Pneumocystis jirovecii and Cystic Fibrosis in Brittany, France

Abstract

Pneumocystis jirovecii is a transmissible fungus with a high pulmonary tropism. The prevalence of P. jirovecii in patients with cystic fibrosis (CF) has been estimated in Germany at 7.4%, in Spain at 21.5% and in Brazil at 38.2%. Data on the prevalence of P. jirovecii in CF patients in France remain scarce, particularly in Brittany, where the prevalence of CF is high (from 1/1600 to 1/4500). Our objectives were to determine the prevalence of colonization of the airways by P. jirovecii in Brittany in CF patients monitored at the "Centre de Ressources et de Compétences de la Mucoviscidose (CRCM)" of Rennes compared to that previously observed at the CRCM of Roscoff-Brest. Sputa from 86 patients (178 specimens) followed in Rennes were analyzed retrospectively. The detection of P. jirovecii was performed using real-time PCR targeting the gene encoding the mitochondrial large subunit of ribosomal RNA. Pneumocystis jirovecii DNA was detected in 3/86 patients (3.5%) monitored at Rennes, whereas it had previously been detected in 1/76 patients (1.3%) monitored at Roscoff-Brest, thus showing an overall prevalence of 2.5% in Brittany. These results obtained from two Breton centers taken together show that P. jirovecii prevalence in patients with CF in Brittany is lower than those observed in Germany, Spain, Brazil or in other regions of France. This study is a preliminary step in determining the risk factors for P. jirovecii acquisition, its epidemiological and clinical significance in CF patients through a prospective multicenter study.

A Multidisciplinary Approach to Pretransplant and Posttransplant Management of Cystic Fibrosis–Associated Liver Disease

“…This includes prophylaxis with fluconazole for Candida , acyclovir for herpes simplex virus, valganciclovir for cytomegalovirus (guided by the recipients’ and the donors’ status), and with trimethoprim‐sulfamethoxazole for Pneumocystis jiroveci . Prophylaxis for P. jiroveci is prudent given reports, primarily from Europe, describing colonization with P. jiroveci in CF patients . Additionally, for individuals with CF, some experts recommend a course of antibiotics targeting recently detected pulmonary pathogens immediately following transplant.…”

The myriad challenges of respiratory fungal infection in cystic fibrosis

“…Identification of P jirovecii in CF patients is described throughout the world, with regional differences appreciated. French studies describe a prevalence of P jirovecii of 2.5–12.5%, while a cohort of Brazilian CF patients had a prevalence of 38.2% …”

Fungal Respiratory Infections in Cystic Fibrosis (CF): Recent Progress and Future Research Agenda

“…These two case presentations indicated that the recovery of some fungi like E. dermatitidis in patients with bronchiectasis should lead to search for a mild form of CF [10]. Nevez et al [11] detail the extensive laboratory processes setup in Brittany for the demonstration of Pneumocystis jirovecii in CF patients. The prevalence of Pneumocystis jirovecii was found to be 2.5% in Brittany despite the overall higher prevalence of CF in the population [11].…”

“…Nevez et al [11] detail the extensive laboratory processes setup in Brittany for the demonstration of Pneumocystis jirovecii in CF patients. The prevalence of Pneumocystis jirovecii was found to be 2.5% in Brittany despite the overall higher prevalence of CF in the population [11]. The authors also describe successful genotyping of P. jirovecii in two of the three instances to set the stage for future evaluation of links between genotype evolution and virulence [11].…”

“…Antifungal therapy in CF patients [7,9,[14][15][16][17] 4. Aspergillus, Exophiala and Pneumocystis in CF patients [8][9][10][11] 5. Microbiome and ecology of fungal pathogens [18][19][20] 6.…”