Grouped Cases of Pulmonary Pneumocystosis After Solid Organ Transplantation: Advantages of Coordination by an Infectious Diseases Unit for Overall Management and Epidemiological Monitoring

Abstract

OBJECTIVE To determine the origin of grouped cases of Pneumocystis pneumonia in solid-organ transplant recipients at our institution. DESIGN A case series with clinical examinations, genotyping, and an epidemiological survey. SETTING A university hospital in France. PATIENTS We report 12 solid-organ transplant recipients with successive cases of Pneumocystis pneumonia that occurred over 3 years; 10 of these cases occurred in a single year. METHODS We used molecular typing of P. jirovecii strains by multilocus sequence typing and clinical epidemiological survey to determine potential dates and places of transmission. RESULTS Between May 2014 and March 2015, 10 solid-organ transplant recipients (5 kidney transplants, 4 heart transplants, and 1 lung transplant) presented with Pneumocystis pneumonia. Molecular genotyping revealed the same P. jirovecii strain in at least 6 patients. This Pneumocystis strain was not identified in control patients (ie, nontransplant patients presenting with pulmonary pneumocystosis) during this period. The epidemiological survey guided by sequencing results provided information on the probable or possible dates and places of contamination for 5 of these patients. The mobile infectious diseases unit played a coordination role in the clinical management (adaptation of the local guidelines) and epidemiological survey. CONCLUSION Our cardiac and kidney transplant units experienced grouped cases of pulmonary pneumocystosis. Genotyping and epidemiological surveying results suggested interhuman contamination, which was quickly eliminated thanks to multidisciplinary coordination. Infect Control Hosp Epidemiol 2017;38:179-185.

Single‐center outbreak of Pneumocystis jirovecii pneumonia in heart transplant recipients

“…5 Nosocomial clusters of PJP have been previously described. [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] By associating the study of patient contacts and the molecular identification of PJ genotypes, they strongly support the theory of an interhuman PJP transmission. Following solid organ transplantation, the risk for PJP is higher in the first 6 months, in patients with prolonged leukopenia or receiving increased immunosuppression (eg, graft rejection) and during invasive cytomegalovirus (CMV) infection.…”

“…a Defined as a 50% or greater rise in serum creatinine. b Requiring blood transfusion.To our knowledge, very few cases of HTx patients developing PJP are described in the literature, including a recent single-center PJP cluster taking place in a cohort of 7 HTx cases and additional 4 HTx cases included in a mixed cohort of solid organ transplant recipients 7,21. We thus described a PJP outbreak of 6 cases in 10 months among HTx recipients, to our knowledge one of the largest cluster so far described in this patient category occurred in a short period of time, further confirming the risk of potential nosocomial PJ interhuman transmission.…”

Trends in the Epidemiology of Pneumocystis Pneumonia in Immunocompromised Patients without HIV Infection

“…Over the past two decades, there is an increasing trend of PCP outbreaks in immunocompromised patients without HIV/AIDS, particularly in transplant recipients, as recently reviewed by Delliere et al [ 309 ]. The largest number of cases involved in PCP outbreaks was reported in France (150 cases), followed by Australia (97 cases) and the UK (58 cases) ( Figure 4 , Table S4 [ 58 , 77 , 107 , 310 , 311 , 312 , 313 , 314 , 315 , 316 , 317 , 318 , 319 , 320 , 321 , 322 , 323 , 324 , 325 , 326 , 327 , 328 , 329 , 330 , 331 , 332 , 333 , 334 , 335 , 336 , 337 , 338 , 339 , 340 , 341 , 342 , 343 ]).…”

Airborne Interindividual Transmission of Pneumocystis jirovecii

“…PCP outbreaks occurring in hospitals over the past 60 years favor the hypothesis of interindividual transmission of P. jirovecii. Between 1968 and 2019, almost 60 outbreaks were described worldwide, mainly in renal transplant recipients as well as in HIV-infected and cancer patients [22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41]. Although interindividual transmission of P. jirovecii was suggested, it remained hypothetical until 1998 due to the absence of genotyping methods.…”