<i><scp>P</scp>neumocystis jirovecii</i> colonization among renal transplant recipients

Fritzsche, Carlos; Riebold, D.; Fuehrer, Andreas; Mitzner, Andrea; Klammt, Sebastian; Mueller-Hilke, Brigitte; Reisinger, Emil C.

doi:10.1111/nep.12054

Cited by 26 publications

(19 citation statements)

References 36 publications

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“…It has been proposed that patients with inflammatory rheumatic diseases or systemic autoimmune diseases should be screened for P. jirovecii colonization and treated prior to the prescription of immunosuppressive therapy (25,26). Moreover, independently of the potential selfbenefit of co-trimoxazole treatment for patients with P. jirovecii detection, a growing number of studies have stressed the risk of colonized patients infecting other immunocompromised patients during hospital care or consultations, as recently shown in renal transplant patients (5,27) (28,29). Therefore, future strategies could also consider treatment, at least in targeted patients or hospital care units, to prevent airborne dissemination (14,30).…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, PCP is also of increasing importance in non-HIV immunocompromised patients such as transplant patients, patients with hematological malignancies or solid cancers, and patients receiving corticosteroid therapy (CST) or other immunosuppressive drugs within the framework of connective tissue diseases or chronic inflammatory diseases (2)(3)(4)(5), reaching 50% of cases in the most recent series (6,7). Although chemoprophylaxis guidelines recommend co-trimoxazole in transplant patients for 6 to 12 months following transplantation, there is currently no consensus on chemoprophylaxis in other non-HIV immunocompromised patients, except for granulomatosis with polyangiitis (Wegener's granulomatosis) (8).…”

Section: T He Ascomycete Fungus Pneumocystis Jirovecii Is Responsiblementioning

confidence: 99%

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Diagnosis of Pneumocystis jirovecii Pneumonia in Immunocompromised Patients by Real-Time PCR: a 4-Year Prospective Study

et al. 2014

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Pneumocystis jirovecii pneumonia (PCP) is a life-threatening infection in immunocompromised patients. Quantitative real-time PCR (qPCR) is more sensitive than microscopic examination for the detection of P. jirovecii but also detects colonized patients. Hence, its positive predictive value (PPV) needs evaluation. In this 4-year prospective observational study, all immunocompromised patients with acute respiratory symptoms who were investigated for PCP were included, totaling 659 patients (814 bronchoalveolar lavage fluid samples). Patients with negative microscopy but positive qPCR were classified through medical chart review as having retained PCP, possible PCP, or colonization, and their clinical outcomes were compared to those of patients with microscopically proven PCP. Overall, 119 patients were included for analysis, of whom 35, 41, and 43 were classified as having retained PCP, possible PCP, and colonization, respectively. The 35 patients with retained PCP had clinical findings similar to those with microscopically proven PCP but lower fungal loads (P < 0.001) and were mainly non-HIV-infected patients (P < 0.05). Although the mean amplification threshold was higher in colonized patients, it was not possible to determine a discriminant qPCR cutoff. The PPV of qPCR in patients with negative microscopy were 29.4% and 63.8% when considering retained PCP and retained plus possible PCP, respectively. Patients with possible PCP had a higher mortality rate than patients with retained PCP or colonization (63% versus 3% and 16%, respectively); patients who died had not received co-trimoxazole. In conclusion, qPCR is a useful tool to diagnose PCP in non-HIV patients, and treatment might be better targeted through a multicomponent algorithm including both clinical/radiological parameters and qPCR results.

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Section: Discussionmentioning

confidence: 99%

Section: T He Ascomycete Fungus Pneumocystis Jirovecii Is Responsiblementioning

confidence: 99%

Diagnosis of Pneumocystis jirovecii Pneumonia in Immunocompromised Patients by Real-Time PCR: a 4-Year Prospective Study

et al. 2014

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“…Pneumocystis jirovecii pneumonia (PCP) is one of the most frequent opportunistic infections [1,2] and remains one of the leading causes of morbidity and mortality in HIV patients and patients with impaired cell-mediated immunity [3]. …”

Section: Introductionmentioning

confidence: 99%

Clinical Course, Radiological Manifestations, and Outcome of Pneumocystis jirovecii Pneumonia in HIV Patients and Renal Transplant Recipients

et al. 2016

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BackgroundPneumocystis jirovecii pneumonia (PCP) is a frequent opportunistic infection in immunocompromised patients. In literature, presentation and outcome of PCP differs between patients with human immunodeficiency virus (HIV) infection and renal transplant recipients (RTRs).MethodsWe conducted a cross-sectional study of patients with PCP based on the HIV and renal transplant registries at our institution. Radiological and clinical data from all confirmed PCP cases between 2005 and 2012 were compared.ResultsForty patients were included: 16 with HIV and 24 RTRs. Radiologically, HIV patients had significantly more areas of diffuse lung affection (81% HIV vs. 25% RTR; p = 0.02), more ground glass nodules 5–10 mm (69% vs. 4%; p = <0.001) and enlarged hilar lymph nodes were found only in HIV patients (44%). Cough and dyspnea were the most common clinical signs (>80%) in both groups. Duration from illness onset to hospital presentation was longer in the HIV patients (median of 18 vs. 10 days (p = 0.02)), implying a less fulminant clinical course. Sixty percent of PCP cases in RTRs occurred >12 months after transplantation. Lengths of hospitalization, admission rates to the intensive care unit, and requirements for mechanical ventilation were similar. Outcome in both groups was favourable.ConclusionsWhile important differences in radiological presentation of PCP between HIV patients and RTRs were found, clinical presentation was similar. PCP only rarely presented with fulminant respiratory symptoms requiring ICU admission, with similar results and outcomes for HIV patients and RTRs. Early diagnosis and treatment is mandatory for clinical success.

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“…Os tipos de estudo encontrados foram relatos de caso (9,1 2,17,22,25,30,37,41,42,44,47,50,51,57,58) , estudos retrospectivos (5,7,8, 10,11,21,24 ,28,29,31,32,35,39,43,45,56) , coorte (13,14,18,19,23,27,33,34,36,38,40,46,48,49,55) , casocontrole (6,15,20,26,59) e revisão de literatura (16,33,52) . Os locais de pesquisa dos artigos selecionados foram China (9,11,45,46,50) , Espanha (12,14,38,39,58) , Tunísia (33) , Bélgica (57) , Dinamarca (15,19) , Malásia (17) , Alemanha (7,18,23,28) , Turquia (21,25,32,34,36) , Brasil…”

Section: Resultsunclassified

Caracterização de infecções pulmonares no pós-operatório tardio de transplante renal: uma revisão integrativa

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et al. 2016

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Characterization of pulmonary infections in the late postoperative period of kidney transplantation: an integrative review Caracterización de infecciones pulmonares en el postoperatorio tardío de trasplante renal: una revisión integrativa RESUMO Objetivo: Caracterizar a natureza e frequência das infecções pulmonares em pacientes adultos pós-transplantados renais tardios. Métodos: Foi realizado um estudo de revisão bibliográfica nas seguintes bases de dados eletrônicas: PubMed, Scielo e Web of Science. Os critérios de elegibilidade do estudo foram: artigos publicados entre os anos de 2010 e 2015, nos idiomas inglês, português ou espanhol, do tipo: ensaios clínicos, randomizados ou não, estudos de caso-controle, estudos de coorte e estudos longitudinais em humanos. Foram excluídos os artigos cujos participantes da pesquisa fossem menores de 18 anos de idade, além dos artigos duplicados em mais de uma das bases de dados. As palavras-chave utilizadas e combinadas na pesquisa foram: pneumonia, infecção pulmonar, infecção, transplante renal, hospitalização. Resultados: Os agentes etiológicos mais incidentes são Pneumocystis jirovecii, Mycobacterium tuberculosis e Aspergillus fumigatus. As infecções pulmonares são devidas, em grande número, ao regime imunossupressor, tempo prolongado de hemodiálise, disfunção de enxerto e transmissão inter humana. Frequentemente, essas infecções evoluem com dispneia progressiva e insuficiência respiratória aguda, sendo necessária ventilação mecânica invasiva ou não invasiva. Conclusão: As evidências científicas apontam uma alta prevalência de infecções pulmonares nos pacientes transplantados renais.

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Pneumocystis jirovecii colonization among renal transplant recipients

Cited by 26 publications

References 36 publications

Diagnosis of Pneumocystis jirovecii Pneumonia in Immunocompromised Patients by Real-Time PCR: a 4-Year Prospective Study

Diagnosis of Pneumocystis jirovecii Pneumonia in Immunocompromised Patients by Real-Time PCR: a 4-Year Prospective Study

Clinical Course, Radiological Manifestations, and Outcome of Pneumocystis jirovecii Pneumonia in HIV Patients and Renal Transplant Recipients

Caracterização de infecções pulmonares no pós-operatório tardio de transplante renal: uma revisão integrativa

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