
- NHC Key Laboratory of Pneumoconiosis, Key Laboratory of Prophylaxis and Treatment and Basic Research of Respiratory Diseases of Shanxi Province , Department of Respiratory and Critical Care Medicine , First Affiliated Hospital of Shanxi Medical University , Taiyuan , P.R. China
| | - Yi-Shan Li
- NHC Key Laboratory of Pneumoconiosis, Key Laboratory of Prophylaxis and Treatment and Basic Research of Respiratory Diseases of Shanxi Province , Department of Respiratory and Critical Care Medicine , First Affiliated Hospital of Shanxi Medical University , Taiyuan , P.R. China
| | - Shu-Feng Wang
- Department of Clinical Inspection , First Affiliated Hospital of Shanxi Medical University , Taiyuan , P.R. China
| | - Jun-Ling Wang
- Department of Translation Medicine , Jinzhou Medical University , Jinzhou , P.R. China
| | - Xin-Ri Zhang
- NHC Key Laboratory of Pneumoconiosis, Key Laboratory of Prophylaxis and Treatment and Basic Research of Respiratory Diseases of Shanxi Province , Department of Respiratory and Critical Care Medicine , First Affiliated Hospital of Shanxi Medical University , Taiyuan , P.R. China
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Ruiz-Ruiz S, Ponce CA, Pesantes N, Bustamante R, Gatti G, San Martin V, Gutierrez M, Bórquez P, Vargas SL, Magne F, Calderón EJ, Pérez-Brocal V, Moya A. A Real-Time PCR Assay for Detection of Low Pneumocystis jirovecii Levels. Front Microbiol 2022; 12:787554. [PMID: 35087490 PMCID: PMC8787145 DOI: 10.3389/fmicb.2021.787554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 12/17/2021] [Indexed: 11/13/2022] Open
Abstract
Here we report a new real-time PCR assay using SYBR Green which provides higher sensitivity for the specific detection of low levels of Pneumocystis jirovecii. To do so, two primer sets were designed, targeting the family of genes that code for the most abundant surface protein of Pneumocystis spp., namely the major surface glycoproteins (Msg), and the mitochondrial large subunit rRNA (mtLSUrRNA) multicopy gene, simultaneously detecting two regions. PCR methods are instrumental in detecting these low levels; however, current nested-PCR methods are time-consuming and complex. To validate our new real-time Msg-A/mtLSUrRNA PCR protocol, we compared it with nested-PCR based on the detection of Pneumocystis mitochondrial large subunit rRNA (mtLSUrRNA), one of the main targets used to detect this pathogen. All samples identified as positive by the nested-PCR method were found positive using our new real-time PCR protocol, which also detected P. jirovecii in three nasal aspirate samples that were negative for both rounds of nested-PCR. Furthermore, we read both rounds of the nested-PCR results for comparison and found that some samples with no PCR amplification, or with a feeble band in the first round, correlated with higher Ct values in our real-time Msg-A/mtLSUrRNA PCR. This finding demonstrates the ability of this new single-round protocol to detect low Pneumocystis levels. This new assay provides a valuable alternative for P. jirovecii detection, as it is both rapid and sensitive.
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Affiliation(s)
- Susana Ruiz-Ruiz
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO)-Salud Pública, València, Spain.,Centro de Investigación Biomédica en Red en Epidemiología y Salud Pública (CIBEResp), Instituto de Salud Carlos III, Madrid, Spain
| | - Carolina A Ponce
- Programa de Microbiología y Micología, Facultad de Medicina, Instituto de Ciencias Biomédicas, Universidad de Chile, Santiago, Chile
| | - Nicole Pesantes
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO)-Salud Pública, València, Spain.,Centro de Investigación Biomédica en Red en Epidemiología y Salud Pública (CIBEResp), Instituto de Salud Carlos III, Madrid, Spain
| | - Rebeca Bustamante
- Programa de Microbiología y Micología, Facultad de Medicina, Instituto de Ciencias Biomédicas, Universidad de Chile, Santiago, Chile
| | - Gianna Gatti
- Programa de Microbiología y Micología, Facultad de Medicina, Instituto de Ciencias Biomédicas, Universidad de Chile, Santiago, Chile
| | | | | | | | - Sergio L Vargas
- Programa de Microbiología y Micología, Facultad de Medicina, Instituto de Ciencias Biomédicas, Universidad de Chile, Santiago, Chile
| | - Fabien Magne
- Programa de Microbiología y Micología, Facultad de Medicina, Instituto de Ciencias Biomédicas, Universidad de Chile, Santiago, Chile
| | - Enrique J Calderón
- Centro de Investigación Biomédica en Red en Epidemiología y Salud Pública (CIBEResp), Instituto de Salud Carlos III, Madrid, Spain.,Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla, Consejo Superior de Investigaciones Científicas (CSIC), and Universidad de Sevilla, Seville, Spain
| | - Vicente Pérez-Brocal
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO)-Salud Pública, València, Spain.,Centro de Investigación Biomédica en Red en Epidemiología y Salud Pública (CIBEResp), Instituto de Salud Carlos III, Madrid, Spain
| | - Andrés Moya
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO)-Salud Pública, València, Spain.,Centro de Investigación Biomédica en Red en Epidemiología y Salud Pública (CIBEResp), Instituto de Salud Carlos III, Madrid, Spain.,Instituto de Biología Integrativa de Sistemas (I2Sysbio), Universitat de València and Consejo Superior de Investigaciones Científicas (CSIC), València, Spain
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Gantois N, Lesaffre A, Durand-Joly I, Bautin N, Le Rouzic O, Nseir S, Reboux G, Scherer E, Aliouat EM, Fry S, Gosset P, Fréalle E. Factors associated with Pneumocystis colonization and circulating genotypes in chronic obstructive pulmonary disease patients with acute exacerbation or at stable state and their homes. Med Mycol 2021; 60:6420247. [PMID: 34734270 DOI: 10.1093/mmy/myab070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 09/20/2021] [Accepted: 11/01/2021] [Indexed: 11/13/2022] Open
Abstract
Pneumocystis jirovecii colonization is frequent during chronic obstructive pulmonary disease (COPD) and patients constitute potential contributors to its interhuman circulation. However, the existence of an environmental reservoir cannot be excluded. We assessed the prevalence and factors associated with Pneumocystis colonization during COPD, and studied circulation between patients and their domestic environment. Pneumocystis molecular detection and mtLSU genotyping were performed in oro-pharyngeal washes (OPW) sampled in 58 patients with COPD acute exacerbation, and in indoor dust, sampled in patients' homes using electrostatic dust collectors (EDCs). Lung and systemic inflammation was assessed. Pneumocystis carriage was evaluated in 28 patients after 18 months at stable state. Pneumocystis was detected in 11/58 OPWs during exacerbation (19.0%). Colonized patients presented a significantly lower body mass index, and higher serum IL-17 and CD62P. One patient presented positive detection of typable isolates in both OPW and EDC, with both isolates harboring mtLSU genotype 3. Pneumocystis genotype 1 was further detected in EDCs from three non-colonized patients and one colonized patient with non-typable isolate. Genotypes 1 and 2 were predominant in clinical isolates (both 42%), with genotype 3 representing 16% of isolates. Pneumocystis was detected in 3/28 patients at stable state (10.7%). These data suggest that Pneumocystis colonization could be facilitated by a lower BMI and be related to acute alteration of lung function during COPD exacerbation. It also suggests Th17 pathway and platelet activation could be involved in the anti-Pneumocystis response during colonization. Last, Pneumocystis detection in EDCs supports its potential persistence in indoor dust. LAY SUMMARY Chronic obstructive pulmonary disease patients tend to be more frequently colonized by Pneumocystis during exacerbation (19.0%) than at stable state (10.7%). Factors associated with colonization include lower BMI, higher IL-17, and CD62P. Pneumocystis detection in patients' dwellings suggests potential persistence in indoor dust.
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Affiliation(s)
- Nausicaa Gantois
- Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, U1019 - UMR 9017 - CIIL - Center for Infection and Immunity of Lille, F-59000 Lille, France
| | - Aymerick Lesaffre
- Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, U1019 - UMR 9017 - CIIL - Center for Infection and Immunity of Lille, F-59000 Lille, France
| | | | - Nathalie Bautin
- CHU Lille, Clinique des Maladies Respiratoires, F-59000 Lille, France
| | - Olivier Le Rouzic
- Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, U1019 - UMR 9017 - CIIL - Center for Infection and Immunity of Lille, F-59000 Lille, France.,CHU Lille, Clinique des Maladies Respiratoires, F-59000 Lille, France
| | - Saad Nseir
- CHU Lille, Pôle de Réanimation, F-59000 Lille, France
| | - Gabriel Reboux
- Chrono-Environnement UMR 6249 CNRS, Université de Bourgogne Franche-Comté & Service de Parasitologie-Mycologie, CHU de Besançon, F-25030 Besançon, France
| | - Emeline Scherer
- Chrono-Environnement UMR 6249 CNRS, Université de Bourgogne Franche-Comté & Service de Parasitologie-Mycologie, CHU de Besançon, F-25030 Besançon, France
| | - El Moukhtar Aliouat
- Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, U1019 - UMR 9017 - CIIL - Center for Infection and Immunity of Lille, F-59000 Lille, France
| | - Stéphanie Fry
- CHU Lille, Clinique des Maladies Respiratoires, F-59000 Lille, France
| | - Philippe Gosset
- Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, U1019 - UMR 9017 - CIIL - Center for Infection and Immunity of Lille, F-59000 Lille, France
| | - Emilie Fréalle
- Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, U1019 - UMR 9017 - CIIL - Center for Infection and Immunity of Lille, F-59000 Lille, France.,CHU Lille, Laboratoire de Parasitologie-Mycologie, F-59000 Lille, France
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Ochoa TJ, Bustamante B, Garcia C, Neyra E, Mendoza K, Calderón EJ, Le Gal S, Miller RF, Ponce CA, Nevez G, Vargas SL. Pneumocystis primary infection in non-immunosuppressed infants in Lima, Peru. J Mycol Med 2021; 32:101202. [PMID: 34598108 DOI: 10.1016/j.mycmed.2021.101202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 08/25/2021] [Accepted: 09/01/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To provide original data on Pneumocystis primary infection in non-immunosuppressed infants from Peru. METHODS A cross sectional study was performed. Infants less than seven months old, without any underlying medical conditions attending the "well baby" outpatient clinic at one hospital in Lima, Peru were prospectively enrolled during a 15-month period from November 2016 to February 2018. All had a nasopharyngeal aspirate (NPA) for detection of P. jirovecii DNA using a PCR assay, regardless of respiratory symptoms. P. jirovecii DNA detection was considered to represent pulmonary colonization contemporaneous with Pneumocystis primary infection. Associations between infants' clinical and demographic characteristics and results of P. jirovecii DNA detection were analyzed. RESULTS P. jirovecii DNA was detected in 45 of 146 infants (30.8%) and detection was not associated with concurrent respiratory symptoms in 40 of 45 infants. Infants with P. jirovecii had a lower mean age when compared to infants not colonized (p <0.05). The highest frequency of P. jirovecii was observed in 2-3-month-old infants (p < 0.01) and in the cooler winter and spring seasons (p <0.01). Multivariable analysis showed that infants living in a home with ≤ 1 bedroom were more likely to be colonized; Odds Ratio =3.03 (95%CI 1.31-7.00; p = 0.01). CONCLUSION Pneumocystis primary infection in this single site in Lima, Peru, was most frequently observed in 2-3-month-old infants, in winter and spring seasons, and with higher detection rates being associated with household conditions favoring close inter-individual contacts and potential transmission of P. jirovecii.
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Affiliation(s)
- Theresa J Ochoa
- Instituto de Medicina Tropical "Alexander von Humboldt", Universidad Peruana Cayetano Heredia, Lima, Perú; School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Perú.
| | - Beatriz Bustamante
- Instituto de Medicina Tropical "Alexander von Humboldt", Universidad Peruana Cayetano Heredia, Lima, Perú; Hospital Cayetano Heredia, Lima, Perú
| | - Coralith Garcia
- Instituto de Medicina Tropical "Alexander von Humboldt", Universidad Peruana Cayetano Heredia, Lima, Perú; School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Perú; Hospital Cayetano Heredia, Lima, Perú
| | - Edgar Neyra
- School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Perú; Genomic Research Unit, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Karina Mendoza
- Instituto de Medicina Tropical "Alexander von Humboldt", Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Enrique J Calderón
- Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/Consejo Superior de Investigaciones Científicas/Universidad de Sevilla, and Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, Hospital Universitario Virgen del Rocío, Seville, Spain
| | - Solene Le Gal
- Groupe d'Étude des Interactions Hôte-Pathogène (GEIHP)-Université d'Angers, Université de Brest, Brest, France; Laboratoire de Mycologie et Parasitologie, CHRU de Brest, Brest, France
| | - Robert F Miller
- Centre for Clinical Research in Infection and Sexual Health, Institute for Global Health, University College London, London, United Kingdom; Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Carolina A Ponce
- Programa de Microbiología y Micología, Instituto de Ciencias Biomédicas (ICBM), Facultad de Medicina Universidad de Chile, Santiago, Chile
| | - Gilles Nevez
- Groupe d'Étude des Interactions Hôte-Pathogène (GEIHP)-Université d'Angers, Université de Brest, Brest, France; Laboratoire de Mycologie et Parasitologie, CHRU de Brest, Brest, France.
| | - Sergio L Vargas
- Programa de Microbiología y Micología, Instituto de Ciencias Biomédicas (ICBM), Facultad de Medicina Universidad de Chile, Santiago, Chile
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Awulachew E, Diriba K, Anja A, Wudneh F, Gemede A. Burden, mortality, and associated factors of Pneumocystis jerovesi pneumonia among human immunodeficiency virus/AIDS patients: Systematic review and meta-analysis. INDIAN JOURNAL OF HEALTH SCIENCES AND BIOMEDICAL RESEARCH (KLEU) 2021. [DOI: 10.4103/kleuhsj.kleuhsj_104_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Peterson K, Berrigan L, Popovic K, Wiebe C, Sun S, Ho J. Lifelong, universal Pneumocystis jirovecii pneumonia prophylaxis: Patient uptake and adherence after kidney transplant. Transpl Infect Dis 2020; 23:e13509. [PMID: 33171008 DOI: 10.1111/tid.13509] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 09/14/2020] [Accepted: 10/11/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Pneumocystis jirovecii pneumonia (PJP) is a significant cause of morbidity and mortality in transplant patients yet little is known about their adherence to prophylaxis. The goal of this study was to evaluate patient uptake and long-term adherence after implementing universal, lifelong PJP prophylaxis. MATERIALS AND METHODS This retrospective cohort study evaluated an adult kidney transplant program 18-months after initiating trimethoprim-sulfamethoxazole (TMP-SMX) 80/400 mg thrice-weekly following a cluster of PJP cases. The protocol incorporated multi-modal patient education and drug tolerability strategies to improve adherence, including a modified re-challenge strategy for TMP-SMX intolerance. Adherence was independently confirmed by the transplant pharmacist and nurse for each patient, with an a priori target ≥ 75% population on prophylaxis. RESULTS Initial uptake was high with 237/250 (94.8%) patients starting prophylaxis. Long-term maintenance was high with 192/237 (81.0%) patients remaining on prophylaxis at 18-months. Of the remaining 45 patients who initiated prophylaxis, 36/237 (15.2%) were non-adherent and 9/237 (3.8%) discontinued prophylaxis by 18-months. Reasons for non-adherence included gastrointestinal upset, fear of drug reactions and cost; but the majority of reasons were not delineated by the patients (31/36, 86.1%). There was a statistically significant increase in serum creatinine 3.3 µmol/L (0.3-6.3 µmol/L 95% CI) and potassium 0.08 mmol/L (0.03-0.15 mmol/L 95% CI) in those prescribed TMP-SMX with only 3/237 (1.3%) patients discontinuing TMP-SMX for an increase in creatinine. CONCLUSION High rates of patient uptake (94.8%) and long-term adherence (81.0%) were observed after implementing universal lifelong PJP prophylaxis. This may be due in part to the in-depth patient education and drug tolerability strategies employed.
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Affiliation(s)
| | - Liam Berrigan
- Winnipeg Regional Health Authority, Winnipeg, MB, Canada
| | | | - Christopher Wiebe
- Department of Medicine, University of Manitoba, Winnipeg, MB, Canada.,Department of Immunology, University of Manitoba, Winnipeg, MB, Canada.,Shared Health Services Manitoba, Winnipeg, MB, Canada
| | - Siyao Sun
- Winnipeg Regional Health Authority, Winnipeg, MB, Canada
| | - Julie Ho
- Department of Medicine, University of Manitoba, Winnipeg, MB, Canada.,Department of Immunology, University of Manitoba, Winnipeg, MB, Canada
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10
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Danesi P, Corrò M, Falcaro C, Carminato A, Furlanello T, Cocchi M, Krockenberger MB, Meyer W, Capelli G, Malik R. Molecular detection of Pneumocystis in the lungs of cats. Med Mycol 2020; 57:813-824. [PMID: 30566653 PMCID: PMC7107658 DOI: 10.1093/mmy/myy139] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 11/09/2018] [Accepted: 11/16/2018] [Indexed: 12/23/2022] Open
Abstract
The genus Pneumocystis comprises potential pathogens that reside normally in the lungs of a wide range of mammals. Although they generally behave as transient or permanent commensals, they can occasionally cause life-threatening pneumonia (Pneumocystis pneumonia; PCP) in immunosuppressed individuals. Several decades ago, the presence of Pneumocystis morphotypes (trophic forms and cysts) was described in the lungs of normal cats and cats with experimentally induced symptomatic PCP (after immunosuppression by corticosteroids); yet to date spontaneous or drug-induced PCP has not been described in the clinical feline literature, despite immunosuppression of cats by long-standing retrovirus infections or after kidney transplantation. In this study, we describe the presence of Pneumocystis DNA in the lungs of normal cats (that died of various unrelated causes; n = 84) using polymerase chain reactions (PCRs) targeting the mitochondrial small and large subunit ribosomal RNA gene (mtSSU rRNA and mtLSU rRNA). The presence of Pneumocystis DNA was confirmed by sequencing in 24/84 (29%) cats, with evidence of two different sequence types (or lineages). Phylogenetically, lineage1 (L1; 19 cats) and lineage 2 (L2; 5 cats) formed separate clades, clustering with Pneumocystis from domestic pigs (L1) and carnivores (L2), respectively. Results of the present study support the notion that cats can be colonized or subclinically infected by Pneumocystis, without histological evidence of damage to the pulmonary parenchyma referable to pneumocystosis. Pneumocystis seems most likely an innocuous pathogen of cats’ lungs, but its possible role in the exacerbation of chronic pulmonary disorders or viral/bacterial coinfections should be considered further in a clinical setting.
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Affiliation(s)
- Patrizia Danesi
- Istituto Zooprofilattico Sperimentale delle Venezie, Legnaro (PD), Italy
| | - Michela Corrò
- Istituto Zooprofilattico Sperimentale delle Venezie, Legnaro (PD), Italy
| | - Christian Falcaro
- Istituto Zooprofilattico Sperimentale delle Venezie, Legnaro (PD), Italy
| | - Antonio Carminato
- Istituto Zooprofilattico Sperimentale delle Venezie, Legnaro (PD), Italy
| | | | - Monia Cocchi
- Istituto Zooprofilattico Sperimentale delle Venezie, Legnaro (PD), Italy
| | - Mark B Krockenberger
- Veterinary Pathology Diagnostic Services, Sydney School of Veterinary Science, University of Sydney, Sydney, New South Wales, Australia
| | - Wieland Meyer
- Molecular Mycology Research Laboratory, Centre for Infectious Diseases and Microbiology, Faculty of Medicine and Health, Westmead Clinical School, Marie Bashir Institute for Emerging Infectious Diseases and Biosecurity, University of Sydney, Westmead Hospital, Westmead Institute for Medical Research, Sydney, Australia
| | - Gioia Capelli
- Istituto Zooprofilattico Sperimentale delle Venezie, Legnaro (PD), Italy
| | - Richard Malik
- Centre for Veterinary Education, B22, University of Sydney, Sydney, New South Wales, Australia
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11
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Colonización por Pneumocystis jirovecii en mujeres gestantes y recién nacidos en Lima, Perú. Rev Iberoam Micol 2020; 37:24-27. [DOI: 10.1016/j.riam.2019.11.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 09/11/2019] [Accepted: 11/08/2019] [Indexed: 12/24/2022] Open
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12
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Dellière S, Gits-Muselli M, Bretagne S, Alanio A. Outbreak-Causing Fungi: Pneumocystis jirovecii. Mycopathologia 2019; 185:783-800. [PMID: 31782069 DOI: 10.1007/s11046-019-00408-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 11/15/2019] [Indexed: 12/17/2022]
Abstract
Pneumocystis jirovecii pneumonia (PCP) is an important cause of morbidity in immunocompromised patients, with a higher mortality in non-HIV than in HIV patients. P. jirovecii is one of the rare transmissible pathogenic fungi and the only one that depends fully on the host to survive and proliferate. Transmissibility among humans is one of the main specificities of P. jirovecii. Hence, the description of multiple outbreaks raises questions regarding preventive care management of the disease, especially in the non-HIV population. Indeed, chemoprophylaxis is well codified in HIV patients but there is a trend for modifications of the recommendations in the non-HIV population. In this review, we aim to discuss the mode of transmission of P. jirovecii, identify published outbreaks of PCP and describe molecular tools available to study these outbreaks. Finally, we discuss public health and infection control implications of PCP outbreaks in hospital setting for in- and outpatients.
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Affiliation(s)
- Sarah Dellière
- Laboratoire de Parasitologie-Mycologie, Groupe Hospitalier Saint-Louis-Lariboisière-Fernand-Widal, Assistance Publique-Hôpitaux de Paris (AP-HP), Université de Paris, Paris, France
- Molecular Mycology Unit, CNRS UMR2000, Institut Pasteur, 25 rue du Dr Roux, 75724, Paris Cedex 15, France
| | - Maud Gits-Muselli
- Laboratoire de Parasitologie-Mycologie, Groupe Hospitalier Saint-Louis-Lariboisière-Fernand-Widal, Assistance Publique-Hôpitaux de Paris (AP-HP), Université de Paris, Paris, France
- Molecular Mycology Unit, CNRS UMR2000, Institut Pasteur, 25 rue du Dr Roux, 75724, Paris Cedex 15, France
| | - Stéphane Bretagne
- Laboratoire de Parasitologie-Mycologie, Groupe Hospitalier Saint-Louis-Lariboisière-Fernand-Widal, Assistance Publique-Hôpitaux de Paris (AP-HP), Université de Paris, Paris, France
- Molecular Mycology Unit, CNRS UMR2000, Institut Pasteur, 25 rue du Dr Roux, 75724, Paris Cedex 15, France
- National Reference Center for Invasive Mycoses and Antifungals (NRCMA), Institut Pasteur, Paris, France
| | - Alexandre Alanio
- Laboratoire de Parasitologie-Mycologie, Groupe Hospitalier Saint-Louis-Lariboisière-Fernand-Widal, Assistance Publique-Hôpitaux de Paris (AP-HP), Université de Paris, Paris, France.
- Molecular Mycology Unit, CNRS UMR2000, Institut Pasteur, 25 rue du Dr Roux, 75724, Paris Cedex 15, France.
- National Reference Center for Invasive Mycoses and Antifungals (NRCMA), Institut Pasteur, Paris, France.
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13
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Abastabar M, Mosayebi E, Shokohi T, Hedayati MT, Jabari Amiri MR, Seifi Z, Haghani I, Aliyali M, Saber S, Sheikholeslami MF. A multi-centered study of Pneumocystis jirovecii colonization in patients with respiratory disorders: Is there a colonization trend in the elderly? Curr Med Mycol 2019; 5:19-25. [PMID: 31850392 PMCID: PMC6910707 DOI: 10.18502/cmm.5.3.1742] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background and Purpose: Pneumocystis jirovecii colonization plays a key role in the progression of pulmonary infection. However, there are limited data regarding the colonization of these fungi in the patients residing in different regions of Iran. Regarding this, the present study was conducted to evaluate the prevalence of P. jirovecii colonization in non-HIV-infected patients with respiratory failure introduced by physicians using nested polymerase chain reaction (PCR). Materials and Methods: This study was conducted on 136 samples obtained from 136 patients with respiratory disorders referring to different hospitals in the capital and north of Iran during 2013-2015. The samples were collected using bronchoalveolar lavage (BAL; n=121) and sputum induction (n=15). Nested PCR method targeting mtLSU rRNA gene was used for the detection of P. jirovecii DNA in the specimens. Results: The nested PCR analysis resulted in the detection of P. jirovecii DNA in 32 (23.5%) patients. The mean age of the participants was 49.04±11.94 years (age range: 14-90 years). The results revealed no correlation between Pneumocystis colonization and gender. The studied patients were divided into two groups of immunocompromised and immunocompetent patients. In the regard, 25.4% of the patients with detectable P. jirovecii DNA were immunocompromised and had cancer, organ transplantation, asthma, sarcoidosis, dermatomyositis, chronic obstructive pulmonary disease, bronchiectasis, and pulmonary vasculitis. On the other hand, Pneumocystis DNA was detected in 21.8% of the immunocompetent patients. Frequencies of P. jirovecii DNA detection in the patients with tuberculosis, hydatid cyst, and unknown underlying diseases were obtained as 20.8%, 25%, and 22%, respectively. The prevalence of Pneumocystis colonization varied based on age. In this regard, P. jirovecii colonization was more prevalent in patients aged above 70 years. Conclusion: As the findings indicated, non-HIV-infected patients, especially the elderly, had a high prevalence of P. jirovecii colonization. Therefore, these patients are probably a potential source of infection for others. Regarding this, it is of paramount importance to adopt monitoring and prophylactic measures to reduce this infection.
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Affiliation(s)
- Mahdi Abastabar
- Invasive Fungi Research Center, Mazandaran University of Medical Sciences, Sari, Iran.,Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Elham Mosayebi
- Student Research Committee, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Tahereh Shokohi
- Invasive Fungi Research Center, Mazandaran University of Medical Sciences, Sari, Iran.,Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mohammad T Hedayati
- Invasive Fungi Research Center, Mazandaran University of Medical Sciences, Sari, Iran.,Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mohammad R Jabari Amiri
- Student Research Committee, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Zahra Seifi
- Student Research Committee, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Iman Haghani
- Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Masoud Aliyali
- Department of Internal Medicine, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Sassan Saber
- Department of Internal Medicine, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam-Fatemeh Sheikholeslami
- Department of Molecular Pathology, National Research Institute of Tuberculosis and Lung Disease, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Molecular Biology, Dr. Khosroshahi Pathobiology Laboratory, Tehran, Iran
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14
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Fata A, Abdollahi B, Rezaeetalab F, Attaran D, Najjari M, Najafzadeh MJ. Molecular diagnosis and genotyping of Pneumocystis jirovecii in bronchoalveolar lavage samples obtained from patients with pulmonary disorder. Curr Med Mycol 2019; 5:13-18. [PMID: 31850391 PMCID: PMC6910711 DOI: 10.18502/cmm.5.3.1741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background and Purpose: Pneumocystis pneumonia (PCP) is one of the most common and life-threatening fungal diseases in patients with human immunodeficiency, treated with immunosuppressive medications. Immunocompetent people can also be a spreading agent for PCP. Regarding this, the aim of the present study was to diagnose and identify Pneumocystis jirovecii in bronchoalveolar lavage (BAL) samples obtained from patients with pulmonary disorder using a molecular method. Materials and Methods: For the purpose of the study, BAL samples (n=138) were collected from patients, undergoing bronchoscopy at the different departments of university hospitals affiliated to Mashhad University of Medical Sciences, Mashhad, Iran, during a period of one year (i.e., April 2014 until May 2015). Giemsa staining and molecular identification were carried out for each sample. The samples were also subjected to nested polymerase chain reaction (PCR), sequencing, and genotyping based on mitochondrial ribosomal large subunit (mtLSU rRNA) of P. jirovecii. The phylogenic tree was constructed by MEGA6 software. Results: The results of direct microscopic examination revealed the presence of P. jirovecii in 3 (2.2%) out of 138 samples; in addition, nested PCR and sequencing led to the detection of species in 17 (12.3%) samples. Out of patients with positive results, 10 (25%) and 7 (7.1%) cases were immunosuppressed and immunocompetent, respectively. The most common clinical symptoms among patients with pneumocystis were fever, dyspnea, and dry cough. In addition, genotypes III and II were the dominant genotypes in our dataset. Conclusion: Nested PCR and sequencing methods showed higher sensitivity and specificity as compared with a direct staining technique. Genotype III was identified as the most dominant type in patients with pulmonary disorder in Mashhad.
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Affiliation(s)
- Abdolmajid Fata
- Department of Parasitology and Mycology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.,Cutaneous Leishmaniasis Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Bahareh Abdollahi
- Department of Parasitology and Mycology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Fariba Rezaeetalab
- Department of Internal Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.,Lung Diseases Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Davood Attaran
- Department of Internal Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.,Lung Diseases Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohsen Najjari
- Department of Parasitology and Mycology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohammad J Najafzadeh
- Department of Parasitology and Mycology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.,Cancer Molecular Pathology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
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15
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Wang M, Xu X, Guo Y, Tao R, Hu C, Dong X, Huang Y, Zhu B. Polymorphisms involving the Pneumocystis jirovecii-related genes in AIDS patients in eastern China. INFECTION GENETICS AND EVOLUTION 2019; 75:103955. [PMID: 31284044 DOI: 10.1016/j.meegid.2019.103955] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 06/25/2019] [Accepted: 07/05/2019] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To investigate the genetic polymorphisms of mitochondrial large ribosomal subunit (mtLSU)-rRNA, dihydrofolate reductase (DHFR), dihydropteroate synthase (DHPS), cytochrome b (CYB), and superoxide dismutase (SOD) genes and its correlation with clinical outcomes of Pneumocystis jirovecii pneumonia in acquired immune deficiency(AIDS) patients. METHODS Eighty AIDS patients with P. jirovecii pneumonia that were admitted to our hospital from 2016 to 2018 were included in this study. Their demographic information and clinical data were collected, as well as corresponding saliva specimens for PCR and sequencing of mtLSU-rRNA, DHFR, DHPS, CYB, and SOD genes to analyze genetic polymorphisms, different polymorphic combinations, and clinical outcomes. RESULTS Of the 80 saliva specimens, mtLSU-rRNA was successfully amplified and sequenced in 30 cases; CYB was successfully amplified and sequenced in 26 cases; and SOD, DHFR, and DHPS were successfully amplified and sequenced in 18 cases. These results indicate that The mtLSU-rRNA, CYB, and SOD genes were highly polymorphic. mt85T and CYB1 were the variants dominantly detected at the mtLSU-rRNA and CYB loci, respectively. The SOD1 and SOD2 variants (each in 50% of the cases) were detected at the SOD locus. Among the 18 cases that were successfully amplified and sequenced for DHFR and DHPS, three DHFR nonsense mutations and no DHPS mutation were observed. The mt85C, CYB1, SOD1, and DHFR312T genes harbored common polymorphisms (n = 4; 22.22%) and the mt85T, CYB1, SOD1, DHFR312T genes were associated with poor clinical outcomes. CONCLUSION The types of genetic polymorphisms and polymorphic combinations of mtLSU-rRNA, DHFR, DHPS, CYB, and SOD in P. jirovecii were related to the clinical outcomes of patients with P. jirovecii pneumonia in Zhejiang Province, China.
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Affiliation(s)
- Mengyan Wang
- The Department of Infectious Diseases, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.
| | - Xiaoke Xu
- The Department of Infectious Diseases, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.
| | - Yongzheng Guo
- The Department of Infectious Diseases, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.
| | - Ran Tao
- The Department of Infectious Diseases, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Caiqin Hu
- The Department of Infectious Diseases, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.
| | - Xiaotian Dong
- The Department of Infectious Diseases, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.
| | - Ying Huang
- The Department of Infectious Diseases, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.
| | - Biao Zhu
- The Department of Infectious Diseases, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.
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16
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Wang M, Dai X, Huang Y, Sun J, Dong X, Guo Y, Hu C, Zhou Q, Zhu B. The presence of Pneumocystis jirovecii DNA in plasma is associated with a higher mortality rate in patients with AIDS-associated Pneumocystis pneumonia. Med Mycol 2019; 57:582-587. [PMID: 30380089 DOI: 10.1093/mmy/myy110] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 08/21/2018] [Accepted: 09/22/2018] [Indexed: 01/21/2023] Open
Abstract
To examine the relationship between Pneumocystis jirovecii DNA (PJ-DNA) levels in blood from AIDS-associated Pneumocystis pneumonia (AIDS-PCP) and mortality, and to correlate mitochondrial large subunit rRNA (mtLSUrRNA) gene polymorphism with mortality, we performed a retrospective study including AIDS-PCP patients between 2014 and 2016 from one hospital in China. PJ-DNA in plasma was measured by nested polymerase chain reaction (PCR) of the mtLSUrRNA gene and in positive specimens we further detected the level of PJ-DNA using qPCR. Polymorphisms were observed at two positions (85 and 248) of the mtLSUrRNA gene by sequencing. The PJ-DNA positivity rate for survivors and nonsurvivors was 13.64% (9/66) and 78.57% (11/14) (P ≤ .001), respectively. Using multivariate analysis, we found that lactate dehydrogenase, PaO2, albumin and PJ-positive in blood were independent predictors of death (P = .011; P = .042; P = .01; P ≤ .001, respectively). The PJ-DNA level in the nonsurvivor group (n = 11) was higher than that of the survivor group (n = 9) (54610.3copies/ ml vs. 934.5 copies/ml, P = .006). Nine had genotype 1, and 88.89% (8/9) patients died. Of nine with genotype 3, 11.11% (1/9) died (P = .003). In conclusion, high PJ-DNA level detected by analyzing plasma and mtLSUrRNA genotype 1 are strongly associated with death in AIDS-PCP patients.
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Affiliation(s)
- Mengyan Wang
- The Department of Infectious Diseases, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Xiahong Dai
- The Department of Infectious Diseases, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Ying Huang
- The Department of Infectious Diseases, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Jia Sun
- The Department of Infectious Diseases, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Xiaotian Dong
- The Department of Infectious Diseases, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Yongzheng Guo
- The Department of Infectious Diseases, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Caiqin Hu
- The Department of Infectious Diseases, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Qihui Zhou
- The Department of Infectious Diseases, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Biao Zhu
- The Department of Infectious Diseases, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
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17
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Petružela J, Bryja J, Bryjová A, Katakweba A, Sabuni C, Baird SJE, de Bellocq JG. Evolutionary history of Pneumocystis fungi in their African rodent hosts. INFECTION GENETICS AND EVOLUTION 2019; 75:103934. [PMID: 31247340 DOI: 10.1016/j.meegid.2019.103934] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 06/17/2019] [Accepted: 06/20/2019] [Indexed: 02/08/2023]
Abstract
Pneumocystis is a genus of parasitic fungi infecting lung tissues in a wide range of mammal species, displaying a strong host specificity and patterns of co-speciation with their hosts. However, a recent study on Asiatic murids challenged these patterns reporting several Pneumocystis lineages/species shared by different host species or even genera in the Rattini and Murini tribes. Here we screened lung samples of 27 species of African rodents from five families for the presence of Pneumocystis DNA. Using reconstructed multi-locus phylogenies of both hosts and parasites, we tested the hypothesis of their co-evolution. We found that Pneumocystis is widespread in African rodents, detected in all but seven screened host species, with species-level prevalence ranging from 5.9 to 100%. Several host species carry pairs of highly divergent Pneumocystis lineages/species. The retrieved co-phylogenetic signal was highly significant (p = .0017). We found multiple co-speciations, sorting events and two host-shift events, which occurred between Murinae and Deomyinae hosts. Comparison of genetic distances suggests higher substitution rates for Pneumocystis relative to the rodent hosts on neutral loci and slower rates on selected ones. We discuss life-history traits and population dynamics factors which could explain the observed results.
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Affiliation(s)
- Jan Petružela
- Institute of Vertebrate Biology, Academy of Sciences of the Czech Republic, Brno, Czech Republic; Faculty of Science, Department of Botany and Zoology, Masaryk University, Brno, Czech Republic.
| | - Josef Bryja
- Institute of Vertebrate Biology, Academy of Sciences of the Czech Republic, Brno, Czech Republic; Faculty of Science, Department of Botany and Zoology, Masaryk University, Brno, Czech Republic
| | - Anna Bryjová
- Institute of Vertebrate Biology, Academy of Sciences of the Czech Republic, Brno, Czech Republic
| | - Abdul Katakweba
- Pest Management Centre, Sokoine University of Agriculture, Morogoro, Tanzania
| | - Christopher Sabuni
- Pest Management Centre, Sokoine University of Agriculture, Morogoro, Tanzania
| | - Stuart J E Baird
- Institute of Vertebrate Biology, Academy of Sciences of the Czech Republic, Brno, Czech Republic
| | - Joëlle Goüy de Bellocq
- Institute of Vertebrate Biology, Academy of Sciences of the Czech Republic, Brno, Czech Republic
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18
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Singh Y, Mirdha BR, Guleria R, Kabra SK, Mohan A, Chaudhry R, Kumar L, Dwivedi SN, Agarwal SK. Novel dihydropteroate synthase gene mutation in Pneumocystis jirovecii among HIV-infected patients in India: Putative association with drug resistance and mortality. J Glob Antimicrob Resist 2019; 17:236-239. [PMID: 30658203 DOI: 10.1016/j.jgar.2019.01.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 12/14/2018] [Accepted: 01/09/2019] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Pneumocystis pneumonia (PCP) remains a debilitating cause of death among HIV-infected patients. The combination trimethoprim/sulfamethoxazole (SXT) is the most effective anti-Pneumocystis treatment and prophylaxis. However, long-term use of this combination has raised alarms about the emergence of resistant organisms. This study was performed to investigate mutations in the dihydropteroate synthase (DHPS) gene and their clinical consequences in HIV-infected patients with PCP. METHODS A total of 76 clinically suspected cases of PCP among HIV-seropositive adult patients from March 2014 to March 2017 were included. Clinical samples (bronchoalveolar lavage fluid and sputum) were investigated for the detection of Pneumocystis jirovecii using both microscopy and nested PCR. DHPS genotyping and mutational analyses were performed and the data were correlated with clinical characteristics. RESULTS Among the 76 enrolled HIV-positive patients, only 17 (22.4%) were positive for P. jirovecii. DHPS gene sequencing showed a novel nucleotide substitution at position 288 (Val96Ile) in three patients (3/12; 25.0%). Patients infected with the mutant P. jirovecii genotype had severe episodes of PCP, did not respond to SXT and had a fatal outcome (P=0.005). All three patients had a CD4+ T-cell count <100 cells/μL, and two also had co-infections. CONCLUSION This study suggests that the emergence of a mutant P. jirovecii genotype is probably associated with drug resistance and mortality. The data also suggest that DHPS mutational analyses should be performed in HIV-seropositive patients to avoid treatment failure and death due to PCP. However, the role of underlying disease severity and co-morbidities should not be underestimated.
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Affiliation(s)
- Yogita Singh
- All India Institute of Medical Sciences, Department of Microbiology, New Delhi 110029, India
| | - Bijay Ranjan Mirdha
- All India Institute of Medical Sciences, Department of Microbiology, New Delhi 110029, India.
| | - Randeep Guleria
- All India Institute of Medical Sciences, Department of Pulmonary Medicine and Sleep Disorders, New Delhi 110029, India
| | - Sushil K Kabra
- All India Institute of Medical Sciences, Department of Pediatrics, New Delhi 110029, India
| | - Anant Mohan
- All India Institute of Medical Sciences, Department of Pulmonary Medicine and Sleep Disorders, New Delhi 110029, India
| | - Rama Chaudhry
- All India Institute of Medical Sciences, Department of Microbiology, New Delhi 110029, India
| | - Lalit Kumar
- All India Institute of Medical Sciences, Department of Medical Oncology, New Delhi 110029, India
| | - Sada Nand Dwivedi
- All India Institute of Medical Sciences, Department of Biostatistics, New Delhi 110029, India
| | - Sanjay K Agarwal
- All India Institute of Medical Sciences, Department of Nephrology, New Delhi 110029, India
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19
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Goüy de Bellocq J, Wasimuddin, Ribas A, Bryja J, Piálek J, Baird SJE. Holobiont suture zones: Parasite evidence across the European house mouse hybrid zone. Mol Ecol 2018; 27:5214-5227. [PMID: 30427096 DOI: 10.1111/mec.14938] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 10/16/2018] [Accepted: 10/17/2018] [Indexed: 02/06/2023]
Abstract
Parasite hybrid zones resulting from host secondary contact have never been described in nature although parasite hybridization is well known and secondary contact should affect them similarly to free-living organisms. When host populations are isolated, diverge and recontact, intimate parasites (host specific, direct life cycle) carried during isolation will also meet and so may form parasite hybrid zones. If so, we hypothesize these should be narrower than the host's hybrid zone as shorter parasite generation time allows potentially higher divergence. We investigate multilocus genetics of two parasites across the European house mouse hybrid zone. We find each host taxon harbours its own parasite taxa. These also hybridize: Parasite hybrid zones are significantly narrower than the host's. Here, we show a host hybrid zone is a suture zone for a subset of its parasite community and highlight the potential of such systems as windows on the evolutionary processes of host-parasite interactions and recombinant pathogen emergence.
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Affiliation(s)
| | - Wasimuddin
- The Czech Academy of Sciences, Institute of Vertebrate Biology, Brno, Czech Republic.,Institute for Infectious Diseases, University of Bern, Bern, Switzerland
| | - Alexis Ribas
- The Czech Academy of Sciences, Institute of Vertebrate Biology, Brno, Czech Republic.,Section of Parasitology, Department of Biology, Healthcare and the Environment, Faculty of Pharmacy and Food Sciences, University of Barcelona, Barcelona, Spain
| | - Josef Bryja
- The Czech Academy of Sciences, Institute of Vertebrate Biology, Brno, Czech Republic.,Department of Botany and Zoology, Faculty of Science, Masaryk University, Brno, Czech Republic
| | - Jaroslav Piálek
- The Czech Academy of Sciences, Institute of Vertebrate Biology, Brno, Czech Republic
| | - Stuart J E Baird
- The Czech Academy of Sciences, Institute of Vertebrate Biology, Brno, Czech Republic
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20
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Szydłowicz M, Jakuszko K, Szymczak A, Piesiak P, Kowal A, Kopacz Ż, Wesołowska M, Lobo ML, Matos O, Hendrich AB, Kicia M. Prevalence and genotyping of Pneumocystis jirovecii in renal transplant recipients-preliminary report. Parasitol Res 2018; 118:181-189. [PMID: 30392033 PMCID: PMC6329730 DOI: 10.1007/s00436-018-6131-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 10/23/2018] [Indexed: 12/24/2022]
Abstract
Pneumocystis jirovecii is an opportunistic fungus occurring in human lungs. The group at highest risk consists of HIV-infected and non-HIV-infected immunosuppressed individuals. In these patients, P. jirovecii infection may lead to Pneumocystis pneumonia; it may, however, persist also in an asymptomatic form. This study aimed to determine the prevalence of P. jirovecii and potential risk factors for infection in a group of renal transplant recipients and to characterize the genetic diversity of this fungus in the studied population. Sputum specimens from 72 patients were tested for presence of P. jirovecii using immunofluorescence microscopy, as well as nested PCR targeting the mtLSU rRNA gene. Genotyping involving analysis of four loci—mtLSU rRNA, CYB, DHPS, and SOD—was used to characterize the diversity of the detected organisms. Pneumocystis DNA was detected in eight (11.11%) patients. It has been shown that low eosinophil count and dual immunosuppressive treatment combining prednisone and calcineurin inhibitors are potential risk factors for colonization. Analysis of genotype distribution showed an association of the wild-type genotype of mtLSU rRNA with lower average age of patients and shorter time after kidney transplantation. Furthermore, CYB 2 genotype was detected only in patients with the ongoing prophylaxis regimen. In conclusion, renal transplant recipients are at risk of Pneumocystis colonization even a long time after transplantation. The present preliminary study identifies specific polymorphisms that appear to be correlated with certain patient characteristics and highlights the need for deeper investigation of these associations in renal transplant recipients.
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Affiliation(s)
- Magdalena Szydłowicz
- Department of Biology and Medical Parasitology, Wroclaw Medical University, ul. J. Mikulicza-Radeckiego 9, 50-345, Wroclaw, Poland.
| | - Katarzyna Jakuszko
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wroclaw, Poland
| | - Anna Szymczak
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wroclaw, Poland
| | - Paweł Piesiak
- Department of Pulmonology and Lung Cancer, Wroclaw Medical University, Wroclaw, Poland
| | - Aneta Kowal
- Department of Pulmonology and Lung Cancer, Wroclaw Medical University, Wroclaw, Poland
| | - Żaneta Kopacz
- Department of Biology and Medical Parasitology, Wroclaw Medical University, ul. J. Mikulicza-Radeckiego 9, 50-345, Wroclaw, Poland
| | - Maria Wesołowska
- Department of Biology and Medical Parasitology, Wroclaw Medical University, ul. J. Mikulicza-Radeckiego 9, 50-345, Wroclaw, Poland
| | - Maria Luísa Lobo
- Global Health and Tropical Medicine, Unit of Medical Parasitology, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Olga Matos
- Global Health and Tropical Medicine, Unit of Medical Parasitology, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Andrzej B Hendrich
- Department of Biology and Medical Parasitology, Wroclaw Medical University, ul. J. Mikulicza-Radeckiego 9, 50-345, Wroclaw, Poland
| | - Marta Kicia
- Department of Biology and Medical Parasitology, Wroclaw Medical University, ul. J. Mikulicza-Radeckiego 9, 50-345, Wroclaw, Poland
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21
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Cissé OH, Hauser PM. Genomics and evolution of Pneumocystis species. INFECTION GENETICS AND EVOLUTION 2018; 65:308-320. [PMID: 30138710 DOI: 10.1016/j.meegid.2018.08.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 08/15/2018] [Accepted: 08/17/2018] [Indexed: 01/20/2023]
Abstract
The genus Pneumocystis comprises highly diversified fungal species that cause severe pneumonia in individuals with a deficient immune system. These fungi infect exclusively mammals and present a strict host species specificity. These species have co-diverged with their hosts for long periods of time (> 100 MYA). Details of their biology and evolution are fragmentary mainly because of a lack of an established long-term culture system. Recent genomic advances have unlocked new areas of research and allow new hypotheses to be tested. We review here new findings of the genomic studies in relation with the evolutionary trajectory of these fungi and discuss the impact of genomic data analysis in the context of the population genetics. The combination of slow genome decay and limited expansion of specific gene families and introns reflect intimate interactions of these species with their hosts. The evolutionary adaptation of these organisms is profoundly influenced by their population structure, which in turn is determined by intrinsic features such as their self-fertilizing mating system, high host specificity, long generation times, and transmission mode. Essential key questions concerning their adaptation and speciation remain to be answered. The next cornerstone will consist in the establishment of a long-term culture system and genetic manipulation that should allow unravelling the driving forces of Pneumocystis species evolution.
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Affiliation(s)
- Ousmane H Cissé
- Critical Care Medicine Department, NIH Clinical Center, National Institutes of Health, Bethesda, MD 20892, USA.
| | - Philippe M Hauser
- Institute of Microbiology, Lausanne University Hospital, Lausanne, Switzerland.
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22
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Ma L, Cissé OH, Kovacs JA. A Molecular Window into the Biology and Epidemiology of Pneumocystis spp. Clin Microbiol Rev 2018; 31:e00009-18. [PMID: 29899010 PMCID: PMC6056843 DOI: 10.1128/cmr.00009-18] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Pneumocystis, a unique atypical fungus with an elusive lifestyle, has had an important medical history. It came to prominence as an opportunistic pathogen that not only can cause life-threatening pneumonia in patients with HIV infection and other immunodeficiencies but also can colonize the lungs of healthy individuals from a very early age. The genus Pneumocystis includes a group of closely related but heterogeneous organisms that have a worldwide distribution, have been detected in multiple mammalian species, are highly host species specific, inhabit the lungs almost exclusively, and have never convincingly been cultured in vitro, making Pneumocystis a fascinating but difficult-to-study organism. Improved molecular biologic methodologies have opened a new window into the biology and epidemiology of Pneumocystis. Advances include an improved taxonomic classification, identification of an extremely reduced genome and concomitant inability to metabolize and grow independent of the host lungs, insights into its transmission mode, recognition of its widespread colonization in both immunocompetent and immunodeficient hosts, and utilization of strain variation to study drug resistance, epidemiology, and outbreaks of infection among transplant patients. This review summarizes these advances and also identifies some major questions and challenges that need to be addressed to better understand Pneumocystis biology and its relevance to clinical care.
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Affiliation(s)
- Liang Ma
- Critical Care Medicine Department, NIH Clinical Center, Bethesda, Maryland, USA
| | - Ousmane H Cissé
- Critical Care Medicine Department, NIH Clinical Center, Bethesda, Maryland, USA
| | - Joseph A Kovacs
- Critical Care Medicine Department, NIH Clinical Center, Bethesda, Maryland, USA
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23
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Brakemeier S, Pfau A, Zukunft B, Budde K, Nickel P. Prophylaxis and treatment of Pneumocystis Jirovecii pneumonia after solid organ transplantation. Pharmacol Res 2018; 134:61-67. [PMID: 29890253 DOI: 10.1016/j.phrs.2018.06.010] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 03/21/2018] [Accepted: 06/07/2018] [Indexed: 12/17/2022]
Abstract
Pneumocystis jirovecii pneumonia (PJP) is an opportunistic infection diagnosed in immunocompromized patients. After solid organ transplantation, early infection has decreased as a result of effective prophylaxis, but late infections and even outbreaks caused by interpatient transmission of pneumocystis by air are present in the SOT community. Different risk factors for PJP have been described and several indications for PJP prophylaxis have to be considered by clinicians in patients even years after transplantation. Diagnosis of PJP is confirmed by microscopy and immunofluorescence staining of bronchial fluid but PCR as well as serum ß-D-Glucan analysis have become increasingly valuable diagnostic tools. Treatment of choice is Trimethoprim/sulfamethoxazole and early treatment improves prognosis. However, mortality of PJP in solid organ transplant patients is still high and many aspects including the optimal management of immunosuppression during PJP treatment require further investigations.
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Affiliation(s)
- Susanne Brakemeier
- Department of Nephrology and Medical Intensive Care, Charité, Berlin, Germany.
| | - Anja Pfau
- Department of Nephrology and Medical Intensive Care, Charité, Berlin, Germany
| | - Bianca Zukunft
- Department of Nephrology and Medical Intensive Care, Charité, Berlin, Germany
| | - Klemens Budde
- Department of Nephrology and Medical Intensive Care, Charité, Berlin, Germany
| | - Peter Nickel
- Department of Nephrology and Medical Intensive Care, Charité, Berlin, Germany
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24
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Schwartz IS, McLoud JD, Berman D, Botha A, Lerm B, Colebunders R, Levetin E, Kenyon C. Molecular detection of airborne Emergomyces africanus, a thermally dimorphic fungal pathogen, in Cape Town, South Africa. PLoS Negl Trop Dis 2018; 12:e0006174. [PMID: 29357352 PMCID: PMC5800596 DOI: 10.1371/journal.pntd.0006174] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 02/06/2018] [Accepted: 12/18/2017] [Indexed: 12/28/2022] Open
Abstract
Emergomyces africanus is a thermally dimorphic fungus that causes a systemic mycosis in immunocompromised persons in South Africa. Infection is presumed to follow inhalation of airborne propagules. We developed a quantitative PCR protocol able to detect as few as 5 Es. africanus propagules per day. Samples were collected in Cape Town, South Africa over 50 weeks by a Burkard spore trap with an alternate orifice. We detected Es. africanus in air samples from 34 days (10%) distributed over 11 weeks. These results suggest environmental exposure to airborne Es. africanus propagules occurs more commonly in endemic areas than previously appreciated.
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Affiliation(s)
- Ilan S. Schwartz
- Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
- Global Health Institute, University of Antwerp, Antwerp, Belgium
| | - Josh D. McLoud
- Biological Sciences, University of Tulsa, Tulsa, Oklahoma, United States of America
| | - Dilys Berman
- University of Cape Town, Cape Town, Western Cape, South Africa
| | - Alfred Botha
- Department of Microbiology, Stellenbosch University, Stellenbosch, Western Cape, South Africa
| | - Barbra Lerm
- Department of Microbiology, Stellenbosch University, Stellenbosch, Western Cape, South Africa
| | | | - Estelle Levetin
- Biological Sciences, University of Tulsa, Tulsa, Oklahoma, United States of America
| | - Chris Kenyon
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
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25
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Sokulska M, Kicia M, Wesołowska M, Piesiak P, Kowal A, Lobo ML, Kopacz Ż, Hendrich AB, Matos O. Genotyping of Pneumocystis jirovecii in colonized patients with various pulmonary diseases. Med Mycol 2017; 56:809-815. [DOI: 10.1093/mmy/myx121] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 10/17/2017] [Indexed: 11/15/2022] Open
Affiliation(s)
- Magdalena Sokulska
- Department of Biology and Medical Parasitology, Wroclaw Medical University, Wroclaw, Poland
| | - Marta Kicia
- Department of Biology and Medical Parasitology, Wroclaw Medical University, Wroclaw, Poland
| | - Maria Wesołowska
- Department of Biology and Medical Parasitology, Wroclaw Medical University, Wroclaw, Poland
| | - Paweł Piesiak
- Department of Pulmonology and Lung Cancer, Wroclaw Medical University, Wroclaw, Poland
| | - Aneta Kowal
- Department of Pulmonology and Lung Cancer, Wroclaw Medical University, Wroclaw, Poland
| | - Maria Luísa Lobo
- Unit of Medical Parasitology, Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Żaneta Kopacz
- Department of Biology and Medical Parasitology, Wroclaw Medical University, Wroclaw, Poland
| | - Andrzej B Hendrich
- Department of Biology and Medical Parasitology, Wroclaw Medical University, Wroclaw, Poland
| | - Olga Matos
- Unit of Medical Parasitology, Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisbon, Portugal
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26
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Genetic diversity and evolution of Pneumocystis fungi infecting wild Southeast Asian murid rodents. Parasitology 2017; 145:885-900. [PMID: 29117878 DOI: 10.1017/s0031182017001883] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Pneumocystis organisms are airborne-transmitted fungal parasites that infect the lungs of numerous mammalian species with strong host specificity. In this study, we investigated the genetic diversity and host specificity of Pneumocystis organisms infecting Southeast Asian murid rodents through PCR amplification of two mitochondrial genes and tested the co-phylogeny hypothesis among these fungi and their rodent hosts. Pneumocystis DNA was detected in 215 of 445 wild rodents belonging to 18 Southeast Asian murid species. Three of the Pneumocystis lineages retrieved in our phylogenetic trees correspond to known Pneumocystis species, but some of the remaining lineages may correspond to new undescribed species. Most of these Pneumocystis species infect several rodent species or genera and some sequence types are shared among several host species and genera. These results indicated a weaker host specificity of Pneumocystis species infecting rodents than previously thought. Our co-phylogenetic analyses revealed a complex evolutionary history among Pneumocystis and their rodent hosts. Even if a significant global signal of co-speciation has been detected, co-speciation alone is not sufficient to explain the observed co-phylogenetic pattern and several host switches are inferred. These findings conflict with the traditional view of a prolonged process of co-evolution and co-speciation of Pneumocystis and their hosts.
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27
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Ricciardi A, Gentilotti E, Coppola L, Maffongelli G, Cerva C, Malagnino V, Mari A, Di Veroli A, Berrilli F, Apice F, Toschi N, Di Cave D, Parisi SG, Andreoni M, Sarmati L. Infectious disease ward admission positively influences P. jiroveci pneumonia (PjP) outcome: A retrospective analysis of 116 HIV-positive and HIV-negative immunocompromised patients. PLoS One 2017; 12:e0176881. [PMID: 28505159 PMCID: PMC5432209 DOI: 10.1371/journal.pone.0176881] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 04/18/2017] [Indexed: 01/15/2023] Open
Abstract
P. jiroveci (Pj) causes a potentially fatal pneumonia in immunocompromised patients and the factors associated with a bad outcome are poorly understood. A retrospective analysis on Pj pneumonia (PjP) cases occurring in Tor Vergata University Hospital, Italy, during the period 2011–2015. The patients’ demographic, clinical and radiological characteristics and the Pj genotypes were considered. The study population included 116 patients, 37.9% of whom had haematological malignancy or underwent haematological stem cell transplantation (HSCT), 22.4% had HIV infection, 16.4% had chronic lung diseases (CLD), 7.8% had a solid cancer, and 3.4% underwent a solid organ transplant (SOT). The remaining 12.1% had a miscellaneous other condition. At univariate analysis, being older than 60 years was significantly correlated with a severe PjP (OR [95%CI] 2.52 [0.10–5.76]; p = 0.031) and death (OR [95%CI] 2.44 [1.05–5.70]; p = 0.036), while a previous trimethoprim/sulfamethoxazole (TMP/SMX) prophylaxis were significantly associated with a less severe pneumonia (OR[95%CI] 0.35 [0.15–0.84], p = 0.023); moreover, death due to PjP was significantly more frequent in patients with CLD (OR[95%CI] 3.26 [1.17–9.05]; p = 0.019) while, admission to the Infectious Diseases Unit was significantly associated with fewer deaths (OR[95%CI] 0.10 [0.03–0.36], p = 0.002). At multivariate analysis, a better PjP outcome was observed in patients taking TMP/SMX prophylaxis and that were admitted to the Infectious Diseases Unit (OR[95%CI] 0.27 [0.07–1.03], p = 0.055, OR[95%CI] 0.16 [0.05–0.55]; p = 0.004, respectively). In conclusion, in our study population, TMP/SMX prophylaxis and infectious disease specialist approach were variables correlated with a better PjP outcome.
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Affiliation(s)
| | | | - Luigi Coppola
- Infectious Diseases, Tor Vergata University, Rome, Italy
| | | | - Carlotta Cerva
- Infectious Diseases, Tor Vergata University, Rome, Italy
| | | | - Alessia Mari
- Respiratory Diseases Unit, Tor Vergata University, Rome, Italy
| | - Ambra Di Veroli
- Department of Haematology, Tor Vergata University, Rome, Italy
| | - Federica Berrilli
- Department of Clinical Sciences and Translational Medicine, Tor Vergata University, Rome, Italy
| | - Fabiana Apice
- Department of Clinical Sciences and Translational Medicine, Tor Vergata University, Rome, Italy
| | - Nicola Toschi
- Department of Biomedicine and Prevention, Tor Vergata University, Rome, Italy
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging and Harvard Medical School, Boston, MA, United States of America
| | - David Di Cave
- Department of Clinical Sciences and Translational Medicine, Tor Vergata University, Rome, Italy
| | - Saverio Giuseppe Parisi
- Department of Molecular Medicine, University of Padua, Padua, Italy, Clinical Microbiology and Virology Unit, Padua University Hospital, Padua, Italy
| | | | - Loredana Sarmati
- Infectious Diseases, Tor Vergata University, Rome, Italy
- * E-mail:
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28
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Singh Y, Mirdha BR, Guleria R, Khalil S, Panda A, Chaudhry R, Mohan A, Kabra SK, Kumar L, Agarwal SK. Circulating genotypes of Pneumocystis jirovecii and its clinical correlation in patients from a single tertiary center in India. Eur J Clin Microbiol Infect Dis 2017; 36:1635-1641. [PMID: 28401321 DOI: 10.1007/s10096-017-2977-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 03/27/2017] [Indexed: 10/19/2022]
Abstract
The present study was carried out with the objectives of genotyping Pneumocystis jirovecii at three distinct loci, to identify the single nucleotide polymorphisms (SNPs), and to study its clinical implications in patients with Pneumocystis pneumonia (PCP). Analysis of genetic diversity in P. jirovecii from immunocompromised patients was carried out by genotyping at three distinct loci encoding mitochondrial large subunit rRNA (mtLSU rRNA), cytochrome b (CYB), and superoxide dismutase (SOD) using polymerase chain reaction (PCR) assays followed by direct DNA sequencing. Of the 300 patients enrolled in the present study, 31 (10.33%) were positive for PCP by a specific mtLSU rRNA nested PCR assay, whereas only 15 P. jirovecii could be amplified at the other two loci (SOD and CYB). These positives were further subjected to sequence typing. Important genotypic combinations between four SNPs (mt85, SOD110, SOD215, and CYB838) and clinical outcomes could be observed in the present study, and mt85A, mt85T, and SOD110C/SOD215T were frequently associated with "negative follow-up". These SNPs were also noted to be relatively more prevalent amongst circulating genotypes in our study population. The present study is the first of its kind from the Indian subcontinent and demonstrated that potential SNPs of P. jirovecii may possibly be attributed to the clinical outcome of PCP episodes in terms of severity or fatality in different susceptible populations likely to develop PCP during their course of illness.
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Affiliation(s)
- Y Singh
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - B R Mirdha
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India.
| | - R Guleria
- Department of Pulmonary Medicine and Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
| | - S Khalil
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - A Panda
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - R Chaudhry
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - A Mohan
- Department of Pulmonary Medicine and Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
| | - S K Kabra
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - L Kumar
- Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - S K Agarwal
- Department of Nephrology, All India Institute of Medical Sciences, New Delhi, India
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29
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Lifelong Prophylaxis With Trimethoprim-Sulfamethoxazole for Prevention of Outbreak of Pneumocystis jirovecii Pneumonia in Kidney Transplant Recipients. Transplant Direct 2017; 3:e151. [PMID: 28573186 PMCID: PMC5441982 DOI: 10.1097/txd.0000000000000665] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 02/11/2017] [Indexed: 12/05/2022] Open
Abstract
Background Outbreaks of Pneumocystis jirovecii pneumonia (PCP) in kidney transplant recipients are frequently reported worldwide. However, the general guidelines propose only short-term prophylaxis with trimethoprim-sulfamethoxazole after kidney transplantation. We experienced 3 PCP outbreaks in the last 10 years despite providing the recommended prophylaxis. The purpose of this study was to find a prophylaxis regimen that could successfully prevent future PCP outbreaks in immunosuppressed kidney transplant recipients. Methods Occurrence of PCP at our hospital since 2004 was reviewed. A total of 48 cases were diagnosed from July 2004 through December 2014. Genotypes of P. jirovecii were determined in these cases. Results Three PCP outbreaks by 3 different genotypes of P. jirovecii in each outbreak occurred with 2-year intervals in last 10 years. Molecular analysis showed that each intraoutbreak was caused by identical P. jirovecii, whereas interoutbreaks were caused by different genotypes. Although short-term prophylaxis was provided to all kidney recipients after each outbreak after identification of a single PCP case, additional outbreaks were not prevented because the universal prophylaxis had already been completed when new case of PCP emerged. Conclusions The contagious nature of P. jirovecii allows easy development of outbreaks of PCP in immunosuppressed kidney transplant recipients. Although the universal short-term prophylaxis is effective in controlling ongoing outbreak, lifelong prophylaxis of kidney transplant recipients should be considered to prevent new outbreaks.
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Chien JY, Liu CJ, Chuang PC, Lee TF, Huang YT, Liao CH, Hung CC, Sheng WH, Yu CJ, Hsueh PR. Evaluation of the automated Becton Dickinson MAX real-time PCR platform for detection of Pneumocystis jirovecii. Future Microbiol 2016; 12:29-37. [PMID: 27936923 DOI: 10.2217/fmb-2016-0115] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
AIM We evaluated the performance of the automated quantitative BD MAX (Becton Dickinson) real-time PCR platform for detecting Pneumocystis jirovecii. MATERIALS & METHODS A total of 34 retrospective and 137 prospective samples were included. RESULTS Retrospectively, all (100%) positive samples were correctly detected by this platform compared with a nested PCR. Among prospective samples, the overall sensitivity, specificity, positive likelihood ratio and negative likelihood ratio were 92.6%, 94.5%, 17.0 and 0.1, respectively. All bronchoalveolar lavage fluid (BALF)/bronchial washing samples were correctly identified by this platform. Samples from patients with colonization had significantly higher median amplification cycle threshold values than patients with P. jirovecii pneumonia. CONCLUSION The quantitative BD MAX real-time PCR is a rapid and highly sensitive modality for detecting P. jirovecii, especially in samples from bronchoalveolar lavage fluid/bronchial washing fluid.
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Affiliation(s)
- Jung-Yien Chien
- Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chia-Jung Liu
- Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Pei-Chien Chuang
- Department of Laboratory Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Tai-Fen Lee
- Department of Laboratory Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Yu-Tsung Huang
- Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan.,Graduate Institute of Clinical Laboratory Sciences & Medical Biotechnology, National Taiwan University, Taipei, Taiwan
| | - Chun-Hsing Liao
- Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Chien-Ching Hung
- Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Wan-Huei Sheng
- Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chong-Jen Yu
- Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Po-Ren Hsueh
- Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.,Department of Laboratory Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
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Abstract
Pneumocystis carinii pneumonia (PCP) remains a serious infection in the immunocompromised host (in the absence of HIV infection) and presents significant management and diagnostic challenges to ICU physicians. Non-HIV PCP is generally abrupt in onset, and follows a fulminate course with high rates of hospitalization, ICT admission, respiratory failure, and requirement for intubation. Mortality is generally high, especially if mechanical ventilation is required. Non-invasive ventilatory support may be considered, although the rapid progression to respiratory failure often necessitates intubation at the time of presentation. Bronchoscopy is often required to establish the diagnosis, and empirical antimicrobial treatment specifically targeted to P. carinii should be initiated while awaiting confirmation. Adjunctive corticosteroids may accelerate recovery, although their use has not yet been established in non-HIV PCP. For the ICU physicians to diagnose PCP, the non-specific presentation of an acute febrile illness and respiratory distress with diffuse pulmonary infiltrates requires a high clinical index of suspician, familiarity with clinical conditions associated with increased risk for PCP, and a low threshold for bronchoscopy to establish the diagnosis.
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Affiliation(s)
- Geoffrey S. Gilmartin
- Division of Pulmonary and Critical Care, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA
| | - Henry Koziel
- Division of Pulmonary and Critical Care, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA.,
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Esteves F, de Sousa B, Calderón E, Huang L, Badura R, Maltez F, Bassat Q, de Armas Y, Antunes F, Matos O. Multicentre study highlighting clinical relevance of new high-throughput methodologies in molecular epidemiology of Pneumocystis jirovecii pneumonia. Clin Microbiol Infect 2016; 22:566.e9-566.e19. [DOI: 10.1016/j.cmi.2016.03.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Revised: 02/19/2016] [Accepted: 03/13/2016] [Indexed: 11/17/2022]
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Barcoding markers for Pneumocystis species in wildlife. Fungal Biol 2016; 120:191-206. [DOI: 10.1016/j.funbio.2015.08.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Revised: 08/21/2015] [Accepted: 08/27/2015] [Indexed: 11/24/2022]
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Goto N, Futamura K, Okada M, Yamamoto T, Tsujita M, Hiramitsu T, Narumi S, Watarai Y. Management of Pneumocystis jirovecii Pneumonia in Kidney Transplantation to Prevent Further Outbreak. CLINICAL MEDICINE INSIGHTS-CIRCULATORY RESPIRATORY AND PULMONARY MEDICINE 2015; 9:81-90. [PMID: 26609250 PMCID: PMC4648609 DOI: 10.4137/ccrpm.s23317] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Revised: 08/11/2015] [Accepted: 08/12/2015] [Indexed: 12/19/2022]
Abstract
The outbreak of Pneumocystis jirovecii pneumonia (PJP) among kidney transplant recipients is emerging worldwide. It is important to control nosocomial PJP infection. A delay in diagnosis and treatment increases the number of reservoir patients and the number of cases of respiratory failure and death. Owing to the large number of kidney transplant recipients compared to other types of organ transplantation, there are greater opportunities for them to share the same time and space. Although the use of trimethoprim-sulfamethoxazole (TMP-SMX) as first choice in PJP prophylaxis is valuable for PJP that develops from infections by trophic forms, it cannot prevent or clear colonization, in which cysts are dominant. Colonization of P. jirovecii is cleared by macrophages. While recent immunosuppressive therapies have decreased the rate of rejection, over-suppressed macrophages caused by the higher levels of immunosuppression may decrease the eradication rate of colonization. Once a PJP cluster enters these populations, which are gathered in one place and uniformly undergoing immunosuppressive therapy for kidney transplantation, an outbreak can occur easily. Quick actions for PJP patients, other recipients, and medical staff of transplant centers are required. In future, lifelong prophylaxis may be required even in kidney transplant recipients.
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Affiliation(s)
- Norihiko Goto
- Department of Transplant Surgery, Nagoya Daini Red Cross Hospital, Nagoya, Japan
| | - Kenta Futamura
- Department of Transplant Surgery, Nagoya Daini Red Cross Hospital, Nagoya, Japan
| | - Manabu Okada
- Department of Transplant Surgery, Nagoya Daini Red Cross Hospital, Nagoya, Japan
| | - Takayuki Yamamoto
- Department of Transplant Surgery, Nagoya Daini Red Cross Hospital, Nagoya, Japan
| | - Makoto Tsujita
- Department of Transplant Surgery, Nagoya Daini Red Cross Hospital, Nagoya, Japan
| | - Takahisa Hiramitsu
- Department of Transplant Surgery, Nagoya Daini Red Cross Hospital, Nagoya, Japan
| | - Shunji Narumi
- Department of Transplant Surgery, Nagoya Daini Red Cross Hospital, Nagoya, Japan
| | - Yoshihiko Watarai
- Department of Transplant Surgery, Nagoya Daini Red Cross Hospital, Nagoya, Japan
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Polvi EJ, Li X, O’Meara TR, Leach MD, Cowen LE. Opportunistic yeast pathogens: reservoirs, virulence mechanisms, and therapeutic strategies. Cell Mol Life Sci 2015; 72:2261-87. [PMID: 25700837 PMCID: PMC11113693 DOI: 10.1007/s00018-015-1860-z] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Revised: 02/06/2015] [Accepted: 02/11/2015] [Indexed: 12/21/2022]
Abstract
Life-threatening invasive fungal infections are becoming increasingly common, at least in part due to the prevalence of medical interventions resulting in immunosuppression. Opportunistic fungal pathogens of humans exploit hosts that are immunocompromised, whether by immunosuppression or genetic predisposition, with infections originating from either commensal or environmental sources. Fungal pathogens are armed with an arsenal of traits that promote pathogenesis, including the ability to survive host physiological conditions and to switch between different morphological states. Despite the profound impact of fungal pathogens on human health worldwide, diagnostic strategies remain crude and treatment options are limited, with resistance to antifungal drugs on the rise. This review will focus on the global burden of fungal infections, the reservoirs of these pathogens, the traits of opportunistic yeast that lead to pathogenesis, host genetic susceptibilities, and the challenges that must be overcome to combat antifungal drug resistance and improve clinical outcome.
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Affiliation(s)
- Elizabeth J. Polvi
- Department of Molecular Genetics, University of Toronto, 1 King’s College Circle, Medical Sciences Building, Room 4368, Toronto, ON M5S 1A8 Canada
| | - Xinliu Li
- Department of Molecular Genetics, University of Toronto, 1 King’s College Circle, Medical Sciences Building, Room 4368, Toronto, ON M5S 1A8 Canada
| | - Teresa R. O’Meara
- Department of Molecular Genetics, University of Toronto, 1 King’s College Circle, Medical Sciences Building, Room 4368, Toronto, ON M5S 1A8 Canada
| | - Michelle D. Leach
- Department of Molecular Genetics, University of Toronto, 1 King’s College Circle, Medical Sciences Building, Room 4368, Toronto, ON M5S 1A8 Canada
- Aberdeen Fungal Group, Institute of Medical Sciences, School of Medical Sciences, University of Aberdeen, Foresterhill, Aberdeen, UK
| | - Leah E. Cowen
- Department of Molecular Genetics, University of Toronto, 1 King’s College Circle, Medical Sciences Building, Room 4368, Toronto, ON M5S 1A8 Canada
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Demanche C, Deville M, Michaux J, Barriel V, Pinçon C, Aliouat-Denis CM, Pottier M, Noël C, Viscogliosi E, Aliouat EM, Dei-Cas E, Morand S, Guillot J. What do Pneumocystis organisms tell us about the phylogeography of their hosts? The case of the woodmouse Apodemus sylvaticus in continental Europe and western Mediterranean islands. PLoS One 2015; 10:e0120839. [PMID: 25830289 PMCID: PMC4382281 DOI: 10.1371/journal.pone.0120839] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Accepted: 02/11/2015] [Indexed: 12/02/2022] Open
Abstract
Pneumocystis fungi represent a highly diversified biological group with numerous species, which display a strong host-specificity suggesting a long co-speciation process. In the present study, the presence and genetic diversity of Pneumocystis organisms was investigated in 203 lung samples from woodmice (Apodemus sylvaticus) collected on western continental Europe and Mediterranean islands. The presence of Pneumocystis DNA was assessed by nested PCR at both large and small mitochondrial subunit (mtLSU and mtSSU) rRNA loci. Direct sequencing of nested PCR products demonstrated a very high variability among woodmouse-derived Pneumocystis organisms with a total number of 30 distinct combined mtLSU and mtSSU sequence types. However, the genetic divergence among these sequence types was very low (up to 3.87%) and the presence of several Pneumocystis species within Apodemus sylvaticus was considered unlikely. The analysis of the genetic structure of woodmouse-derived Pneumocystis revealed two distinct groups. The first one comprised Pneumocystis from woodmice collected in continental Spain, France and Balearic islands. The second one included Pneumocystis from woodmice collected in continental Italy, Corsica and Sicily. These two genetic groups were in accordance with the two lineages currently described within the host species Apodemus sylvaticus. Pneumocystis organisms are emerging as powerful tools for phylogeographic studies in mammals.
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Affiliation(s)
- Christine Demanche
- Laboratoire de Parasitologie (EA4547), Faculté de Pharmacie, Université de Lille, Lille, France; Institut Pasteur de Lille, Centre d'Infection et d'Immunité de Lille, Inserm U1019, UMR CNRS 8204, Université de Lille, BioPôle d'Alfort, Biologie et Diversité des Pathogènes Eucaryotes Emergents, Lille, France
| | - Manjula Deville
- ENVA, UPEC, Research group Dynamyc, Ecole Nationale Vétérinaire d'Alfort, 94704, Maisons-Alfort Cedex, France
| | - Johan Michaux
- CBGP (Centre de Biologie et de Gestion des Populations), UMR INRA/IRD/Cirad/Montpellier SupAgro, Campus international de Baillarguet, CS 30016, 34988, Montferrier-sur-Lez cedex, France; Institut de Botanique (B22), University of Liège, 4000, Liège, (Sart Tilman), Belgium
| | - Véronique Barriel
- Muséum national d'histoire naturelle, CR2P-UMR 7207 CNRS, MNHN, Univ Paris06, Paris, France
| | - Claire Pinçon
- Departement of Biostatistics (EA2694), Université de Lille, Lille, France
| | - Cécile Marie Aliouat-Denis
- Laboratoire de Parasitologie (EA4547), Faculté de Pharmacie, Université de Lille, Lille, France; Institut Pasteur de Lille, Centre d'Infection et d'Immunité de Lille, Inserm U1019, UMR CNRS 8204, Université de Lille, BioPôle d'Alfort, Biologie et Diversité des Pathogènes Eucaryotes Emergents, Lille, France
| | - Muriel Pottier
- Laboratoire de Parasitologie (EA4547), Faculté de Pharmacie, Université de Lille, Lille, France; Institut Pasteur de Lille, Centre d'Infection et d'Immunité de Lille, Inserm U1019, UMR CNRS 8204, Université de Lille, BioPôle d'Alfort, Biologie et Diversité des Pathogènes Eucaryotes Emergents, Lille, France
| | - Christophe Noël
- Geneius Laboratories Ltd, INEX Business Centre, Newcastle upon Tyne, United Kingdom
| | - Eric Viscogliosi
- Institut Pasteur de Lille, Centre d'Infection et d'Immunité de Lille, Inserm U1019, UMR CNRS 8204, Université de Lille, BioPôle d'Alfort, Biologie et Diversité des Pathogènes Eucaryotes Emergents, Lille, France
| | - El Moukhtar Aliouat
- Laboratoire de Parasitologie (EA4547), Faculté de Pharmacie, Université de Lille, Lille, France; Institut Pasteur de Lille, Centre d'Infection et d'Immunité de Lille, Inserm U1019, UMR CNRS 8204, Université de Lille, BioPôle d'Alfort, Biologie et Diversité des Pathogènes Eucaryotes Emergents, Lille, France
| | - Eduardo Dei-Cas
- Institut Pasteur de Lille, Centre d'Infection et d'Immunité de Lille, Inserm U1019, UMR CNRS 8204, Université de Lille, BioPôle d'Alfort, Biologie et Diversité des Pathogènes Eucaryotes Emergents, Lille, France; Parasitologie-Mycologie (EA4547) Faculté de Médecine, Université de Lille, CHRU, Lille, France
| | - Serge Morand
- Institut des Sciences de l'Evolution, UMR CNRS-IRD-UM2, Université de Montpellier 2, F-34093, Montpellier, France; CIRAD-CNRS, Centre d'Infectiologie Christophe Mérieux du Laos, Vientiane, Lao PDR
| | - Jacques Guillot
- ENVA, UPEC, Research group Dynamyc, Ecole Nationale Vétérinaire d'Alfort, 94704, Maisons-Alfort Cedex, France
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Sheikholeslami MF, Sadraei J, Farnia P, Forozandeh Moghadam M, Emadi Kochak H. Co-infection of Mycobacterium tuberculosis and Pneumocystis jirovecii in the Iranian Patients With Human Immunodeficiency Virus. Jundishapur J Microbiol 2015; 8:e17254. [PMID: 25825645 PMCID: PMC4376971 DOI: 10.5812/jjm.17254] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2013] [Revised: 06/09/2014] [Accepted: 07/30/2014] [Indexed: 11/16/2022] Open
Abstract
Background: Based on the authors’ knowledge, there is no study on the co-infection of opportunistic agents such as Mycobacterium tuberculosis and Pneumocystis jirovecii in the lungs of Iranian patients with immunosuppression. Objectives: The current study aimed to show the rate of co-infection of M. tuberculosis and P. jirovecii in patients with Human Immunodeficiency Virus (HIV). Patients and Methods: Forty-five pulmonary samples were collected from 30 patients with HIV who also infected with Tuberculosis and Pneumonia. All of the patients were admitted to two university hospitals of Mycobacteriology and the Iranian HIV/AIDS research centers. DNA of P. jirovecii was detected using nested-Polymerase Chain Reaction (nested-PCR) assay. Results: All of the patients were male with the mean age of 32.95 ± 7.15 years. The mean of CD4 cell count was 109.25 cell/mm3. Of 30 patients with HIV, three (10%) were co-infected with M. tuberculosis and P. jirovecii. No other causes of pneumonia were found in those three patients and CD4 cell counts less than 50 cell/mm3 was reported. Conclusions: The results of the current study showed a high rate of co-infection of M. tuberculosis and P. jirovecii in the Iranian patients with HIV. As the immune system condition worsened, the probability of occurrence of Pneumocystis Pneumonia (PCP) increased. Therefore, more specific, most rapid and sensitive tests should be utilized for diagnosis of PCP in this group of patients.
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Affiliation(s)
- Maryam Fatemeh Sheikholeslami
- Department of Parasitology, Tarbiat Modares University, Tehran, IR Iran
- Mycobacteriology Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences Tehran, IR Iran
| | - Javid Sadraei
- Department of Parasitology, Tarbiat Modares University, Tehran, IR Iran
- Corresponding author: Javid Sadraei, Department of Parasitology, Tarbiat Modares University, Tehran, IR Iran. Tel:+98-2182883841, Fax: +98-2182884555, E-mail:
| | - Parissa Farnia
- Mycobacteriology Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences Tehran, IR Iran
| | | | - Hamid Emadi Kochak
- Iranian HIV/AIDS Research Center, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, IR Iran
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Nowland MH, Brammer DW, Garcia A, Rush HG. Biology and Diseases of Rabbits. LABORATORY ANIMAL MEDICINE 2015. [PMCID: PMC7150064 DOI: 10.1016/b978-0-12-409527-4.00010-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Beginning in 1931, an inbred rabbit colony was developed at the Phipps Institute for the Study, Treatment and Prevention of Tuberculosis at the University of Pennsylvania. This colony was used to study natural resistance to infection with tuberculosis (Robertson et al., 1966). Other inbred colonies or well-defined breeding colonies were also developed at the University of Illinois College of Medicine Center for Genetics, the Laboratories of the International Health Division of The Rockefeller Foundation, the University of Utrecht in the Netherlands, and Jackson Laboratories. These colonies were moved or closed in the years to follow. Since 1973, the U.S. Department of Agriculture has reported the total number of certain species of animals used by registered research facilities (1997). In 1973, 447,570 rabbits were used in research. There has been an overall decrease in numbers of rabbits used. This decreasing trend started in the mid-1990s. In 2010, 210,172 rabbits were used in research. Despite the overall drop in the number used in research, the rabbit is still a valuable model and tool for many disciplines.
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Chabé M, Khalife S, Gantois N, Even G, Audebert C. An improved single-round PCR leads to rapid and highly sensitive detection of Pneumocystis spp. Med Mycol 2014; 52:841-6. [DOI: 10.1093/mmy/myu032] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Fong S, Daly KR, Tipirneni R, Jarlsberg LG, Djawe K, Koch JV, Swartzman A, Roth B, Walzer PD, Huang L. Antibody responses against Pneumocystis jirovecii in health care workers over time. Emerg Infect Dis 2014; 19:1612-9. [PMID: 24048016 PMCID: PMC3810734 DOI: 10.3201/eid1910.121836] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
In a previous cross-sectional study, we showed that clinical staff working in a hospital had significantly higher antibody levels than nonclinical staff to Pneumocystis jirovecii. We conducted a longitudinal study, described here, to determine whether occupation and self-reported exposure to a patient with P. jirovecii pneumonia were associated with antibody levels to P. jirovecii over time. Baseline and quarterly serum specimens were collected and analyzed by using an ELISA that targeted different variants of the Pneumocystis major surface glycoprotein (MsgA, MsgB, MsgC1, MsgC3, MsgC8, and MsgC9). Clinical staff had significantly higher estimated geometric mean antibody levels against MsgC1 and MsgC8 than did nonclinical staff over time. Significant differences were observed when we compared the change in antibody levels to the different MsgC variants for staff who were and were not exposed to P. jirovecii pneumonia-infected patients. MsgC variants may serve as indicators of exposure to P. jirovecii in immunocompetent persons.
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Monroy-Vaca EX, de Armas Y, Illnait-Zaragozí MT, Diaz R, Toraño G, Vega D, Álvarez-Lam I, Calderón EJ, Stensvold CR. Genetic diversity of Pneumocystis jirovecii in colonized Cuban infants and toddlers. INFECTION GENETICS AND EVOLUTION 2014; 22:60-6. [DOI: 10.1016/j.meegid.2013.12.024] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Revised: 12/10/2013] [Accepted: 12/29/2013] [Indexed: 11/16/2022]
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González-González AE, Aliouat-Denis CM, Ramírez-Bárcenas JA, Demanche C, Pottier M, Carreto-Binaghi LE, Akbar H, Derouiche S, Chabé M, Aliouat EM, Dei-Cas E, Taylor ML. Histoplasma capsulatum and Pneumocystis spp. co-infection in wild bats from Argentina, French Guyana, and Mexico. BMC Microbiol 2014; 14:23. [PMID: 24495513 PMCID: PMC3916801 DOI: 10.1186/1471-2180-14-23] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2013] [Accepted: 01/27/2014] [Indexed: 12/11/2022] Open
Abstract
Background Histoplasma capsulatum and Pneumocystis organisms cause host infections primarily affecting the lung tissue. H. capsulatum is endemic in the United States of America and Latin American countries. In special environments, H. capsulatum is commonly associated with bat and bird droppings. Pneumocystis-host specificity has been primarily studied in laboratory animals, and its ability to be harboured by wild animals remains as an important issue for understanding the spread of this pathogen in nature. Bats infected with H. capsulatum or Pneumocystis spp. have been found, with this mammal serving as a probable reservoir and disperser; however, the co-infection of bats with both of these microorganisms has never been explored. To evaluate the impact of H. capsulatum and Pneumocystis spp. infections in this flying mammal, 21 bat lungs from Argentina (AR), 13 from French Guyana (FG), and 88 from Mexico (MX) were screened using nested-PCR of the fragments, employing the Hcp100 locus for H. capsulatum and the mtLSUrRNA and mtSSUrRNA loci for Pneumocystis organisms. Results Of the 122 bats studied, 98 revealed H. capsulatum infections in which 55 of these bats exhibited this infection alone. In addition, 51 bats revealed Pneumocystis spp. infection of which eight bats exhibited a Pneumocystis infection alone. A total of 43 bats (eight from AR, one from FG, and 34 from MX) were found co-infected with both fungi, representing a co-infection rate of 35.2% (95% CI = 26.8-43.6%). Conclusion The data highlights the H. capsulatum and Pneumocystis spp.co-infection in bat population’s suggesting interplay with this wild host.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Maria Lucia Taylor
- Department of Microbiology and Parasitology, School of Medicine, National Autonomous University of Mexico, Mexico City 04510, Mexico.
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Sheikholeslami MF, Sadraei J, Farnia P, Forozandeh M, Emadi kochak H, Tabarsi P, Nadji SA, Pirestani M, Masjedi MR, Velayati A. Colonization of Pneumocystis jirovecii in Chronic Obstructive Pulmonary Disease (COPD) patients and the rate of Pneumocystis pneumonia in Iranian non-HIV(+) immunocompromised patients. IRANIAN JOURNAL OF MICROBIOLOGY 2013; 5:411-7. [PMID: 25848514 PMCID: PMC4385170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND OBJECTIVES With increasing rate of immunodeficiency diseases in the world, opportunistic micro-organism such as Pneumocystis jirovecii (P. jirovecii) become more important. Little information is available on prevalence of this life-threatening microorganism in Iran. This study was designed to determine the colonization and the rate of active disease caused by P. jirovecii in two groups of Iranian immunosuppressed patients. MATERIALS AND METHODS Two hundred and fifty five pulmonary samples were collected from two groups of immunosuppressed patients to detect a 260bp fragment of mt LSU rRNA gene of P. jirovecii by nested PCR. The first group was COPD patients consumed oral, inhaled or injectable corticosteroid and the second group was patients with malignancies under chemotherapy. Both groups were referred to National Research Institute of Tuberculosis and Lung Disease and Imam Khomeini hospital because of pulmonary symptoms. All patients introduced to this project were confirmed HIV sera-negative by ELISA and western blot test. RESULTS The mean age of COPD patients was 66.5 ± 11 (41-88) years and all of them were men. The mean age of patients with malignancy (PMs) was 43 ± 11 (23-65) years and 51.6% were men. The P. jirovecii was colonized in 7 of 89 COPD patients (7.9%) and its DNA was isolated from 11 of 153 PMs (7.2%). The microorganism could cause active disease in 7 of 67 (10.5%) PMs who suffered from pneumonia. CONCLUSION The study showed that P. jirovecii was one of colonizing agents in the COPD patients, but it could cause active disease in PMs. Generally, the microorganism can exist in the lung of non-HIV(+) immunosuppressed patients. Therefore, it should be considered as a potential infective agent in non-HIV(+) immunocompromised patients.
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Affiliation(s)
- Maryam Fatemeh Sheikholeslami
- Mycobacteriology Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran,Tarbiat Modares University, Medical Faculty, Parasitology department, Tehran, Iran,Corresponding author: Maryam Fatemeh Sheikholeslami Ph.D of clinical parasitology, Address: Mycobacteriology Research Center, National Research Institute Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran, Tel/Fax: +98-21-26109505,
| | - Javid Sadraei
- Tarbiat Modares University, Medical Faculty, Parasitology department, Tehran, Iran
| | - Parissa Farnia
- Mycobacteriology Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehdi Forozandeh
- Tarbiat Modares University, Medical Faculty, Biotechnology department, Tehran, Iran
| | - Hamid Emadi kochak
- Iranian HIV/AIDS Research Center, Imam Khomini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Payam Tabarsi
- Mycobacteriology Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyed Alireza Nadji
- Virology Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Majid Pirestani
- Tarbiat Modares University, Medical Faculty, Parasitology department, Tehran, Iran
| | - Mohammad Reza Masjedi
- Chronic Respiratory Disease Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - AliAkbar Velayati
- Mycobacteriology Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran,Chronic Respiratory Disease Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Martinez A, Halliez MCM, Aliouat EM, Chabé M, Standaert-Vitse A, Fréalle E, Gantois N, Pottier M, Pinon A, Dei-Cas E, Aliouat-Denis CM. Growth and airborne transmission of cell-sorted life cycle stages of Pneumocystis carinii. PLoS One 2013; 8:e79958. [PMID: 24223207 PMCID: PMC3819301 DOI: 10.1371/journal.pone.0079958] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2013] [Accepted: 09/30/2013] [Indexed: 01/15/2023] Open
Abstract
Pneumocystis organisms are airborne opportunistic pathogens that cannot be continuously grown in culture. Consequently, the follow-up of Pneumocystis stage-to-stage differentiation, the sequence of their multiplication processes as well as formal identification of the transmitted form have remained elusive. The successful high-speed cell sorting of trophic and cystic forms is paving the way for the elucidation of the complex Pneumocystis life cycle. The growth of each sorted Pneumocystis stage population was followed up independently both in nude rats and in vitro. In addition, by setting up a novel nude rat model, we attempted to delineate which cystic and/or trophic forms can be naturally aerially transmitted from host to host. The results showed that in axenic culture, cystic forms can differentiate into trophic forms, whereas trophic forms are unable to evolve into cystic forms. In contrast, nude rats inoculated with pure trophic forms are able to produce cystic forms and vice versa. Transmission experiments indicated that 12 h of contact between seeder and recipient nude rats was sufficient for cystic forms to be aerially transmitted. In conclusion, trophic- to cystic-form transition is a key step in the proliferation of Pneumocystis microfungi because the cystic forms (but not the trophic forms) can be transmitted by aerial route from host to host.
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Affiliation(s)
- Anna Martinez
- Biology and Diversity of Emerging Eukaryotic Pathogens (BDEEP), Center for Infection and Immunity of Lille (CIIL), INSERM U1019, CNRS UMR 8204, EA-4547, Univ Lille Nord de France, Institut Pasteur de Lille, Lille, France ; Japan Collection of Microorganisms, RIKEN BioResource Center, Koyadai, Tsukuba, Ibaraki, Japan
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Sheikholeslami MF, Sadraei J, Farnia P, Forozandeh Moghadam M, Emadi Kochak H. Typing ofPneumocystis jiroveciiisolates from Iranian immunosuppressed patients based on the Internal Transcribed Spacer (ITS) region of the rRNA gene. Med Mycol 2013; 51:843-50. [DOI: 10.3109/13693786.2013.811553] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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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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Walzer PD. The ecology of pneumocystis: perspectives, personal recollections, and future research opportunities. J Eukaryot Microbiol 2013; 60:634-45. [PMID: 24001365 DOI: 10.1111/jeu.12072] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Revised: 07/17/2013] [Accepted: 07/17/2013] [Indexed: 11/28/2022]
Abstract
I am honored to receive the second Lifetime Achievement Award by International Workshops on Opportunistic Protists and to give this lecture. My research involves Pneumocystis, an opportunistic pulmonary fungus that is a major cause of pneumonia ("PcP") in the immunocompromised host. I decided to focus on Pneumocystis ecology here because it has not attracted much interest. Pneumocystis infection is acquired by inhalation, and the cyst stage appears to be the infective form. Several fungal lung infections, such as coccidiomycosis, are not communicable, but occur by inhaling < 5 μm spores from environmental sources (buildings, parks), and can be affected by environmental factors. PcP risk factors include environmental constituents (temperature, humidity, SO2 , CO) and outdoor activities (camping). Clusters of PcP have occurred, but no environmental source has been found. Pneumocystis is communicable and outbreaks of PcP, especially in renal transplant patients, are an ongoing problem. Recent evidence suggests that most viable Pneumocystis organisms detected in the air are confined to a patient's room. Further efforts are needed to define the risk of Pneumocystis transmission in health care facilities; to develop more robust preventive measures; and to characterize the effects of climatological and air pollutant factors on Pneumocystis transmission in animal models similar to those used for respiratory viruses.
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Affiliation(s)
- Peter D Walzer
- Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio, 45267-0560; Research Service, Veterans Affairs Medical Center, Cincinnati, Ohio, 45220
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Curran T, McCaughey C, Coyle PV. Pneumocystis jirovecii multilocus genotyping profiles in Northern Ireland. J Med Microbiol 2013; 62:1170-1174. [DOI: 10.1099/jmm.0.057794-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Pneumocystis jirovecii causes pneumonia, a severe opportunistic infection in immunosuppressed patients that has both person-to-person airborne transmission and environmental transmission as important routes of infection. An increasing incidence of P. jirovecii in Northern Ireland prompted a detailed epidemiological and molecular review that included enhanced surveillance on all lower respiratory specimens. Genotyping of these P. jirovecii positive specimens was undertaken using multiple locus sequence typing (MLST) targeting known variable regions of the P. jirovecii genome. Multiple circulating types were found among all patient risk categories. However, a predominance of one MLST type was found in a P. jirovecii outbreak amongst the renal transplant population. Our results demonstrate the diversity of P. jirovecii strains amongst the local immunosuppressed cohort and highlight the importance of genotyping in the investigation of common sources of P. jirovecii amongst immunosuppressed patients.
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Affiliation(s)
- Tanya Curran
- Regional Virus Laboratory, Microbiology Department, Kelvin Building, Royal Victoria Hospital, Belfast, Northern Ireland BT12 6BA, UK
| | - Conall McCaughey
- Regional Virus Laboratory, Microbiology Department, Kelvin Building, Royal Victoria Hospital, Belfast, Northern Ireland BT12 6BA, UK
| | - Peter V. Coyle
- Regional Virus Laboratory, Microbiology Department, Kelvin Building, Royal Victoria Hospital, Belfast, Northern Ireland BT12 6BA, UK
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Jarboui MA, Mseddi F, Sellami H, Sellami A, Makni F, Ayadi A. [Pneumocystis: epidemiology and molecular approaches]. ACTA ACUST UNITED AC 2013; 61:239-44. [PMID: 23849772 DOI: 10.1016/j.patbio.2013.05.001] [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: 03/12/2013] [Accepted: 05/17/2013] [Indexed: 10/26/2022]
Abstract
Pneumocystosis is a common opportunistic infection in immunocompromised patients, especially in AIDS patients. The diagnosis of this pneumonia has presented several difficulties due to the low sensitivity of conventional staining methods and the absence of culture system for Pneumocystis. The molecular biology techniques, especially the PCR, have improved the detection of DNA of this fungus in invasive and noninvasive samples, and in the environment which highlighted human transmission and the existence of environmental source of Pneumocystis. In addition, various molecular biology techniques were used for typing of Pneumocystis strains, especially P. jirovecii, which is characterized by a significant genetic biodiversity. Finally, the widespread use of cotrimoxazole for the treatment and prophylaxis of pneumocystosis has raised questions about possible resistance to sulfa drugs in P. jirovecii.
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Affiliation(s)
- M A Jarboui
- Laboratoire de biologie moléculaire parasitaire et fongique, faculté de médecine, université de Sfax, rue de Magida Boulila, 3029 Sfax, Tunisie.
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Rate of Pneumocystis pneumonia in Iranian HIV+ Patients with Pulmonary Infiltrates. Jundishapur J Microbiol 2013. [DOI: 10.5812/jjm.10052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
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