Document Detail

An outbreak of Pneumocystis jiroveci pneumonia with 1 predominant genotype among renal transplant recipients: interhuman transmission or a common environmental source?
MedLine Citation:
PMID:  17407029     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: An outbreak of Pneumocystis jiroveci pneumonia (PCP) occurred among renal transplant recipients attending the outpatient department at the Leiden University Medical Centre (Leiden, The Netherlands) from 1 March 2005 through 1 February 2006. Clinical, epidemiological, and molecular data were analyzed to trace the outbreak's origin. METHODS: Renal transplant recipients with a clinical suspected diagnosis of PCP were included in the study. The diagnosis had to be confirmed by direct microscopy or real-time polymerase chain reaction of the dihydropteroate synthase gene in a bronchoalveolar fluid specimen. To detect contacts between patients, a transmission map was constructed. A case-control analysis was performed to asses whether infection was associated with certain wardrooms. Genotyping of Pneumocystis isolates was performed by sequence analysis of the internal transcribed spacer (ITS) number 1 and 2 gene regions. RESULTS: Twenty-two confirmed PCP cases were identified; approximately 0-1 would have been expected over the same time period. No risk factor was predominantly present, and standard immunosuppressive regimens had not changed. Liver transplant recipients who used the same outpatient facilities had not acquired PCP. The transmission map findings were compatible with interhuman transmission on multiple occasions. The case-control study did not point to wardrooms as a common source. Genotyping by sequencing of the ITS1 and ITS2 gene regions revealed type Ne in 12 of 16 successfully typed samples. Genotype Ne was found in only 2 of 12 reference samples. CONCLUSIONS: The clinical data and genotyping results are compatible with either interhuman transmission or an environmental source of infection. More complex models may account for PCP clusters.
Mark G J de Boer; Lesla E S Bruijnesteijn van Coppenraet; Andre Gaasbeek; Stefan P Berger; Luc B S Gelinck; Hans C van Houwelingen; Peterhans van den Broek; Ed J Kuijper; Frank P Kroon; Jan P Vandenbroucke
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Publication Detail:
Type:  Journal Article     Date:  2007-03-26
Journal Detail:
Title:  Clinical infectious diseases : an official publication of the Infectious Diseases Society of America     Volume:  44     ISSN:  1537-6591     ISO Abbreviation:  Clin. Infect. Dis.     Publication Date:  2007 May 
Date Detail:
Created Date:  2007-04-04     Completed Date:  2007-04-19     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  9203213     Medline TA:  Clin Infect Dis     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1143-9     Citation Subset:  IM    
Department of Infectious Diseases, Centre for Infectious Diseases, Leiden University Medical Centre, Leiden, The Netherlands.
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MeSH Terms
Aged, 80 and over
Air Pollution, Indoor / adverse effects
Case-Control Studies
Cross Infection / transmission*
Disease Outbreaks*
Kidney Transplantation*
Pneumocystis jirovecii / genetics*
Pneumonia, Pneumocystis / epidemiology*,  transmission*,  virology
Comment In:
Clin Infect Dis. 2007 May 1;44(9):1150-1   [PMID:  17407030 ]

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