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Grønseth S, Rogne T, Hannula R, Åsvold BO, Afset JE, Damås JK. Semiquantitative Real-Time PCR to Distinguish Pneumocystis Pneumonia from Colonization in a Heterogeneous Population of HIV-Negative Immunocompromised Patients. Microbiol Spectr 2021; 9:e0002621. [PMID: 34346746 PMCID: PMC8552647 DOI: 10.1128/spectrum.00026-21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 06/14/2021] [Indexed: 11/20/2022] Open
Abstract
Pneumocystis jirovecii is a threat to iatrogenically immunosuppressed individuals, a heterogeneous population at rapid growth. We assessed the ability of an in-house semiquantitative real-time PCR assay to discriminate Pneumocystis pneumonia (PCP) from colonization and identified risk factors for infection in these patients. Retrospectively, 242 PCR-positive patients were compared according to PCP status, including strata by immunosuppressive conditions, human immunodeficiency virus (HIV) infection excluded. Associations between host characteristics and cycle threshold (CT) values, semiquantitative real-time PCR correlates of fungal loads in lower respiratory tract specimens, were investigated. CT values differed significantly according to PCP status. Overall, a CT value of 36 allowed differentiation between PCP and colonization with sensitivity and specificity of 71.3% and 77.1%, respectively. A CT value of less than 31 confirmed PCP, whereas no CT value permitted exclusion. A considerable diversity was uncovered; solid organ transplant (SOT) recipients had significantly higher fungal loads than patients with hematological malignancies. In SOT recipients, a CT cutoff value of 36 resulted in sensitivity and specificity of 95.0% and 83.3%, respectively. In patients with hematological malignancies, a higher CT cutoff value of 37 improved sensitivity to 88.5% but reduced specificity to 66.7%. For other conditions, assay validity appeared inferior. Corticosteroid usage was an independent predictor of PCP in a multivariable analysis and was associated with higher fungal loads at PCP expression. Semiquantitative real-time PCR improves differentiation between PCP and colonization in immunocompromised HIV-negative individuals with acute respiratory syndromes. However, heterogeneity in disease evolution requires separate cutoff values across intrinsic and iatrogenic predisposition for predicting non-HIV PCP. IMPORTANCE Pneumocystis jirovecii is potentially life threatening to an increasing number of individuals with compromised immune systems. This microorganism can cause severe pneumonia in susceptible hosts, including patients with cancer and autoimmune diseases and people undergoing solid organ transplantation. Together, these patients constitute an ever-diverse population. In this paper, we demonstrate that the heterogeneity herein has important implications for how we diagnose and assess the risk of Pneumocystis pneumonia (PCP). Specifically, low loads of microorganisms are sufficient to cause infection in patients with blood cancer compared to those in solid organ recipients. With this new insight into host versus P. jirovecii biology, clinicians can manage patients at risk of PCP more accurately. As a result, we take a significant step toward offering precision medicine to a vulnerable patient population. One the one hand, these patients have propensity for adverse effects from antimicrobial treatment. On the other hand, this population is susceptible to life-threatening infections, including PCP.
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Affiliation(s)
- Stine Grønseth
- Department of Clinical and Molecular Medicine, NTNU, Trondheim, Norway
| | - Tormod Rogne
- Department of Circulation and Medical Imaging, NTNU, Trondheim, Norway
- Department of Chronic Disease Epidemiology, Center for Perinatal, Pediatric and Environmental Epidemiology, Yale School of Public Health, New Haven, Connecticut, USA
| | - Raisa Hannula
- Department of Infectious Diseases, St. Olavs hospital, Trondheim University Hospital, Trondheim, Norway
| | - Bjørn Olav Åsvold
- K.G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, NTNU, Trondheim, Norway
- HUNT Research Center, Department of Public Health and Nursing, NTNU, Levanger, Norway
- Department of Endocrinology, St. Olavs hospital, Trondheim University Hospital, Trondheim, Norway
| | - Jan Egil Afset
- Department of Clinical and Molecular Medicine, NTNU, Trondheim, Norway
- Department of Medical Microbiology, St. Olavs hospital, Trondheim University Hospital, Trondheim, Norway
| | - Jan Kristian Damås
- Department of Clinical and Molecular Medicine, NTNU, Trondheim, Norway
- Department of Infectious Diseases, St. Olavs hospital, Trondheim University Hospital, Trondheim, Norway
- Centre of Molecular Inflammation Research, NTNU, Trondheim, Norway
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Charpentier E, Garnaud C, Wintenberger C, Bailly S, Murat JB, Rendu J, Pavese P, Drouet T, Augier C, Malvezzi P, Thiébaut-Bertrand A, Mallaret MR, Epaulard O, Cornet M, Larrat S, Maubon D. Added Value of Next-Generation Sequencing for Multilocus Sequence Typing Analysis of a Pneumocystis jirovecii Pneumonia Outbreak1. Emerg Infect Dis 2018; 23:1237-1245. [PMID: 28726611 PMCID: PMC5547796 DOI: 10.3201/eid2308.161295] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Pneumocystis jirovecii is a major threat for immunocompromised patients, and clusters of pneumocystis pneumonia (PCP) have been increasingly described in transplant units during the past decade. Exploring an outbreak transmission network requires complementary spatiotemporal and strain-typing approaches. We analyzed a PCP outbreak and demonstrated the added value of next-generation sequencing (NGS) for the multilocus sequence typing (MLST) study of P. jirovecii strains. Thirty-two PCP patients were included. Among the 12 solid organ transplant patients, 5 shared a major and unique genotype that was also found as a minor strain in a sixth patient. A transmission map analysis strengthened the suspicion of nosocomial acquisition of this strain for the 6 patients. NGS-MLST enables accurate determination of subpopulation, which allowed excluding other patients from the transmission network. NGS-MLST genotyping approach was essential to deciphering this outbreak. This innovative approach brings new insights for future epidemiologic studies on this uncultivable opportunistic fungus.
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Pini P, Orsi CF, La Regina A, Peppoloni S, Berrilli F, Blasi E, Di Cave D. Pneumocystis jirovecii genotyping: experience in a tertiary-care hospital in Northern Italy. New Microbiol 2017; 40:208-211. [PMID: 28920631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 07/31/2017] [Indexed: 06/07/2023]
Abstract
Respiratory samples from Pneumocystis jirovecii pneumonia (PJP) cases collected at a tertiary-care university hospital in Modena were analyzed for the presence of specific polymorphisms in the mitochondrial large subunit ribosomal RNA (mtLSU-rRNA). Retrospectively, 57 cases were selected in a six-year period and 34 out of the 57 processed BAL samples returned PCR positive results, thus allowing further molecular analysis. The following P.jirovecii genotype distribution was observed: genotype 3 (50%), genotype 2 (23%), genotype 1 (18%), genotypes 1 or 4 (9%). These data add novel insights on P.jirovecii epidemiology, investigating a previously unstudied area of Northern Italy. A peculiar local distribution is highlighted with respect to other areas within the national panorama, thus encouraging further in-depth studies in an attempt to better understand the overall situation concerning P.jirovecii genotype circulation.
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Affiliation(s)
- Pietro Pini
- Azienda Ospedaliero-Universitaria Policlinic of Modena, Modena, Italy
| | | | | | | | - Federica Berrilli
- Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Elisabetta Blasi
- Azienda Ospedaliero-Universitaria Policlinic of Modena, Modena, Italy
- University of Modena and Reggio Emilia, Modena, Italy
| | - David Di Cave
- Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, Rome, Italy
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Calderón Sandubete E, de Armas Rodríguez Y, Capó de Paz V. [Pneumocystis jirovecii: one hundred years of history]. Rev Cubana Med Trop 2011; 63:97-116. [PMID: 23437517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
INTRODUCTION Pneumocystis jirovecii is one of the most important opportunistic pathogens affecting AIDS individuals and immunodepressive patients. In spite of the fact that it was observed one hundred years ago for the first time, many fundamental aspects of its biology and the morbidity it causes are still unknown. OBJECTIVE this paper was aimed at presenting updating on the main aspects of the history, the epidemiology and the biology of P. jirovecii and the disease it causes. CONCLUSIONS a number of review articles have been published since the discovery, all of which provide details and novel elements of the microorganism. However, few original papers dealing with this problem have been found in the Spanish literature.
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Magne D, Angoulvant A, Botterel F, Bouges-Michel C, Bougnoux ME, Bouree P, Chochillon C, Cornet M, Dannaoui E, Fekkar A, Galeazzi G, Yera H, Sarfati C, Roux P. Pneumocystosis: a network survey in the Paris area 2003-2008. Eur J Clin Microbiol Infect Dis 2011; 30:673-5. [PMID: 21229281 DOI: 10.1007/s10096-010-1139-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2010] [Accepted: 12/20/2010] [Indexed: 11/25/2022]
Abstract
The aims of this network group were to collect epidemiological data of PcP cases in 14 hospitals in the Paris area and to determine the Di-Hydro Pteroate Synthase (DHPS) genotypes, genetic markers for possible sulfamide resistance. From January 1, 2003 to December 31, 2008, 993 (mean 166/year) PcP cases have been reported. Sixty-five percent of patients were HIV-positive. The median count of CD4 lymphocytes was 32/mm(3) (30 in HIV-positive patients, 152 in HIV-negative patients). In HIV-positive patients, PcP revealed the HIV infection in 39%. Among 304 PcP occurring in HIV known infected patients, no prophylaxis was prescribed for 64%; cotrimoxazole prophylaxis had been prescribed to 47 patients but only one of them had the right compliance. In HIV-negative patients (264), corticosteroids were prescribed in 59% and cytotoxic chemotherapies in 34%; 78% did not receive prophylaxis. One hundred sixty nine tumoral pathologies and 116 transplantations were notified. The mortality rate was 16% at day 14 (13% in HIV-positive patients, 26% in HIV-negative patients). Mutations in DHPS genes were detected in 18.5% of samples; 12.5% of patients were infected with several strains. The total annual number of cases has been stable for five years but the proportion of HIV-negative patients increased from 25% to 43%.
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Affiliation(s)
- D Magne
- Hôpital St Antoine, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes, Paris, France.
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Herrag M, Elfassy Fihry MT, Alaoui Yazidi A. [Pneumocystis jirovecii: what does this mean?]. Rev Pneumol Clin 2010; 66:342-346. [PMID: 21167441 DOI: 10.1016/j.pneumo.2009.09.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2009] [Accepted: 09/13/2009] [Indexed: 05/30/2023]
Abstract
Pneumocystis was discovered nearly a century ago. It causes fatal pneumonia in immunocompromised individuals, especially in AIDS patients. Knowledge of the different species remained rudimentary until the mid-eighties when DNA analysis revealed its extensive diversity. In fact, it is no longer considered as a zoonosis. Pneumocystis organisms derived from different hosts have very different DNA sequences, indicating multiple species. Due to the genetic and functional disparities, the organism that causes human PCP is now named Pneumocystis jirovecii/Frenkel, 1999. We continue to call Pneumocystis carinii the species found in rats. This will allow for a single international language and avoid confusion. Changing the organism's name does not preclude the use of the well-known acronym PCP because it can also be read "PneumoCystis Pneumonia." The DNA sequences and genotypage have shown that variations exist among samples of P. jiroveci. Molecular biology is helpful in the study of the mechanisms of transmission, which can only occur in the same host and the different resistances as well as providing a better understanding of the relationship between host and pathogen. P. jirovecii pneumonia in immunosuppressed patients was previously thought to result from the reactivation of a latent infection acquired in early childhood. However, today, it is believed to result from a new infection from an exogenous source.
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Affiliation(s)
- M Herrag
- Service de pneumologie, hôpital Ibn Nafis, CHU Mohammed VI, faculté de médecine et de pharmacie, université Cadi Ayyad, Marrakech, Maroc.
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Hauser P, Rabodonirina M, Nevez G. Hypothetical Pneumocystis jirovecii transmission from immunocompetent carriers to infant. Emerg Infect Dis 2009; 15:506-7; author reply 507. [PMID: 19239783 PMCID: PMC2681130 DOI: 10.3201/eid1503.081350] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Montes-Cano MA, Chabe M, Fontillon-Alberdi M, de-Lahorra C, Respaldiza N, Medrano FJ, Varela JM, Dei-Cas E, Calderon EJ. Vertical transmission of Pneumocystis jirovecii in humans. Emerg Infect Dis 2009; 15:125-7. [PMID: 19116075 PMCID: PMC2660686 DOI: 10.3201/eid1501.080242] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Costa MC, Esteves F, Antunes F, Matos O. Multilocus genotyping of Pneumocystis jirovecii in immunocompromised patients: preliminary results. J Eukaryot Microbiol 2007; 53 Suppl 1:S104-5. [PMID: 17169017 DOI: 10.1111/j.1550-7408.2006.00190.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Marina C Costa
- Instituto de Higiene e Medicina Tropical, Unidade de Protozoários Oportunistas/VIH e outras Protozooses, Unidade de Parasitologia e Microbiologia Médicas, 1349-008 Lisboa, Portugal
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Huang L, Welsh DA, Miller RF, Beard CB, Lawrence GG, Fox M, Swartzman A, Bensley MR, Carbonnet D, Davis JL, Chi A, Yoo BJ, Jones JL. Pneumocystis jirovecii dihydropteroate synthase gene mutations and human immunodeficiency virus-associated Pneumocystis pneumonia. J Eukaryot Microbiol 2007; 53 Suppl 1:S114-6. [PMID: 17169022 DOI: 10.1111/j.1550-7408.2006.00195.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Laurence Huang
- HIV/AIDS Division, Division of Pulmonary and Critical Care Medicine, San Francisco General Hospital, University of California San Francisco, San Francisco, California 94110, USA.
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Valerio A, Tronconi E, Mazza F, Cargnel A, Fantoni G, Atzori C. DHPS-mutated isolates of Pneumocystis jirovecii from HIV-infected individuals: analysis of related ITS genotypes. J Eukaryot Microbiol 2007; 53 Suppl 1:S108-9. [PMID: 17169019 DOI: 10.1111/j.1550-7408.2006.00192.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Antonella Valerio
- 2nd Department of Infectious Diseases, L. Sacco Hospital, 20157 Milan, Italy
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15
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Rabodonirina M, Nahimana A, Weber R, Francioli P, Bille J, Hauser PM. Geographical variation in the prevalence of Pneumocystis jirovecii dihydropteroate synthase mutations within Western Europe. J Eukaryot Microbiol 2007; 53 Suppl 1:S112-3. [PMID: 17169021 DOI: 10.1111/j.1550-7408.2006.00194.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Meja Rabodonirina
- Parasitology Unit, Croix-Rousse Hospital, Hospices Civils de Lyon, 103 Grande-Rue de la Croix-Rousse, 69317 Lyon Cedex 04, France.
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Totet A, Gresillon K, Matos O, Lundgren B, Larsen HH, Roux P, Hauser P, Raccurt C, Nevez G. Pneumocystis jirovecii genotypes in European patients with chronic obstructive pulmonary diseases. J Eukaryot Microbiol 2007; 53 Suppl 1:S102-3. [PMID: 17169016 DOI: 10.1111/j.1550-7408.2006.00189.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Anne Totet
- Amiens University Hospital, Department of Medical Parasitology and Mycology, University Hospital, Avenue René Laënnec, 80054, Amiens, France.
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Montes-Cano MA, de la Horra C, Dapena FJ, Mateos I, Friaza V, Respaldiza N, Muñoz-Lobato F, Medrano FJ, Calderon EJ, Varela JM. Dynamic colonisation by different Pneumocystis jirovecii genotypes in cystic fibrosis patients. Clin Microbiol Infect 2007; 13:1008-11. [PMID: 17711486 DOI: 10.1111/j.1469-0691.2007.01789.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Although asymptomatic carriers of Pneumocystis jirovecii with cystic fibrosis (CF) have been described previously, the molecular epidemiology of P. jirovecii in CF patients has not yet been clarified. This study identified the distribution and dynamic evolution of P. jirovecii genotypes based on the mitochondrial large-subunit (mt LSU) rRNA gene. The mt LSU rRNA genotypes of P. jirovecii isolates in 33 respiratory samples from CF patients were investigated using nested PCR and direct sequencing. Three different genotypes were detected: 36.3% genotype 1 (85C/248C); 15.1% genotype 2 (85A/248C); 42.4% genotype 3 (85T/248C); and 6% mixed genotypes. Patients studied during a 1-year follow-up period showed a continuous colonisation/clearance cycle involving P. jirovecii and an accumulative tendency to be colonised with genotype 3.
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Affiliation(s)
- M A Montes-Cano
- Department of Internal Medicine, Virgen Del Rocio University Hospital, Seville, Spain.
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Abstract
This study explored whether seasonal and/or climatic factors influenced detection of specific genotypes of Pneumocystis jirovecii. Between 1989 and 2001, 155 isolates of P. jirovecii were obtained from patients undergoing bronchoscopic alveolar lavage. For each isolate, the month and climatic conditions were noted. Genotypes of P. jirovecii were distinguished by polymorphisms in the mitochondrial large-subunit rRNA gene. There were monthly and seasonal variations in the frequency of detection of mixed genotypes (p 0.018 and p 0.031, respectively) and genotype 2 (p 0.029 and p 0.086, respectively). There was no association between month/season and genotypes 1, 3 and 4, or between monthly temperature or rainfall and any genotype.
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Affiliation(s)
- R F Miller
- Centre for Sexual Health and HIV Research, Department of Population Sciences and Primary Care, Royal Free and University College Medical School, University College London, London, UK.
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Villamil Cajoto I, Villacián Vicedo MJ. Pneumocystis, continúa la polémica. Rev Clin Esp 2007; 207:152; author reply 152-3. [PMID: 17397644 DOI: 10.1016/s0014-2565(07)73345-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Hawksworth DL. Responsibility in naming pathogens: the case of Pneumocystis jirovecii, the causal agent of pneumocystis pneumonia. Lancet Infect Dis 2007; 7:3-5; discussion 5. [PMID: 17182335 DOI: 10.1016/s1473-3099(06)70663-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Beser J, Hagblom P, Fernandez V. Frequent in vitro recombination in internal transcribed spacers 1 and 2 during genotyping of Pneumocystis jirovecii. J Clin Microbiol 2007; 45:881-6. [PMID: 17202274 PMCID: PMC1829102 DOI: 10.1128/jcm.02245-06] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Pneumocystis jirovecii is the causative agent of Pneumocystis pneumonia (PCP) in immunocompromised persons. Knowledge of the transmission and epidemiology of PCP is still incipient, and investigations on these subjects are based exclusively on applications of molecular typing techniques. The polymorphic internal transcribed spacers ITS1 and ITS2 in the ribosomal DNA operon, which in the P. jirovecii genome exist as single-copy DNA, are commonly used as target loci for isolate typing. In the course of genotyping P. jirovecii in respiratory specimens from PCP patients by amplification and cloning of a large number of ITS sequences, we found mixed infections (two or more types) in 50% of the samples. In a majority of the specimens with mixed infections, we detected many ITS haplotypes (combinations of ITS1 and ITS2 types) that appeared to be products of recombination between globally common ITS haplotypes present in the same sample. Here we present results of a series of experiments showing that essentially all ITS recombinants are chimeras formed during the genotyping process. Under standard conditions, as many as 37% of the amplified sequences could be hybrid DNA artifacts. We show that by modifying PCR amplification conditions, ITS chimera formation could be largely abolished and the erroneous establishment of artifactual haplotypes avoided. The accurate assessment of genetic diversity is fundamental for a better understanding of the epidemiology and biology of P. jirovecii infections.
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Affiliation(s)
- Jessica Beser
- Department of Parasitology, Mycology and Environmental Microbiology, Swedish Institute for Infectious Disease Control, SE-17182 Solna, Sweden
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Montes-Cano MA, de la Horra C, Respaldiza N, Medrano FJ, Varela JM, Calderon EJ. Polymorphisms inPneumocystis jiroveciiStrains in Spanish Children with Cystic Fibrosis. J Infect Dis 2006; 193:1332-3. [PMID: 16586372 DOI: 10.1086/503112] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Totet A, Duwat H, Daste G, Berry A, Escamilla R, Nevez G. Pneumocystis jirovecii genotypes and granulomatous pneumocystosis. Med Mal Infect 2006; 36:229-31. [PMID: 16580165 DOI: 10.1016/j.medmal.2005.11.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2005] [Accepted: 11/16/2005] [Indexed: 11/20/2022]
Abstract
This study describes the initial data concerning molecular typing of Pneumocystis jirovecii in a patient having developed granulomatous Pneumocystis pneumonia (PCP). Three types, B(1)a(3), B(1)a(4), B(1)b(2), were identified. All three had been described in reports concerning patients with common diffuse alveolar PCP. The present data show that identical microorganisms can be involved in both granulomatous PCP and diffuse alveolar PCP and that the pathogenesis of the granulomatous response to P. jirovecii may more likely be related to host factors.
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Affiliation(s)
- A Totet
- Service de Parasitologie et Mycologie Médicale, Centre Hospitalier Universitaire, Hôpital sud, 1, avenue René-Laennec, 80054 Amiens, France
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Beard CB, Fox MR, Lawrence GG, Guarner J, Hanzlick RL, Huang L, del Rio C, Rimland D, Duchin JS, Colley DG. Genetic Differences inPneumocystisIsolates Recovered from Immunocompetent Infants and from Adults with AIDS: Epidemiological Implications. J Infect Dis 2005; 192:1815-8. [PMID: 16235182 DOI: 10.1086/497381] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2005] [Accepted: 06/14/2005] [Indexed: 01/22/2023] Open
Abstract
Polymerase chain reaction analysis, direct DNA sequencing, and histological staining were used to determine whether Pneumocystis jirovecii was present in lung tissue specimens obtained, at autopsy, from 58 infants without identifiable immunodeficiency. The results of genotyping of these specimens were compared with the results of genotyping of specimens obtained from 384 human immunodeficiency virus (HIV)-infected adults with Pneumocystis pneumonia. P. jirovecii DNA was detected at the mitochondrial large subunit rRNA and dihydropteroate synthase loci in 100% and 53%, respectively, of the specimens obtained from infants. All specimens obtained from adults tested positive for P. jirovecii at both loci. Genotype distributions at both loci were significantly different in the 2 populations (P < .0001). The observation of different strains circulating in immunocompetent infants and HIV-infected adults suggests independent transmission cycles that warrant further study.
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Affiliation(s)
- Charles B Beard
- Division of Vector-Borne Infectious Diseases, Centers for Disease Control and Prevention (CDC), Fort Collins, CO 80521, USA.
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Abstract
Pneumocystis carinii pneumonia (PCP) is a life-threatening infection that occurs in immunocompromised individuals, particularly those with advanced human immunodeficiency virus (HIV) infection. Interestingly, morbidity and mortality is related to the underlying cause of immunosuppression, with AIDS patients faring better than oncology patients for example. In addition, the prognosis of PCP has been correlated with markers of inflammation rather than with organism numbers. There is now increasing evidence that lung damage occurring during PCP is a result of the type and extent of the host inflammatory response to P. carinii rather than a result of direct damage by the organism. This review will discuss the experimental and clinical data demonstrating how the host-mediated inflammatory response to infection with P. carinii determines the ultimate outcome of PCP. A better understanding of the pathophysiology of PCP should lead to the development of improved therapies for the treatment of PCP.
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Affiliation(s)
- Francis Gigliotti
- University of Rochester School of Medicine & Dentistry, 601 Elmwood Avenue, Box 690, Rochester, NY 14642, USA.
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Durand-Joly I, Chabé M, Soula F, Delhaes L, Camus D, Dei-Cas E. Molecular diagnosis ofPneumocystispneumonia. ACTA ACUST UNITED AC 2005; 45:405-10. [PMID: 16061360 DOI: 10.1016/j.femsim.2005.06.006] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2005] [Accepted: 06/20/2005] [Indexed: 11/20/2022]
Abstract
The detection of Pneumocystis DNA in clinical specimens by using PCR assays is leading to important advances in Pneumocystis pneumonia (PcP) clinical diagnosis, therapy and epidemiology. Highly sensitive and specific PCR tools improved the clinical diagnosis of PcP allowing an accurate, early diagnosis of Pneumocystis infection, which should lead to a decreased duration from onset of symptoms to treatment, a period with recognized impact on prognosis. This aspect has marked importance in HIV-negative immunocompromised patients, who develop often PcP with lower parasite rates than AIDS patients. The specific amplification of selected polymorphous sequences of Pneumocystis jirovecii genome, especially of internal transcribed spacer regions of the nuclear rRNA operon, has led to the identification of specific parasite genotypes which might be associated with PcP severity. Moreover, multi-locus genotyping revealed to be a useful tool to explore person-to-person transmission. Furthermore, PCR was recently used for detecting P. jirovecii dihydropteroate synthase gene mutations, which are apparently associated with sulfa drug resistance. PCR assays detected Pneumocystis-DNA in bronchoalveolar lavage fluid or biopsy specimens, but also in oropharyngeal washings obtained by rinsing of the mouth. This non-invasive procedure may reach 90%-sensitivity and has been used for monitoring the response to treatment in AIDS patients and for typing Pneumocystis isolates.
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Abstract
OBJECTIVE To review and update the literature on current trends with regard to Pneumocystis carinii (jiroveci ) diagnosis, treatment modalities, and its role in human disease processes. DATA SOURCES Bibliographic databases (PubMed and Ovid) were searched for material and data between 1980 and September 2003 relevant to the review. Indexing terms used were "Pneumocystis carinii pneumonia," and "Pneumocystis jiroveci," with the English language as a constraint. Other sources were the PhD thesis of one of the authors (J.F.W., London University, 1993) and the library at the Arabian Gulf University in the Kingdom of Bahrain. STUDY SELECTION Acquired immunodeficiency syndrome and organ transplant cases with Pneumocystis carinii pneumonia. DATA EXTRACTION Independent extraction by 2 observers. DATA SYNTHESIS We reviewed the major characteristics of P carinii (jiroveci ) with special emphasis on the more recently acquired data including the presence of a round pore in the cyst wall, which appears to be used for the release of sporozoites, supporting the hypothesis of sexual reproduction in P carinii (jiroveci ). CONCLUSIONS Opportunistic infection with P carinii (jiroveci ) remains a significant cause of morbidity and mortality in human immunodeficiency virus and non-human immunodeficiency virus-associated immunosuppressed patients. Diagnosis may be achieved in the majority of cases by routine cytochemical stains and specialized techniques such as immunocytochemistry and polymerase chain reaction. The incidence of P carinii pneumonia can significantly be reduced with effective use of prophylaxis and early detection of cases at high risk. Immunization for P carinii pneumonia is in the early stages and presents a challenging area for research.
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Hauser PM. The development of a typing method for an uncultivable microorganism: the example of Pneumocystis jirovecii. Infection, Genetics and Evolution 2004; 4:199-203. [PMID: 15450199 DOI: 10.1016/j.meegid.2004.01.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2003] [Revised: 01/12/2004] [Accepted: 01/17/2004] [Indexed: 11/26/2022]
Abstract
The development of a molecular typing method for the uncultivable fungus Pneumocystis jirovecii is described. The method consists of the amplification by PCR of four variable regions of P. jirovecii genome, followed by the detection of the polymorphisms by the single-strand conformation polymorphism technique. About 70% of the patients harbored two or rarely three alleles of at least one of the four genomic regions. This was shown to most probably be due to co-infections with several P. jirovecii types. Each combination of four alleles of the four genomic regions defines a type. Analysis of the alleles and their abundance allows identification of the co-infecting types in about 65% of the specimens co-infected with two types. The method has been validated by the evaluation of several criteria. The main advantage of the method is that it is relatively cheap and that up to 50 specimens can be analysed at the same time. Its main disadvantage is that about 30% of the specimens cannot be typed because of the complexity of the alleles configuration. This multitarget typing method has been used for several epidemiological purposes.
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Affiliation(s)
- Philippe M Hauser
- Institut de Microbiologie, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
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Helweg-Larsen J. Pneumocystis jiroveci. Applied molecular microbiology, epidemiology and diagnosis. Dan Med Bull 2004; 51:251-73. [PMID: 16009058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Affiliation(s)
- Jannik Helweg-Larsen
- Department of Infectious Diseases, The Copenhagen HIV Programme, H:S Hvidovre Hospital, Copenhagen
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35
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Abstract
Three protistan genomes were analyzed for differential genetic traits that may be associated with biological adaptations to their unique life styles. The microsporidian, Encephalitozoon cuniculi, an obligate intracellular parasite; the ascomycetes, Pneumocystis carinii, considered an opportunistic pathogen; and Saccharomyces cerevisiae, a model organism exhibiting a free-living life style, were used in comparisons of genomic architecture, reproductive strategies, and metabolic capacity predicted by the presence of signature genes. Genome size, gene number, and metabolic function decreased as the organisms became more dependent on their hosts. In contrast, gene density and the percentage of genes dedicated to cell growth and division were substantially increased in the genome of E. cuniculi. The obligate life style was associated with reductions in gene number, genome size, and reduced metabolic capacity while the free-living life style was coincident with gene duplications and duplication of large portions of the genome. The genomic characteristics and metabolic capacity of P. carinii were usually intermediate between those of the other two protistan genomes, but unique characteristics such as the presence of a single rDNA locus may indicate that these organisms could be in the process of becoming more host dependent.
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Affiliation(s)
- Melanie T Cushion
- University of Cincinnati College of Medicine, Division of Infectious Diseases, Cincinnati, Ohio 45267-0560, USA.
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Chabé M, Vargas SL, Eyzaguirre I, Aliouat EM, Follet-Dumoulin A, Creusy C, Fleurisse L, Recourt C, Camus D, Dei-Cas E, Durand-Joly I. Molecular typing of Pneumocystis jirovecii found in formalin-fixed paraffin-embedded lung tissue sections from sudden infant death victims. Microbiology 2004; 150:1167-1172. [PMID: 15133076 DOI: 10.1099/mic.0.26895-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Previous studies have provided histological evidence of an association between primary Pneumocystis infection and sudden infant death syndrome (SIDS). The aim of this work was to determine the species of clustered Pneumocystis organisms found in formalin-fixed paraffin-embedded (FFPE) lung tissue sections from Chilean sudden infant death (SID) victims. This approach needed first to optimize a DNA extraction method from such histological sections. For that purpose, the QIAamp DNA Isolation from Paraffin-Embedded Tissue method (Qiagen) was first tested on FFPE lung tissue sections of immunosuppressed Wistar rats inoculated with rat-derived PNEUMOCYSTIS: Successful DNA extraction was assessed by the amplification of a 346 bp fragment of the mitochondrial large subunit rRNA gene of the Pneumocystis species using a previously described PCR assay. PCR products were analysed by direct sequencing and sequences corresponding to Pneumocystis carinii were found in all the samples. This method was then applied to FFPE lung tissue sections from Chilean SID victims. Pneumocystis jirovecii was successfully identified in the three tested samples. In conclusion, an efficient protocol for isolating PCR-ready DNA from FFPE lung tissue sections was developed. It established that the Pneumocystis species found in the lungs of Chilean SID victims was P. jirovecii.
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Affiliation(s)
- M Chabé
- Ecology of Parasitism, EA-3609-IFR17, Pasteur Institute of Lille, 1 rue du Professeur-Calmette BP245, 59019 Lille, France
| | - S L Vargas
- Respiratory Infections Laboratory, Biomedical Sciences Institute, University of Chile School of Medicine, Independencia 1027, Santiago, Chile
| | - I Eyzaguirre
- Respiratory Infections Laboratory, Biomedical Sciences Institute, University of Chile School of Medicine, Independencia 1027, Santiago, Chile
| | - E M Aliouat
- Ecology of Parasitism, EA-3609-IFR17, Pasteur Institute of Lille, 1 rue du Professeur-Calmette BP245, 59019 Lille, France
| | - A Follet-Dumoulin
- Ecology of Parasitism, EA-3609-IFR17, Pasteur Institute of Lille, 1 rue du Professeur-Calmette BP245, 59019 Lille, France
| | - C Creusy
- Free Faculty of Medicine, Lille Catholic University, rue du Port, 59046 Lille, France
| | - L Fleurisse
- Free Faculty of Medicine, Lille Catholic University, rue du Port, 59046 Lille, France
| | - C Recourt
- Ecology of Parasitism, EA-3609-IFR17, Pasteur Institute of Lille, 1 rue du Professeur-Calmette BP245, 59019 Lille, France
| | - D Camus
- Parasitology-Mycology Service, Faculty of Medicine, Lille-2 University Hospital Center, 1 place Verdun, 59045 Lille, France
- Ecology of Parasitism, EA-3609-IFR17, Pasteur Institute of Lille, 1 rue du Professeur-Calmette BP245, 59019 Lille, France
| | - E Dei-Cas
- Parasitology-Mycology Service, Faculty of Medicine, Lille-2 University Hospital Center, 1 place Verdun, 59045 Lille, France
- Ecology of Parasitism, EA-3609-IFR17, Pasteur Institute of Lille, 1 rue du Professeur-Calmette BP245, 59019 Lille, France
| | - I Durand-Joly
- Parasitology-Mycology Service, Faculty of Medicine, Lille-2 University Hospital Center, 1 place Verdun, 59045 Lille, France
- Ecology of Parasitism, EA-3609-IFR17, Pasteur Institute of Lille, 1 rue du Professeur-Calmette BP245, 59019 Lille, France
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Totet A, Duwat H, Magois E, Jounieaux V, Roux P, Raccurt C, Nevez G. Similar genotypes of Pneumocystis jirovecii in different forms of Pneumocystis infection. Microbiology (Reading) 2004; 150:1173-1178. [PMID: 15133077 DOI: 10.1099/mic.0.26919-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
This study describes the genotyping of Pneumocystis jirovecii organisms isolated from three groups of patients that developed diverse forms of P. jirovecii infection; the patients were monitored in the same French hospital. Forty archival specimens from 13 adults with Pneumocystis pneumonia, eight adults colonized by P. jirovecii and 19 immunocompetent infants infected with the fungus contemporaneously with a bronchiolitis episode were analysed retrospectively. Genotyping was performed by analysis of sequences of the internal transcribed spacer (ITS)1 and ITS2 regions, and of the dihydropteroate synthase (DHPS) locus. At the ITS regions, a high diversity of genotypes, identical main genotypes (B1a3 and B2a1) and the occurrence of mixed infections (more than one genotype) were observed in the three patient groups. At the DHPS locus, the results indicated the presence of mutants in the two adult groups, as well as in the infant group. Consequently, at these two independent genomic regions, P. jirovecii isolates from patients who developed different forms of infection and who lived in the same geographical region presented common characteristics. These results suggest that patients infected with P. jirovecii, whatever the form of infection they present, are part of a common human reservoir for P. jirovecii.
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Affiliation(s)
- Anne Totet
- Service de Parasitologie, Mycologie et Médecine des Voyages, Hôpital Sud, Centre Hospitalier Universitaire, Université de Picardie Jules Verne, 1 rue Laennec, 80054 Amiens, Paris, France
| | - Hyacinthe Duwat
- Service de Parasitologie, Mycologie et Médecine des Voyages, Hôpital Sud, Centre Hospitalier Universitaire, Université de Picardie Jules Verne, 1 rue Laennec, 80054 Amiens, Paris, France
| | - Eline Magois
- Service de Parasitologie, Mycologie et Médecine des Voyages, Hôpital Sud, Centre Hospitalier Universitaire, Université de Picardie Jules Verne, 1 rue Laennec, 80054 Amiens, Paris, France
| | - Vincent Jounieaux
- Service de Parasitologie, Mycologie et Médecine des Voyages, Hôpital Sud, Centre Hospitalier Universitaire, Université de Picardie Jules Verne, 1 rue Laennec, 80054 Amiens, Paris, France
| | - Patricia Roux
- Centre Hospitalier Universitaire Saint Antoine, Paris, France
| | - Christian Raccurt
- Service de Parasitologie, Mycologie et Médecine des Voyages, Hôpital Sud, Centre Hospitalier Universitaire, Université de Picardie Jules Verne, 1 rue Laennec, 80054 Amiens, Paris, France
| | - Gilles Nevez
- Service de Parasitologie, Mycologie et Médecine des Voyages, Hôpital Sud, Centre Hospitalier Universitaire, Université de Picardie Jules Verne, 1 rue Laennec, 80054 Amiens, Paris, France
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Affiliation(s)
- Scott P Keely
- Department of Molecular Genetics, Biochemistry & Microbiology, University of Cincinnati College of Medicine, Cincinnati, OH 45267-0524, USA.
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39
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Abstract
Pneumocystis produces respiratory infection in immunocompromised individuals of several species of mammals, including humans. Each mammalian species has its own specific Pneumocystis species, which does not cross-infect other mammals. The species infecting humans has now been renamed P. jerovici, since P. carinii is reserved for one of two species infecting rats. Long believed to be a protozoan, Pneumocystis is now classified as an Archiascomycetous fungus. This is based on new molecular taxonomic techniques using DNA sequence analysis of srRNA genes. Only two of about 140 copies of the gene that exist in Pneumocystis were used for sequencing, so the evidence is not conclusive; however, it is supported by morphological evidence such as fungus-specific nucleus-associated organelles for cell division. There is also ultrastructural evidence of meiotic division and sexual conjugation. Clinically, several lines of evidence suggest the improbability of latent infection. Adult infections appear to be new infections, a fact that invites a new perspective on prevention.
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Affiliation(s)
- Gurdip S Sidhu
- Department of Pathology, New York University School of Medicine, New York, New York, USA.
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