Molecular evidence of interhuman transmission in an outbreak of Pneumocystis jirovecii pneumonia among renal transplant recipients
S. Gianella
Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
Search for more papers by this authorL. Haeberli
Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
Search for more papers by this authorB. Joos
Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
Search for more papers by this authorB. Ledergerber
Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
Search for more papers by this authorR.P. Wüthrich
Division of Nephrology, University Hospital Zurich, Zurich, Switzerland
Search for more papers by this authorR. Weber
Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
Search for more papers by this authorH. Kuster
Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
Search for more papers by this authorP.M. Hauser
Institute of Microbiology, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Lausanne, Switzerland
Search for more papers by this authorT. Fehr
Division of Nephrology, University Hospital Zurich, Zurich, Switzerland
Search for more papers by this authorN.J. Mueller
Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
Search for more papers by this authorS. Gianella
Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
Search for more papers by this authorL. Haeberli
Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
Search for more papers by this authorB. Joos
Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
Search for more papers by this authorB. Ledergerber
Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
Search for more papers by this authorR.P. Wüthrich
Division of Nephrology, University Hospital Zurich, Zurich, Switzerland
Search for more papers by this authorR. Weber
Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
Search for more papers by this authorH. Kuster
Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
Search for more papers by this authorP.M. Hauser
Institute of Microbiology, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Lausanne, Switzerland
Search for more papers by this authorT. Fehr
Division of Nephrology, University Hospital Zurich, Zurich, Switzerland
Search for more papers by this authorN.J. Mueller
Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
Search for more papers by this authorAbstract
S. Gianella, L. Haeberli, B. Joos, B. Ledergerber, R.P. Wüthrich, R. Weber, H. Kuster, P.M. Hauser, T. Fehr, N.J. Mueller. Molecular evidence of interhuman transmission in an outbreak of Pneumocystis jirovecii pneumonia among renal transplant recipients.Transpl Infect Dis 2010: 12: 1–10. All rights reserved
Abstract: Pneumocystis jirovecii pneumonia (PCP) remains an important cause of morbidity and mortality in immunocompromised individuals. The epidemiology and pathogenesis of this infection are poorly understood, and the exact mode of transmission remains unclear. Recent studies reported clusters of PCP among immunocompromised patients, raising the suspicion of interhuman transmission. An unexpected increase of the incidence of PCP cases in our nephrology outpatient clinic prompted us to conduct a detailed analysis. Genotyping of 7 available specimens obtained from renal transplant recipients was performed using multi-locus DNA sequence typing (MLST). Fragments of 4 variable regions of the P. jirovecii genome (ITS1, 26S, mt26S, β-tubulin) were sequenced and compared with those of 4 independent control patients. MLST analysis revealed identical sequences of the 4 regions among all 7 renal allograft recipients with available samples, indicating an infection with the same P. jirovecii genotype. We observed that all but 1 of the 19 PCP-infected transplant recipients had at least 1 concomitant visit with another PCP-infected patient within a common waiting area. This study provides evidence that nosocomial transmission among immunocompromised patients may have occurred in our nephrology outpatient clinic. Our findings have epidemiological implications and suggest that prolonged chemoprophylaxis for PCP may be warranted in an era of more intense immunosuppression.
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