1887

Abstract

Against a background of point-source outbreaks of pneumonia (PCP) in renal transplant units in Europe, we undertook a retrospective 3 year observational review of PCP in Northern Ireland. This showed an unexpected increase in incidence, with a mortality rate of 30 %. Fifty-one cases were confirmed compared to 10 cases confirmed in the preceding 7 years. Where undiagnosed HIV infection had previously been the main risk factor for PCP, this was now equally matched by chemotherapy for haematological and non-haematological malignancy and immune suppression for a range of autoimmune conditions. Congenital immunodeficiency and transplantation were less common predisposing factors, but renal grafts also showed a rising incidence. Asymptomatic carriage was uncommon. At presentation both upper and lower respiratory samples were of equal use in establishing the diagnosis, and treatment resulted in rapid clearance. These data suggest the need for considering PCP in at-risk patients, reviewing its mode of acquisition and whether iatrogenic colonization is a treatable pre-condition.

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2012-07-01
2019-10-20
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References

  1. Alanio A. , Desoubeaux G. , Sarfati C. , Hamane S. , Bergeron A. , Azoulay E. , Molina J. M. , Derouin F. , Menotti J. . ( 2011; ). Real-time PCR assay-based strategy for differentiation between active Pneumocystis jirovecii pneumonia and colonization in immunocompromised patients. . Clin Microbiol Infect 17:, 1531–1537. [CrossRef] [PubMed]
    [Google Scholar]
  2. Assefa G. , Nigussie Y. , Aderaye G. , Worku A. , Lindquist L. . ( 2011; ). Chest X-ray evaluation of pneumonia-like syndromes in smear negative HIV-positive patients with atypical chest X-ray. Findings in Ethiopian setting. . Ethiop Med J 49:, 35–42.[PubMed]
    [Google Scholar]
  3. Azoulay E. , Bergeron A. , Chevret S. , Bele N. , Schlemmer B. , Menotti J. . ( 2009; ). Polymerase chain reaction for diagnosing Pneumocystis pneumonia in non-HIV immunocompromised patients with pulmonary infiltrates. . Chest 135:, 655–661. [CrossRef] [PubMed]
    [Google Scholar]
  4. Bandt D. , Monecke S. . ( 2007; ). Development and evaluation of a real-time PCR assay for detection of Pneumocystis jiroveci . . Transpl Infect Dis 9:, 196–202. [CrossRef] [PubMed]
    [Google Scholar]
  5. Brancart F. , Rodriguez-Villalobos H. , Fonteyne P. A. , Peres-Bota D. , Liesnard C. . ( 2005; ). Quantitative TaqMan PCR for detection of Pneumocystis jiroveci . . J Microbiol Methods 61:, 381–387. [CrossRef] [PubMed]
    [Google Scholar]
  6. Chabé M. , Dei-Cas E. , Creusy C. , Fleurisse L. , Respaldiza N. , Camus D. , Durand-Joly I. . ( 2004; ). Immunocompetent hosts as a reservoir of Pneumocystis organisms: histological and RT-PCR data demonstrate active replication. . Eur J Clin Microbiol Infect Dis 23:, 89–97. [CrossRef] [PubMed]
    [Google Scholar]
  7. Choukri F. , Menotti J. , Sarfati C. , Lucet J. C. , Nevez G. , Garin Y. J. , Derouin F. , Totet A. . ( 2010; ). Quantification and spread of Pneumocystis jirovecii in the surrounding air of patients with Pneumocystis pneumonia. . Clin Infect Dis 51:, 259–265. [CrossRef] [PubMed]
    [Google Scholar]
  8. Cregan P. , Yamamoto A. , Lum A. , VanDerHeide T. , MacDonald M. , Pulliam L. . ( 1990; ). Comparison of four methods for rapid detection of Pneumocystis carinii in respiratory specimens. . J Clin Microbiol 28:, 2432–2436.[PubMed]
    [Google Scholar]
  9. de Boer M. G. , Bruijnesteijn van Coppenraet L. E. , Gaasbeek A. , Berger S. P. , Gelinck L. B. , van Houwelingen H. C. , van den Broek P. , Kuijper E. J. , Kroon F. P. , Vandenbroucke J. P. . ( 2007; ). An outbreak of Pneumocystis jiroveci pneumonia with 1 predominant genotype among renal transplant recipients: interhuman transmission or a common environmental source?. Clin Infect Dis 44:, 1143–1149. [CrossRef] [PubMed]
    [Google Scholar]
  10. Fujisawa T. , Suda T. , Matsuda H. , Inui N. , Nakamura Y. , Sato J. , Toyoshima M. , Nakano Y. , Yasuda K. . & other authors ( 2009; ). Real-time PCR is more specific than conventional PCR for induced sputum diagnosis of Pneumocystis pneumonia in immunocompromised patients without HIV infection. . Respirology 14:, 203–209. [CrossRef] [PubMed]
    [Google Scholar]
  11. Gupta R. , Iyer V. K. , Mirdha B. R. , Guleria R. , Kumar L. , Agarwal S. K. . ( 2010; ). Role of cytology and polymerase chain reaction based detection of Pneumocystis jirovecii infection in bronchoalveolar lavage fluid. . Acta Cytol 54:, 296–302. [CrossRef] [PubMed]
    [Google Scholar]
  12. Hughes W. T. . ( 1982; ). Natural mode of acquisition for de novo infection with Pneumocystis carinii . . J Infect Dis 145:, 842–848. [CrossRef] [PubMed]
    [Google Scholar]
  13. Hugot J. P. , Demanche C. , Barriel V. , Dei-Cas E. , Guillot J. . ( 2003; ). Phylogenetic systematics and evolution of primate-derived Pneumocystis based on mitochondrial or nuclear DNA sequence comparison. . Syst Biol 52:, 735–744. [CrossRef] [PubMed]
    [Google Scholar]
  14. Jarboui M. A. , Sellami A. , Sellami H. , Cheikhrouhou F. , Makni F. , Ben Arab N. , Ben Jemaa M. , Ayadi A. . ( 2010; ). Molecular diagnosis of Pneumocystis jiroveci pneumonia in immunocompromised patients. . Mycoses 53:, 329–333.[PubMed]
    [Google Scholar]
  15. Jiancheng W. , Minjun H. , Yi-jun A. , Lan S. , Zengzhu G. , Jianrong S. , Xixiong K. . ( 2009; ). Screening Pneumocystis carinii pneumonia in non-HIV-infected immunocompromised patients using polymerase chain reaction. . Diagn Microbiol Infect Dis 64:, 396–401. [CrossRef] [PubMed]
    [Google Scholar]
  16. Kameda H. , Tokuda H. , Sakai F. , Johkoh T. , Mori S. , Yoshida Y. , Takayanagi N. , Taki H. , Hasegawa Y. . & other authors ( 2011; ). Clinical and radiological features of acute-onset diffuse interstitial lung diseases in patients with rheumatoid arthritis receiving treatment with biological agents: importance of Pneumocystis pneumonia in Japan revealed by a multicenter study. . Intern Med 50:, 305–313. [CrossRef] [PubMed]
    [Google Scholar]
  17. Larsen H. H. , von Linstow M. L. , Lundgren B. , Høgh B. , Westh H. , Lundgren J. D. . ( 2007; ). Primary Pneumocystis infection in infants hospitalized with acute respiratory tract infection. . Emerg Infect Dis 13:, 66–72. [CrossRef] [PubMed]
    [Google Scholar]
  18. Maskell N. A. , Waine D. J. , Lindley A. , Pepperell J. C. , Wakefield A. E. , Miller R. F. , Davies R. J. . ( 2003; ). Asymptomatic carriage of Pneumocystis jiroveci in subjects undergoing bronchoscopy: a prospective study. . Thorax 58:, 594–597. [CrossRef] [PubMed]
    [Google Scholar]
  19. McCaughan J. A. , Courtney A. E. . ( 2012; ). Pneumocystis jiroveci pneumonia in renal transplantation: time to review our practice?. Nephrol Dial Transplant 27:, 13–15. [CrossRef] [PubMed]
    [Google Scholar]
  20. Mekinian A. , Queyrel V. , Durand-Joly I. , Moranne O. , Denis G. , Delhaes L. , Morell-Dubois S. , Lambert M. , Launay D. . & other authors ( 2010; ). [Positive Pneumocystis jirovecii PCR in immunocompromised patients with a systemic disease: infection or colonisation?]. . Rev Med Interne 31:, 194–199 (in French). [CrossRef] [PubMed]
    [Google Scholar]
  21. Mori S. , Cho I. , Sugimoto M. . ( 2009; ). A followup study of asymptomatic carriers of Pneumocystis jiroveci during immunosuppressive therapy for rheumatoid arthritis. . J Rheumatol 36:, 1600–1605. [CrossRef] [PubMed]
    [Google Scholar]
  22. Morris A. M. , Masur H. . ( 2011; ). A serologic test to diagnose Pneumocystis pneumonia: are we there yet?. Clin Infect Dis 53:, 203–204. [CrossRef] [PubMed]
    [Google Scholar]
  23. Neff R. T. , Jindal R. M. , Yoo D. Y. , Hurst F. P. , Agodoa L. Y. , Abbott K. C. . ( 2009; ). Analysis of USRDS: incidence and risk factors for Pneumocystis jiroveci pneumonia. . Transplantation 88:, 135–141. [CrossRef] [PubMed]
    [Google Scholar]
  24. NICE ( 2011; ). Increasing the uptake of HIV testing among men who have sex with men. . NICE Guidance PH 34, http://guidance.nice.org.uk/PHG/Wave19/4.
  25. Olsson M. , Eriksson B. M. , Elvin K. , Strandberg M. , Wahlgren M. . ( 2001; ). Genotypes of clustered cases of Pneumocystis carinii pneumonia. . Scand J Infect Dis 33:, 285–289. [CrossRef] [PubMed]
    [Google Scholar]
  26. Oz H. S. , Hughes W. T. . ( 2000; ). Search for Pneumocystis carinii DNA in upper and lower respiratory tract of humans. . Diagn Microbiol Infect Dis 37:, 161–164. [CrossRef] [PubMed]
    [Google Scholar]
  27. Rohner P. , Jacomo V. , Studer R. , Schrenzel J. , Graf J. D. . ( 2009; ). Detection of Pneumocystis jirovecii by two staining methods and two quantitative PCR assays. . Infection 37:, 261–265.[PubMed] [CrossRef]
    [Google Scholar]
  28. Samuel C. M. , Whitelaw A. , Corcoran C. , Morrow B. , Hsiao N. Y. , Zampoli M. , Zar H. J. . ( 2011; ). Improved detection of Pneumocystis jirovecii in upper and lower respiratory tract specimens from children with suspected Pneumocystis pneumonia using real-time PCR: a prospective study. . BMC Infect Dis 11:, 329. [CrossRef] [PubMed]
    [Google Scholar]
  29. Stringer J. R. , Beard C. B. , Miller R. F. , Wakefield A. E. . ( 2002; ). A new name (Pneumocystis jiroveci) for Pneumocystis from humans. . Emerg Infect Dis 8:, 891–896.[PubMed] [CrossRef]
    [Google Scholar]
  30. Su Y. S. , Lu J. J. , Perng C. L. , Chang F. Y. . ( 2008; ). Pneumocystis jirovecii pneumonia in patients with and without human immunodeficiency virus infection. . J Microbiol Immunol Infect 41:, 478–482.[PubMed]
    [Google Scholar]
  31. Tasaka S. , Hasegawa N. , Kobayashi S. , Yamada W. , Nishimura T. , Takeuchi T. , Ishizaka A. . ( 2007; ). Serum indicators for the diagnosis of Pneumocystis pneumonia. . Chest 131:, 1173–1180. [CrossRef] [PubMed]
    [Google Scholar]
  32. Vargas S. L. , Pizarro P. , López-Vieyra M. , Neira-Avilés P. , Bustamante R. , Ponce C. A. . ( 2010; ). Pneumocystis colonization in older adults and diagnostic yield of single versus paired noninvasive respiratory sampling. . Clin Infect Dis 50:, e19–e21. [CrossRef] [PubMed]
    [Google Scholar]
  33. Vidal S. , de la Horra C. , Martín J. , Montes-Cano M. A. , Rodríguez E. , Respaldiza N. , Rodríguez F. , Varela J. M. , Medrano F. J. , Calderón E. J. . ( 2006; ). Pneumocystis jirovecii colonisation in patients with interstitial lung disease. . Clin Microbiol Infect 12:, 231–235. [CrossRef] [PubMed]
    [Google Scholar]
  34. Wakefield A. E. . ( 1996; ). DNA sequences identical to Pneumocystis carinii f. sp. carinii and Pneumocystis carinii f. sp. hominis in samples of air spora. . J Clin Microbiol 34:, 1754–1759.[PubMed]
    [Google Scholar]
  35. Wakefield A. E. , Lindley A. R. , Ambrose H. E. , Denis C. M. , Miller R. F. . ( 2003; ). Limited asymptomatic carriage of Pneumocystis jiroveci in human immunodeficiency virus-infected patients. . J Infect Dis 187:, 901–908. [CrossRef] [PubMed]
    [Google Scholar]
  36. Yazaki H. , Goto N. , Uchida K. , Kobayashi T. , Gatanaga H. , Oka S. . ( 2009; ). Outbreak of Pneumocystis jiroveci pneumonia in renal transplant recipients: P. jiroveci is contagious to the susceptible host. . Transplantation 88:, 380–385. [CrossRef] [PubMed]
    [Google Scholar]
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