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Grouped Cases of Pulmonary Pneumocystosis After Solid Organ Transplantation: Advantages of Coordination by an Infectious Diseases Unit for Overall Management and Epidemiological Monitoring

Published online by Cambridge University Press:  28 November 2016

Claire Wintenberger ,
Daniele Maubon ,
Elena Charpentier ,
John Rendu ,
Patricia Pavese ,
Caroline Augier ,
Paolo Malvezzi ,
Boubou Camara ,
Marie-Reine Mallaret  and
Laurence Bouillet
...Show all authors
Claire Wintenberger*
Affiliation:
Service de Médecine Interne, CHU de Grenoble, France
Daniele Maubon
Affiliation:
Laboratoire de Mycologie, CHU de Grenoble, France
Elena Charpentier
Affiliation:
Laboratoire de Mycologie, CHU de Grenoble, France
John Rendu
Affiliation:
Laboratoire de Biochimie et Génétique Moléculaire, CHU de Grenoble, France
Patricia Pavese
Affiliation:
Service de Maladies Infectieuses et Tropicales, CHU de Grenoble, France
Caroline Augier
Affiliation:
Service de Cardiologie, CHU de Grenoble, France
Paolo Malvezzi
Affiliation:
Service de Néphrologie, CHU de Grenoble, France
Boubou Camara
Affiliation:
Service de Pneumologie, CHU de Grenoble, France
Marie-Reine Mallaret
Affiliation:
Service D’hygiène Hospitalière Et Gestions Des Risques, CHU de Grenoble; France
Laurence Bouillet
Affiliation:
Service de Médecine Interne, CHU de Grenoble, France
Olivier Epaulard
Affiliation:
Service de Maladies Infectieuses et Tropicales, CHU de Grenoble, France
*
Address correspondence to Claire Wintenberger, Service de Médecine Interne, CHU de Grenoble, CS 10217 - 38043 Grenoble Cedex 9, France (cwintenberger@chu-grenoble.fr).
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Abstract

OBJECTIVE

To determine the origin of grouped cases of Pneumocystis pneumonia in solid-organ transplant recipients at our institution.

DESIGN

A case series with clinical examinations, genotyping, and an epidemiological survey.

SETTING

A university hospital in France.

PATIENTS

We report 12 solid-organ transplant recipients with successive cases of Pneumocystis pneumonia that occurred over 3 years; 10 of these cases occurred in a single year.

METHODS

We used molecular typing of P. jirovecii strains by multilocus sequence typing and clinical epidemiological survey to determine potential dates and places of transmission.

RESULTS

Between May 2014 and March 2015, 10 solid-organ transplant recipients (5 kidney transplants, 4 heart transplants, and 1 lung transplant) presented with Pneumocystis pneumonia. Molecular genotyping revealed the same P. jirovecii strain in at least 6 patients. This Pneumocystis strain was not identified in control patients (ie, nontransplant patients presenting with pulmonary pneumocystosis) during this period. The epidemiological survey guided by sequencing results provided information on the probable or possible dates and places of contamination for 5 of these patients. The mobile infectious diseases unit played a coordination role in the clinical management (adaptation of the local guidelines) and epidemiological survey.

CONCLUSION

Our cardiac and kidney transplant units experienced grouped cases of pulmonary pneumocystosis. Genotyping and epidemiological surveying results suggested interhuman contamination, which was quickly eliminated thanks to multidisciplinary coordination.

Infect Control Hosp Epidemiol 2017;38:179–185

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 38 , Issue 2 , February 2017 , pp. 179 - 185
Copyright
© 2016 by The Society for Healthcare Epidemiology of America. All rights reserved 

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Footnotes

PREVIOUS PRESENTATION: C. Wintenberger, D. Maubon, C. Augier, P. Malvezzi, B. Camara, M. R. Mallaret, and O. Epaulard presented part of these data as poster ID 04, “Coordination par l’équipe mobile d’infectiologie d’une réponse multidisciplinaire: Exemple de cas groupés de pneumocystose chez des patients transplantés d’organes solides,” at the 16th Journées Nationales d’Infectiologie on June 11, 2015, in Nancy, France.

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