11th congress of the french speaking society of transplantationKidney transplantation: ComplicationsAn Epidemic of Pneumocystis Jiroveci Pneumonia in a Renal Transplantation Center: Role of T-Cell Lymphopenia
Section snippets
Patients and Methods
In 2010, we diagnosed 9 cases of P jiroveci pneumonia, whereas this complication had almost totally disappeared in our center (no case between years 2004 and 2007; 1 case/year in 2008 and 2009). As reported by others, we suspected an outbreak of P jiroveci pneumonia epidemic with potential nosocomial interhuman transmission. We then reviewed the charts of these 9 patients and compared them with the 66 other patients who received a renal allograft in our institution during the same period
Immunosuppression
As induction, 7 patients received low-dose Thymoglobulin (1 mg/kg/d × 5 days) and 2 received Basiliximab. Maintenance treatment included mycophenolic acid associated with tacrolimus (n = 7), Neoral (n = 1), or Rapamune (1), and with steroids (n = 8).
P jiroveci pneumonia episodes occurred between May 2010 and January 2011 at a mean posttransplantation time of 5.6 months (range, 2.4–146 months). Among the 9 cases, only 7 were definitively confirmed (presence of P jiroveci in the bronchoalveolar
Discussion
We report here an outbreak of P jiroveci pneumonia occurring in our transplantation unit during 9 months in 2010. Six of 9 patients had undergone transplantation during 2010: they had been hospitalized (8–15 days) in the same ward and they frequently attended the same outpatient clinics for regular surveillance. Each of the affected patients had been in contact at least with 1 other PCP patient, either during hospitalization or in the waiting room, strongly suggesting that transmission of the
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Cited by (26)
The Changing Landscape of Pneumocystis Jiroveci Infection in Kidney Transplant Recipients: Single-Center Experience of Late-Onset Pneumocystis Pneumonia
2021, Transplantation ProceedingsCitation Excerpt :T-cell immunity, a crucial part of the immune response against opportunistic pathogens, is impaired, implying that CMV enables Pneumocystis infection [35]. The higher risk of PCP in lymphogenic patients further supports the significance of cell-mediated immunity against Pneumocystis [8,21,36-38]. In patients who are HIV positive, the risk of acquiring the infection is directly related to the T lymphocyte count, particularly when it falls below 200/μL [12].
Investigation of outbreaks of Pneumocystis jirovecii pneumonia in two Scottish renal units
2017, Journal of Hospital InfectionCitation Excerpt :The possibility of transmission in the common waiting areas at the outpatient clinics was explored, and whilst there was some degree of contact between patients, particulary in the Glasgow outbreak, this did not explain the majority of cases of PCP. In a PCP outbreak in France in 2010 involving nine renal transplant patients, each individual had been in contact with at least one other in the outpatient setting.15 Furthermore Yazaki et al. found evidence of PCP DNA in consulting rooms during an outbreak in the outpatient setting involving 27 renal transplant patients.16
Risk Evaluation and Outcome of Pneumocystis jirovecii Pneumonia in Kidney Transplant Patients
2016, Transplantation ProceedingsCitation Excerpt :In the present study, PJP was diagnosed late after transplantation (mean 54 months after transplantation), with the earliest case of PJP being diagnosed 83 days after TMP-SMX prophylaxis was stopped. Only a few studies on PJP risk have been performed in transplant patients with routine PJP prophylaxis [5,13,31–36], but they confirm the effectiveness of prophylaxis as well as the occurrence of late infections with a mortality that is still high [5]. This clearly demonstrates the benefit of prophylaxis but also the need for guidelines how to deal with the infection risk over time.
Pneumocystis pneumonia outbreak among renal transplant recipients at a North American transplant center: Risk factors and implications for infection control
2016, American Journal of Infection ControlCitation Excerpt :Further, we demonstrated a significant increase in overlap of ambulatory care visits among case patients, especially in the laboratory, suggesting that human-to-human transmission or environment–human transmission could facilitate infection outbreaks in the ambulatory care setting. Several other studies have also examined risk factors for PCP infection in renal transplant recipients, and lymphopenia has emerged as a common risk factor.21,23,24 To determine whether lymphopenia is a product of PCP infection itself, Iiart et al23 conducted an analysis of lymphocyte counts over time in solid organ transplant patients.
Risk factors of pneumocystis pneumonia in solid organ recipients in the era of the common use of posttransplantation prophylaxis
2015, American Journal of Transplantation