Outbreak of Pneumocystis jirovecii pneumonia in renal transplant recipients on prophylaxis: Our observation and experience

Chandola, Parnika; Lall, Mahima; Sen, Sourav; Bharadwaj, Reena

doi:10.4103/0255-0857.136594

Cited by 11 publications

(7 citation statements)

References 14 publications

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“…[ 2 ] Infections occurring after transplantation account for half of the deaths and considerable morbidity in India. [ 3 4 ] Urinary tract infection (UTI) is the most common infection in the posttransplant period followed by candidiasis and tuberculosis (TB). [ 5 ] Hepatitis B and C viral (HBV and HCV) infection, cytomegalovirus (CMV), and pneumocystis are also common infections that are encountered in RTR.…”

Section: Introductionmentioning

confidence: 99%

Profile of infections in renal transplant recipients from India

Kumar

Agarwal

Hooda

et al. 2016

J Family Med Prim Care

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Background:Infectious disorders are a major cause of concern in renal transplant recipients (RTRs) leading to considerable morbidity and mortality. We studied the profile and outcomes of infectious disorders in a cohort of RTR.Materials and Methods:In this prospective, observational study, we evaluated all RTR who presented with the features of infection. We also included asymptomatic patients with microbiological evidence of infection. We excluded patients with acute rejection, drug toxicity, and malignancy. Descriptive statistics were used to analyze the results.Results:The study population (n = 45, 35 male and 10 female) had a mean age of 35.5 ± 10.4 years and follow-up after transplant was 2.1 ± 1.7 years. Urinary tract infection (UTI, n = 15) is the most common infection followed by tuberculosis (TB, n = 8), cytomegalovirus (n = 6), candidiasis (n = 7), and hepatitis (n = 11). Miscellaneous infections such as cryptosporidiosis and pneumocystis were seen in 10 patients. Simultaneous infections with two organisms were seen in 7 patients. Four patients succumbed to multiorgan dysfunction following sepsis, another 4 patients developed chronic graft dysfunction, while the remaining 35 RTR had a good graft function.Conclusion:Infectious complications are very common in the posttransplant period including UTI and TB. Further large scale studies are required to identify the potential risk factors leading to infections in RTR.

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Section: Introductionmentioning

confidence: 99%

Profile of infections in renal transplant recipients from India

Kumar

Agarwal

Hooda

et al. 2016

J Family Med Prim Care

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“…38,39 Recently, several series of grouped PCP cases in SOT recipients were reported, particularly among kidney transplant patients. [15][16][17][20][21][22]35 Historical series had shown a prevalence between 5% and 40% of PCP in SOT recipients within the first year post transplant. 7,8,10,12 In contrast, more recent series reported PCP infections occurring long after transplantation, 17 and the phenomenon could be due, at least partially, to the general use of anti-PCP prophylaxis in the months following transplantation.…”

Section: Discussionmentioning

confidence: 99%

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

Wintenberger

Maubon

Charpentier

et al. 2016

Infect. Control Hosp. Epidemiol.

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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.

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“…[1][2][3] Several outbreaks of post-transplant PCP have been reported. [4][5][6][7][8][9][10][11][12][13][14] PCP clusters and outbreaks have been in a broad geographical distribution including both the Northern and Southern hemispheres. 1,9,11,15 Although most outbreaks have been limited to kidney transplant patients, recipients of other organ allografts are also at risk.…”

Section: Introductionmentioning

confidence: 99%

“…[4][5][6][7][8][9][10][11][12][13][14] PCP clusters and outbreaks have been in a broad geographical distribution including both the Northern and Southern hemispheres. 1,9,11,15 Although most outbreaks have been limited to kidney transplant patients, recipients of other organ allografts are also at risk. 1,4,[16][17][18][19] Multilocus sequence typing (MLST) has been successfully used in investigation of PCP clusters to determine the genotype(s) of P. jirovecii considering the diversity of this fungal pathogen.…”

Section: Introductionmentioning

confidence: 99%

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Long‐lasting cluster of nosocomial pneumonia with a single Pneumocystis jirovecii genotype involving different organ allograft recipients

Hosseini-Moghaddam

Dufresne

Gutierrez

et al. 2020

Clinical Transplantation

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Pneumocystis pneumonia (PCP) outbreaks may occur in solid organ transplant (SOT) patients. Transmissibility of Pneumocystis jirovecii among SOT and non-SOT patients has not been investigated. Ten SOT (ie, 4 heart, 4 kidney, 2 liver allograft recipients) and 11 non-SOT (ie, 7 HIV-infected, 3 hematologic malignancies, and 1 stem cell transplant) patients with PCP were admitted to London Health Sciences Center (LHSC) from October 2014 to August 2016. We investigated the course of illness and outcome of PCP in SOT and non-SOT patients. Post-transplant PCP was frequently an acute-onset disease (90% vs. 18.2%, p = .01) requiring ICU admission (70% vs. 20%, p = .03) and hemodialysis (60% vs. 0, p = .003). Mortality was more frequent in SOT patients (40% vs. 18.1%, p = .36). Multilocus sequence typing (MLST) demonstrated circulation of a single genotype of P. jirovecii among SOT patients. However, 8 different genotypes were detected from non-SOT patients. Reinstitution of prophylaxis successfully controlled post-transplant cluster until end of observation period in October 2019. No transmission was detected from non-SOT patients to SOT recipients. Detection of a single P. jirovecii genotype from all SOT recipients highlights the likelihood of nosocomial transmission. No source control method is recommended by current guidelines. Improvement of preventive strategies is required.

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Outbreak of Pneumocystis jirovecii pneumonia in renal transplant recipients on prophylaxis: Our observation and experience

Cited by 11 publications

References 14 publications

Profile of infections in renal transplant recipients from India

Profile of infections in renal transplant recipients from India

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

Long‐lasting cluster of nosocomial pneumonia with a single Pneumocystis jirovecii genotype involving different organ allograft recipients

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