Elsevier

Transplantation Proceedings

Volume 44, Issue 9, November 2012, Pages 2818-2820
Transplantation Proceedings

11th congress of the french speaking society of transplantation
Kidney transplantation: Complications
An Epidemic of Pneumocystis Jiroveci Pneumonia in a Renal Transplantation Center: Role of T-Cell Lymphopenia

https://doi.org/10.1016/j.transproceed.2012.09.089Get rights and content

Abstract

Although only 2 cases of Pneumocystis jiroveci pneumonia were observed in our center between 2004 and 2009, we diagnosed 9 cases in 2010. Each patient had been in contact in the hospital with at least 1 other patient suffering P jiroveci pneumonia. Genotyping of P jiroveci pneumonia strains demonstrates a total homogeneity of the DNA sequences in the 7 patients already analyzed. CD4+ lymphocyte count was significantly lower at M3 in P jiroveci pneumonia patients than in controls. Our clinical and molecular data confirm that interhuman transmission of P jiroveci is possible, particularly to lymphopenic transplant recipients.

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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