Free Standard AU & NZ Shipping For All Book Orders Over $80!
Register      Login
Microbiology Australia Microbiology Australia Society
Microbiology Australia, bringing Microbiologists together
Shopping Cart: ( empty )
You are here: Home > Journals > MA > MA14016
RESEARCH ARTICLE
Contents Vol 35(1)

Hospital-acquired Pneumocystis pneumonia: a renewed concern?

Sharon Chen A B F , Brian Nankivell C , Carolina Firacative B , Kathy Kable C , Debbie Marriott D , Peter MacDonald E , Wieland Meyer B and Jeremy Chapman C
+ Author Affiliations
- Author Affiliations

A Centre for Infectious Diseases and Microbiology Laboratory Services, ICPMR – Pathology West, Westmead Hospital, NSW 2145, Australia

B Molecular Mycology Research Laboratory, Centre for Infectious Diseases and Microbiology, Sydney Medical School – Western, University of Sydney, NSW 2145, Australia

C Department of Renal Medicine, Westmead Hospital, University of Sydney, NSW 2145, Australia

D Department of Microbiology and Infectious Diseases, St Vincent’s Hospital, NSW 2010, Australia

E Department of Cardiology, St Vincent’s Hospital, NSW 2010, Australia

F Corresponding author. Tel: +61 2 9845 6255, Fax: +61 2 9893 8659, Email: Sharon.chen@health.nsw.gov.au

Microbiology Australia 35(1) 57-59 https://doi.org/10.1071/MA14016
Published: 4 February 2014

Abstract

Pneumocystis pneumonia (PCP), caused by the fungus Pneumocystis jirovecii, is a life-threatening pulmonary infection in immuncompromised hosts. Solid organ transplant (SOT) recipients are among those at increased risk, with infection attributed to reactivation of dormant colonisation1. Prior to the institution of routine antimicrobial prophylaxis, the overall incidence of PCP in SOT recipients was 5–15%, with the lowest incidence in kidney recipients (2–15%) and the highest, in lung and heart/lung recipients (10–40%)2,3. Prophylaxis with trimethoprim-sulfamethoxazole (TMP-SXZ) has reduced the risk of PCP by ≈91% and has largely eliminated PCP within the first year of transplantation. Prophylaxis is important since PCP-related mortality is as high as 60% despite treatment with TMP-SXZ2,4,5. Late infection was considered highly unusual1,6. However, the optimal duration of prophylaxis is uncertain. The occurrence of recent PCP case clusters in kidney transplant units in Europe and Asia (summarised in a review article; see reference 6)6 and in Australia7 has challenged our current appreciation of PCP as an ‘infection of the past’ outside patients with HIV/AIDS. It also gives pause to the likelihood of de novo infection, its mode of transmission and to the validity of current antimicrobial prophylactic regimens used, if any. This article outlines the clusters in Australia, hypothesises why this may have occurred and presents the recent consensus proposal for outbreak containment and prophylaxis against PCP. Details of the outbreaks in other regions are not reviewed.


References

[1]  Catherinot, E. et al. (2010) Pneumocystis jirovecii pneumonia. Infect. Dis. Clin. North Am. 24, 107–138.
|  Pneumocystis jirovecii pneumonia.Crossref | GoogleScholarGoogle Scholar | 20171548PubMed |

[2]  Gordon, S.M. et al. (1999) Should prophylaxis for Pneumocystis carinii pneumonia in solid organ transplant recipients ever be discontinued? Clin. Infect. Dis. 28, 240–246.
| Should prophylaxis for Pneumocystis carinii pneumonia in solid organ transplant recipients ever be discontinued?Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK1M7mt1Sjsw%3D%3D&md5=0dcf96faf52d633ca711c0eb5e44bbb6CAS | 10064238PubMed |

[3]  Martin, S.I. and Fishman, J.A. (2009) Pneumocystis pneumonia in solid organ transplant recipients. Am. J. Transplant. 9, S227–S233.
|  Pneumocystis pneumonia in solid organ transplant recipients.Crossref | GoogleScholarGoogle Scholar | 20070684PubMed |

[4]  Sepkowitz, K.A. (2002) Opportunistic infections in patients with and patients without acquired immunodeficiency syndrome. Clin. Infect. Dis. 34, 1098–1107.
| Opportunistic infections in patients with and patients without acquired immunodeficiency syndrome.Crossref | GoogleScholarGoogle Scholar | 11914999PubMed |

[5]  Green, H. et al. (2007) Prophylaxis for Pneumocystis pneumonia (PCP) in non-HIV immunocompromised patients. Cochrane Database Syst. Rev. 3, CD005590.
| 17636808PubMed |

[6]  de Boer, M.J. et al. (2011) Outbreaks and clustering of Pneumocystis pneumonia in kidney transplant recipients: a systematic review. Med. Mycol. 49, 673–681.

[7]  Phipps, L. et al. (2011) Nosocomial Pneumocystis jirovecii pneumonia: lessons learned from a cluster in kidney transplant recipients. Transplantation 92, 1327–1334.
| Nosocomial Pneumocystis jirovecii pneumonia: lessons learned from a cluster in kidney transplant recipients.Crossref | GoogleScholarGoogle Scholar | 22129760PubMed |

[8]  Nankivell, B.J. et al. (2013) Molecular epidemiology linking multihospital clusters of opportunistic Pneumocystis jirovecii pneumonia. Clin. Infect. Dis. 57, 1058–1059.
| Molecular epidemiology linking multihospital clusters of opportunistic Pneumocystis jirovecii pneumonia.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BC3sXhslaktb7I&md5=365c3801e551e7b40ce84163a7f13489CAS | 23794722PubMed |

[9]  Radisic, M. et al. (2003) Risk factors for Pneumocystis carinii pneumonia in kidney transplant recipients: a case-control study. Transpl. Infect. Dis. 5, 84–93.
| Risk factors for Pneumocystis carinii pneumonia in kidney transplant recipients: a case-control study.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3svosVWisg%3D%3D&md5=95e3bffed357e0dc60f2817b1f2b80baCAS | 12974789PubMed |

[10]  Choukri, F. et al. (2010) Quantification and spread of Pneumocystis jirovecii in the surrounding air of patients with Pneumocystis pneumonia. Clin. Infect. Dis. 51, 259–265.
| Quantification and spread of Pneumocystis jirovecii in the surrounding air of patients with Pneumocystis pneumonia.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BC3cXhtVGlsL3L&md5=1698340e6506370af0399e97a99d9516CAS | 20572759PubMed |

[11]  Le Gal, S. et al. (2012) A cluster of Pneumocystis infections among renal transplant recipients: molecular evidence of colonized patients as potential infectious sources of Pneumocystis jirovecii. Clin. Infect. Dis. 54, e62–e71.
| A cluster of Pneumocystis infections among renal transplant recipients: molecular evidence of colonized patients as potential infectious sources of Pneumocystis jirovecii.Crossref | GoogleScholarGoogle Scholar | 22337822PubMed |

[12]  Gianella, S. et al. (2010) Molecular evidence of interhuman transmission in an outbreak of Pneumocystis jirovecii pneumonia among renal transplant recipients. Transpl. Infect. Dis. 12, 1–10.
| Molecular evidence of interhuman transmission in an outbreak of Pneumocystis jirovecii pneumonia among renal transplant recipients.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BC3czkvVKnuw%3D%3D&md5=6df07d5f3fff6aea5a1430c44d7aed33CAS | 19744285PubMed |

[13]  Yazaki, H. et al. (2009) Outbreak of Pneumocystis jirovecii pneumonia in renal transplant recipients: P. jirovecii is contagious to the susceptible host. Transplantation 88, 380–385.
| Outbreak of Pneumocystis jirovecii pneumonia in renal transplant recipients: P. jirovecii is contagious to the susceptible host.Crossref | GoogleScholarGoogle Scholar | 19667941PubMed |

[14]  Thomas, S. et al. (2011) Increasing frequency of Pneumocystis jirovecii pneumonia in renal transplant recipients in the Untied Kingdom: clonal variability, clusters, and geographic location. Clin. Infect. Dis. 53, 307–308.
| Increasing frequency of Pneumocystis jirovecii pneumonia in renal transplant recipients in the Untied Kingdom: clonal variability, clusters, and geographic location.Crossref | GoogleScholarGoogle Scholar | 21765086PubMed |

[15]  Hauser, P. et al. (2013) Pneumocystis jirovecii genotypes involved in Pneumocystis pneumonia outbreaks among renal transplant recipients. Clin. Infect. Dis. 56, 165–166.
|  Pneumocystis jirovecii genotypes involved in Pneumocystis pneumonia outbreaks among renal transplant recipients.Crossref | GoogleScholarGoogle Scholar | 22990847PubMed |

[16]  Radonirina, M. et al. (2004) Molecular evidence of interhuman transmission of Pnuemocystis pneumonia among renal transplant recipients hospitalized with HIV-infected patients. Emerg. Infect. Dis. 10, 1766–1773.

[17]  Sassi, M. et al. (2012) Outbreaks of Pneumocystis pneumonia in 2 renal transplant centres linked to a single strain of Pneumocystis: implications for transmission and virulence. Clin. Infect. Dis. 54, 1437–1444.
| Outbreaks of Pneumocystis pneumonia in 2 renal transplant centres linked to a single strain of Pneumocystis: implications for transmission and virulence.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BC38XmsFejsLc%3D&md5=0bdf979ed151833667ad39c47a2c8abaCAS | 22431811PubMed |

[18]  Rostved, A. et al. (2013) Outbreak of pneumocystis pneumonia in renal and liver transplant patients caused by genotypically distinct strains of Pneumocystis jirovecii. Transplantation 96, 834–842.
| Outbreak of pneumocystis pneumonia in renal and liver transplant patients caused by genotypically distinct strains of Pneumocystis jirovecii.Crossref | GoogleScholarGoogle Scholar | 23903011PubMed |

[19]  Chabé, M. et al. (2011) Pneumocystis: from a doubtful unique entity to a group of highly diversified fungal species. FEMS Yeast Res. 11, 2–17.
|  Pneumocystis: from a doubtful unique entity to a group of highly diversified fungal species.Crossref | GoogleScholarGoogle Scholar | 21114625PubMed |

[20]  Cushion, M. (2010) Are members of the fungal genus Pneumocystis (a) commensals; (b) opportunists; (c) pathogens; or (d) all of the above? PLoS Pathog. 6, e1001009.
| Are members of the fungal genus Pneumocystis (a) commensals; (b) opportunists; (c) pathogens; or (d) all of the above?Crossref | GoogleScholarGoogle Scholar | 20885786PubMed |

[21]  Chapman, J.R. et al. (2013) Post-transplant Pneumocystis pneumonia – a re–emerged public health problem? Kidney Int. 84, 240–243.
| Post-transplant Pneumocystis pneumonia – a re–emerged public health problem?Crossref | GoogleScholarGoogle Scholar | 23739237PubMed |

[22]  Goto, N. and Oka, S. (2011) Pneumocystis jirovecii pneumonia in kidney transplantation. Transpl. Infect. Dis. 13, 551–558.
|  Pneumocystis jirovecii pneumonia in kidney transplantation.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BC38%2FosFWrug%3D%3D&md5=8b991455f84e193f7ab9c46ec843fc93CAS | 22093172PubMed |