A Pneumocystis jirovecii pneumonia outbreak in a single kidney-transplant center: role of cytomegalovirus co-infection
Pneumocystis jirovecii pneumonia (PCP) and cytomegalovirus (CMV) infection represent possible complications of medical immunosuppression. Between 2005 and 2010, non-human immunodeficiency virus (HIV) PCP patients admitted to a nephrology unit were analyzed for outcome, CMV comorbidity, and patient-t...
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| Veröffentlicht in: | European journal of clinical microbiology & infectious diseases 2012-09, Vol.31 (9), p.2429-2437 |
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| creator | Pliquett, R. U. Asbe-Vollkopf, A. Hauser, P. M. Presti, L. L. Hunfeld, K. P. Berger, A. Scheuermann, E. H. Jung, O. Geiger, H. Hauser, I. A. |
| description | Pneumocystis jirovecii
pneumonia (PCP) and cytomegalovirus (CMV) infection represent possible complications of medical immunosuppression. Between 2005 and 2010, non-human immunodeficiency virus (HIV) PCP patients admitted to a nephrology unit were analyzed for outcome, CMV comorbidity, and patient-to-patient contacts prior to PCP. In contrast to 2002–2004 (no cases) and 2008–2010 (10 cases), a PCP outbreak of 29 kidney-transplant recipients and one patient with anti-glomerular basement membrane disease occurred between 2005 and 2007. None of the patients were on PCP chemoprophylaxis. In four PCP patients, the genotyping data of bronchoalveolar lavage specimen showed an identical
Pneumocystis
strain. PCP cases had a higher incidence of CMV infection (12 of 30 PCP patients) and CMV disease (four patients) when compared to matched PCP-free controls (
p
|
| doi_str_mv | 10.1007/s10096-012-1586-x |
| format | Article |
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pneumonia (PCP) and cytomegalovirus (CMV) infection represent possible complications of medical immunosuppression. Between 2005 and 2010, non-human immunodeficiency virus (HIV) PCP patients admitted to a nephrology unit were analyzed for outcome, CMV comorbidity, and patient-to-patient contacts prior to PCP. In contrast to 2002–2004 (no cases) and 2008–2010 (10 cases), a PCP outbreak of 29 kidney-transplant recipients and one patient with anti-glomerular basement membrane disease occurred between 2005 and 2007. None of the patients were on PCP chemoprophylaxis. In four PCP patients, the genotyping data of bronchoalveolar lavage specimen showed an identical
Pneumocystis
strain. PCP cases had a higher incidence of CMV infection (12 of 30 PCP patients) and CMV disease (four patients) when compared to matched PCP-free controls (
p
< 0.05). Cotrimoxazole and, if applicable, ganciclovir were started 2.0 ± 4.0 days following admission, and immunosuppressive medication was reduced. In-hospital mortality was 10% and the three-year mortality was 20%. CMV co-infection did not affect mortality. CMV co-infection more frequently occurred during a cluster outbreak of non-HIV PCP in comparison to PCP-free controls. Here, CMV awareness and specific therapy of both CMV infection and PCP led to a comparatively favorable patient outcome. The role of patient isolation should be further investigated in incident non-HIV PCP.</description><identifier>ISSN: 0934-9723</identifier><identifier>EISSN: 1435-4373</identifier><identifier>DOI: 10.1007/s10096-012-1586-x</identifier><identifier>PMID: 22402816</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer-Verlag</publisher><subject>Adult ; Aged ; Alveoli ; Antifungal Agents - administration & dosage ; Antiviral Agents - administration & dosage ; Basement membranes ; Biological and medical sciences ; Biomedical and Life Sciences ; Biomedicine ; Bronchus ; Case-Control Studies ; Coinfection - epidemiology ; Comorbidity ; cotrimoxazole ; Cross Infection - complications ; Cross Infection - epidemiology ; Cross Infection - microbiology ; Cytomegalovirus ; Cytomegalovirus - pathogenicity ; Cytomegalovirus Infections - complications ; Cytomegalovirus Infections - epidemiology ; Data processing ; Disease Outbreaks ; Epidemics ; Female ; Ganciclovir ; Ganciclovir - administration & dosage ; Genotype ; Genotyping ; HIV ; Human immunodeficiency virus ; Humans ; Immune system ; Immunocompromised Host ; Immunosuppression ; Infection ; Infections ; Infectious diseases ; Internal Medicine ; Kidney Transplantation - adverse effects ; Kidney transplants ; Kidneys ; Male ; Medical Microbiology ; Medical sciences ; Middle Aged ; Molecular Typing ; Mortality ; Mycological Typing Techniques ; Nephrology ; Outbreaks ; Patients ; Pneumocystis ; Pneumocystis carinii - classification ; Pneumocystis carinii - genetics ; Pneumocystis carinii - isolation & purification ; Pneumology ; Pneumonia ; Pneumonia, Pneumocystis - complications ; Pneumonia, Pneumocystis - epidemiology ; Pneumonia, Pneumocystis - microbiology ; Respiratory system : syndromes and miscellaneous diseases ; Trimethoprim, Sulfamethoxazole Drug Combination - administration & dosage ; Viral diseases</subject><ispartof>European journal of clinical microbiology & infectious diseases, 2012-09, Vol.31 (9), p.2429-2437</ispartof><rights>Springer-Verlag 2012</rights><rights>2015 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c435t-28c6aa734753529e3e3d3073f3fc1f0c2e8b127cd55647e1414b0935f36e5c8e3</citedby><cites>FETCH-LOGICAL-c435t-28c6aa734753529e3e3d3073f3fc1f0c2e8b127cd55647e1414b0935f36e5c8e3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s10096-012-1586-x$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s10096-012-1586-x$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=26255111$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/22402816$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Pliquett, R. U.</creatorcontrib><creatorcontrib>Asbe-Vollkopf, A.</creatorcontrib><creatorcontrib>Hauser, P. M.</creatorcontrib><creatorcontrib>Presti, L. L.</creatorcontrib><creatorcontrib>Hunfeld, K. P.</creatorcontrib><creatorcontrib>Berger, A.</creatorcontrib><creatorcontrib>Scheuermann, E. H.</creatorcontrib><creatorcontrib>Jung, O.</creatorcontrib><creatorcontrib>Geiger, H.</creatorcontrib><creatorcontrib>Hauser, I. A.</creatorcontrib><title>A Pneumocystis jirovecii pneumonia outbreak in a single kidney-transplant center: role of cytomegalovirus co-infection</title><title>European journal of clinical microbiology & infectious diseases</title><addtitle>Eur J Clin Microbiol Infect Dis</addtitle><addtitle>Eur J Clin Microbiol Infect Dis</addtitle><description>Pneumocystis jirovecii
pneumonia (PCP) and cytomegalovirus (CMV) infection represent possible complications of medical immunosuppression. Between 2005 and 2010, non-human immunodeficiency virus (HIV) PCP patients admitted to a nephrology unit were analyzed for outcome, CMV comorbidity, and patient-to-patient contacts prior to PCP. In contrast to 2002–2004 (no cases) and 2008–2010 (10 cases), a PCP outbreak of 29 kidney-transplant recipients and one patient with anti-glomerular basement membrane disease occurred between 2005 and 2007. None of the patients were on PCP chemoprophylaxis. In four PCP patients, the genotyping data of bronchoalveolar lavage specimen showed an identical
Pneumocystis
strain. PCP cases had a higher incidence of CMV infection (12 of 30 PCP patients) and CMV disease (four patients) when compared to matched PCP-free controls (
p
< 0.05). Cotrimoxazole and, if applicable, ganciclovir were started 2.0 ± 4.0 days following admission, and immunosuppressive medication was reduced. In-hospital mortality was 10% and the three-year mortality was 20%. CMV co-infection did not affect mortality. CMV co-infection more frequently occurred during a cluster outbreak of non-HIV PCP in comparison to PCP-free controls. Here, CMV awareness and specific therapy of both CMV infection and PCP led to a comparatively favorable patient outcome. The role of patient isolation should be further investigated in incident non-HIV PCP.</description><subject>Adult</subject><subject>Aged</subject><subject>Alveoli</subject><subject>Antifungal Agents - administration & dosage</subject><subject>Antiviral Agents - administration & dosage</subject><subject>Basement membranes</subject><subject>Biological and medical sciences</subject><subject>Biomedical and Life Sciences</subject><subject>Biomedicine</subject><subject>Bronchus</subject><subject>Case-Control Studies</subject><subject>Coinfection - epidemiology</subject><subject>Comorbidity</subject><subject>cotrimoxazole</subject><subject>Cross Infection - complications</subject><subject>Cross Infection - epidemiology</subject><subject>Cross Infection - microbiology</subject><subject>Cytomegalovirus</subject><subject>Cytomegalovirus - pathogenicity</subject><subject>Cytomegalovirus Infections - complications</subject><subject>Cytomegalovirus Infections - epidemiology</subject><subject>Data processing</subject><subject>Disease Outbreaks</subject><subject>Epidemics</subject><subject>Female</subject><subject>Ganciclovir</subject><subject>Ganciclovir - administration & dosage</subject><subject>Genotype</subject><subject>Genotyping</subject><subject>HIV</subject><subject>Human immunodeficiency virus</subject><subject>Humans</subject><subject>Immune system</subject><subject>Immunocompromised Host</subject><subject>Immunosuppression</subject><subject>Infection</subject><subject>Infections</subject><subject>Infectious diseases</subject><subject>Internal Medicine</subject><subject>Kidney Transplantation - adverse effects</subject><subject>Kidney transplants</subject><subject>Kidneys</subject><subject>Male</subject><subject>Medical Microbiology</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Molecular Typing</subject><subject>Mortality</subject><subject>Mycological Typing Techniques</subject><subject>Nephrology</subject><subject>Outbreaks</subject><subject>Patients</subject><subject>Pneumocystis</subject><subject>Pneumocystis carinii - classification</subject><subject>Pneumocystis carinii - genetics</subject><subject>Pneumocystis carinii - isolation & purification</subject><subject>Pneumology</subject><subject>Pneumonia</subject><subject>Pneumonia, Pneumocystis - complications</subject><subject>Pneumonia, Pneumocystis - epidemiology</subject><subject>Pneumonia, Pneumocystis - microbiology</subject><subject>Respiratory system : syndromes and miscellaneous diseases</subject><subject>Trimethoprim, Sulfamethoxazole Drug Combination - administration & dosage</subject><subject>Viral diseases</subject><issn>0934-9723</issn><issn>1435-4373</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2012</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNqNkUuLFDEUhYMoTjv6A9xIQAQ30bxT5W4YfMHAuNB1kU7fNOmpStok1Uz_e9PT7YOBATcJ5H7n3nNzEHrJ6DtGqXlf2tlrQhknTHWa3D5CCyaFIlIY8RgtaC8k6Q0XZ-hZKRvaNJ0xT9EZ55LyjukF2l3gbxHmKbl9qaHgTchpBy4EvL17jsHiNNdlBnuDQ8QWlxDXI-CbsIqwJzXbWLajjRU7iBXyB5xTKyeP3b6mCdZ2TLuQ54JdIiF6cDWk-Bw98XYs8OJ0n6Mfnz5-v_xCrq4_f728uCKurVEJ75y21ghplFC8BwFiJagRXnjHPHUcuiXjxq2U0tIAk0wu29LKCw3KdSDO0dtj321OP2codZhCcTA2w5DmMjCqe9b3XHb_gQqhmhMtGvr6HrpJc45tkQNluKGc0kaxI-VyKiWDH7Y5TDbvGzQc8huO-Q0tv-GQ33DbNK9OneflBKs_it-BNeDNCbDF2dG373eh_OU0V4ox1jh-5EorxTXkfy0-NP0XJk2zSw</recordid><startdate>20120901</startdate><enddate>20120901</enddate><creator>Pliquett, R. 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U. ; Asbe-Vollkopf, A. ; Hauser, P. M. ; Presti, L. L. ; Hunfeld, K. P. ; Berger, A. ; Scheuermann, E. H. ; Jung, O. ; Geiger, H. ; Hauser, I. 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U.</au><au>Asbe-Vollkopf, A.</au><au>Hauser, P. M.</au><au>Presti, L. L.</au><au>Hunfeld, K. P.</au><au>Berger, A.</au><au>Scheuermann, E. H.</au><au>Jung, O.</au><au>Geiger, H.</au><au>Hauser, I. A.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>A Pneumocystis jirovecii pneumonia outbreak in a single kidney-transplant center: role of cytomegalovirus co-infection</atitle><jtitle>European journal of clinical microbiology & infectious diseases</jtitle><stitle>Eur J Clin Microbiol Infect Dis</stitle><addtitle>Eur J Clin Microbiol Infect Dis</addtitle><date>2012-09-01</date><risdate>2012</risdate><volume>31</volume><issue>9</issue><spage>2429</spage><epage>2437</epage><pages>2429-2437</pages><issn>0934-9723</issn><eissn>1435-4373</eissn><abstract>Pneumocystis jirovecii
pneumonia (PCP) and cytomegalovirus (CMV) infection represent possible complications of medical immunosuppression. Between 2005 and 2010, non-human immunodeficiency virus (HIV) PCP patients admitted to a nephrology unit were analyzed for outcome, CMV comorbidity, and patient-to-patient contacts prior to PCP. In contrast to 2002–2004 (no cases) and 2008–2010 (10 cases), a PCP outbreak of 29 kidney-transplant recipients and one patient with anti-glomerular basement membrane disease occurred between 2005 and 2007. None of the patients were on PCP chemoprophylaxis. In four PCP patients, the genotyping data of bronchoalveolar lavage specimen showed an identical
Pneumocystis
strain. PCP cases had a higher incidence of CMV infection (12 of 30 PCP patients) and CMV disease (four patients) when compared to matched PCP-free controls (
p
< 0.05). Cotrimoxazole and, if applicable, ganciclovir were started 2.0 ± 4.0 days following admission, and immunosuppressive medication was reduced. In-hospital mortality was 10% and the three-year mortality was 20%. CMV co-infection did not affect mortality. CMV co-infection more frequently occurred during a cluster outbreak of non-HIV PCP in comparison to PCP-free controls. Here, CMV awareness and specific therapy of both CMV infection and PCP led to a comparatively favorable patient outcome. The role of patient isolation should be further investigated in incident non-HIV PCP.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer-Verlag</pub><pmid>22402816</pmid><doi>10.1007/s10096-012-1586-x</doi><tpages>9</tpages></addata></record> |
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| identifier | ISSN: 0934-9723 |
| ispartof | European journal of clinical microbiology & infectious diseases, 2012-09, Vol.31 (9), p.2429-2437 |
| issn | 0934-9723 1435-4373 |
| language | eng |
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| source | MEDLINE; SpringerLink Journals - AutoHoldings |
| subjects | Adult Aged Alveoli Antifungal Agents - administration & dosage Antiviral Agents - administration & dosage Basement membranes Biological and medical sciences Biomedical and Life Sciences Biomedicine Bronchus Case-Control Studies Coinfection - epidemiology Comorbidity cotrimoxazole Cross Infection - complications Cross Infection - epidemiology Cross Infection - microbiology Cytomegalovirus Cytomegalovirus - pathogenicity Cytomegalovirus Infections - complications Cytomegalovirus Infections - epidemiology Data processing Disease Outbreaks Epidemics Female Ganciclovir Ganciclovir - administration & dosage Genotype Genotyping HIV Human immunodeficiency virus Humans Immune system Immunocompromised Host Immunosuppression Infection Infections Infectious diseases Internal Medicine Kidney Transplantation - adverse effects Kidney transplants Kidneys Male Medical Microbiology Medical sciences Middle Aged Molecular Typing Mortality Mycological Typing Techniques Nephrology Outbreaks Patients Pneumocystis Pneumocystis carinii - classification Pneumocystis carinii - genetics Pneumocystis carinii - isolation & purification Pneumology Pneumonia Pneumonia, Pneumocystis - complications Pneumonia, Pneumocystis - epidemiology Pneumonia, Pneumocystis - microbiology Respiratory system : syndromes and miscellaneous diseases Trimethoprim, Sulfamethoxazole Drug Combination - administration & dosage Viral diseases |
| title | A Pneumocystis jirovecii pneumonia outbreak in a single kidney-transplant center: role of cytomegalovirus co-infection |
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