A Pneumocystis jirovecii pneumonia outbreak in a single kidney-transplant center: role of cytomegalovirus co-infection

Abstract

Pneumocystis jirovecii pneumonia (PCP) and cytomegalovirus (CMV) infection represent possible complications of medical immunosuppression. Between 2005 and 2010, non-human immunodeficiency virus (HIV) PCP patients admitted to a nephrology unit were analyzed for outcome, CMV comorbidity, and patient-to-patient contacts prior to PCP. In contrast to 2002-2004 (no cases) and 2008-2010 (10 cases), a PCP outbreak of 29 kidney-transplant recipients and one patient with anti-glomerular basement membrane disease occurred between 2005 and 2007. None of the patients were on PCP chemoprophylaxis. In four PCP patients, the genotyping data of bronchoalveolar lavage specimen showed an identical Pneumocystis strain. PCP cases had a higher incidence of CMV infection (12 of 30 PCP patients) and CMV disease (four patients) when compared to matched PCP-free controls (p < 0.05). Cotrimoxazole and, if applicable, ganciclovir were started 2.0 ± 4.0 days following admission, and immunosuppressive medication was reduced. In-hospital mortality was 10% and the three-year mortality was 20%. CMV co-infection did not affect mortality. CMV co-infection more frequently occurred during a cluster outbreak of non-HIV PCP in comparison to PCP-free controls. Here, CMV awareness and specific therapy of both CMV infection and PCP led to a comparatively favorable patient outcome. The role of patient isolation should be further investigated in incident non-HIV PCP.

Risk Factors of Pneumocystis Pneumonia in Solid Organ Recipients in the Era of the Common Use of Posttransplantation Prophylaxis

“…The presence of CMV infections was associated with PCP in uni-and multivariate analyses, as published by others authors (12,(22)(23)(24)44). In our study, the number of CMV primo-infection was not significantly different between the case and the control groups and the difference observed in the number of CMV infections was mainly due to CMV reactivation.…”

“…A threshold of risk (peripheral CD4þ T cell counts <200/mL) is now commonly used for HIV-positive patients (19,20) but is not clearly established for HIV-negative immunocompromised patients (21), and particularly for SOT patients. Several case-control studies have identified cytomegalovirus (CMV) infections and the treatments of acute rejection episodes as risk factors for the occurrence of PCP in SOT patients (12,(22)(23)(24). Nevertheless, most of these studies were carried out on patients who never received PCP prophylaxis after the transplantation and who developed PCP in the first year after transplantation.…”

Prospective, comprehensive, and effective viral monitoring in Cuban children undergoing solid organ transplantation

“…Co-infections are frequently detected in immunocompromised patients as the altered host immune response is unable to control latent viruses (Bissinger et al, 2005; Pliquett et al 2012). However, the exact implications of co-infections with regard to the pathogenesis of transplantation-associated diseases are not well known (Sampaio et al, 2012).…”

Varicella-Like Cutaneous Toxoplasmosis in a Patient with Aplastic Anemia

“…In a mouse model, murine CMV infection induced the reactivation of dormant T. gondii-associated pneumonia, raising the possibility that CMV infection can play a role in the reactivation of T. gondii (9). The disease-promoting role of CMV in Pneumocystis pneumonia is well known and has been described previously (21,22). The diagnosis of disseminated toxoplasmosis was made in retrospect; thus, no specific anti-Toxoplasma treatment was given during hospitalization or prior to the patient's death.…”