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Nosocomial Transmission of Opportunistic Infections

Published online by Cambridge University Press:  02 January 2015

Julie Louise Gerberding
Julie Louise Gerberding*
Affiliation:
San Francisco General Hospital, San Francisco, California
*
San Francisco General Hospital, 1001 Potrero Ave, Bldg 1, Rm 301, San Francisco, CA 94110
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Abstract

Immunocompromised patients are at high risk for opportunistic infections. Traditionally, these infections were thought to arise from endogenous reactivation of previously acquired latent infections, and nosocomial transmission therefore was deemed to be so unlikely that no special infection control interventions were needed to prevent transmission in healthcare settings. However, new data have challenged this view and suggest that some opportunistic pathogens are transmissible from one immunosuppressed patient to another. Epidemiological investigations, molecular genotyping, animal studies, and air-sampling experiments lend support to the hypothesis that reinfection with opportunistic pathogens does occur, that airborne transmission is possible, and that nosocomial spread is a plausible explanation for case clusters. Taken together, these observations support the view that some opportunistic infections are exogenous in origin and that additional epidemiological investigations are needed to define the true risk of nosocomial spread and need for isolation.

Type
From the Fifth International Conference on the Prevention of Infection
Information
Infection Control & Hospital Epidemiology , Volume 19 , Issue 8 , August 1998 , pp. 574 - 577
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1998

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References

1.Lundgren, B, Lebech, M, Lind, K, Nielsen, JO, Lundgren, JD. Antibody response to a major human Pneumocystis carinii surface antigen in patients without evidence of immunosuppression and in patients with suspected atypical pneumonia. Eur J Clin Microbiol Infect Dis 1993;12:105–109.Google Scholar
2.Pifer, LL, Hughes, WT, Stagno, S, Woods, D. Pneumocystis carinii infection: evidence for high prevalence in normal and immunosuppressed children. Pediatrics 1978;61:35–41.Google Scholar
3.Gerrard, MP, Eden, OB, Jameson, B, Craft, AW. Serological study of Pneumocystis carinii infection in the absence of immunosuppression. Arch Dis Child 1987;62:177–179.Google Scholar
4.Smulian, AG, Sullivan, DW, Linke, MJ, Halsey, NA, Quinn, TC, MacPhail, AP, et al. Geographic variation in the humoral response to Pneumocystis carinii. J Infect Dis 1993;167:1243–1247.Google Scholar
5.Shepherd, V, Jameson, B, Knowles, GK. Pneumocystis carinii pneumonitis: a serological study. J Clin Pathol 1979;32:773–777.Google Scholar
6.Kovacs, JA, Halpern, JL, Swan, JC, Moss, J, Parillo, JE, Masur, H. Identification of antigens and antibodies specific for Pneumocystis carinii. J Immunol 1988;140:2023–2031.Google Scholar
7.Sepkowitz, K, Schluger, N, Godwin, T, Armstrong, D, Cerami, A, Bucala, R. DNA amplification in experimental pneumocystosis: characterization of serum Pneumocystis carinii DNA and potential P. carinii carrier states. J Infect Dis 1993;168:421–426.Google Scholar
8.Vargas, SL, Hughes, WT, Wakefield, AE, Oz, HS. Limited persistence in and subsequent elimination of Pneumocystis carinii from the lungs after P. carinii pneumonia. J Infect Dis 1995;172:506–510.Google Scholar
9.Stiller, RA, Paradis, IL, Dauber, JH. Subclinical pneumonitis due to Pneumocystis carinii in a young adult with elevated antibody titers to Epstein-Barr virus. J Infect Dis 1992;166:926–930.Google Scholar
10.Elvin, K. Laboratory diagnosis and occurrence of Pneumocystis carinii. Scand J Infect Dis 1994;94(suppl):1–34.Google Scholar
11.Millard, PR, Heryet, AR. Observations favouring Pneumocystis carinii pneumonia as a primary infection: a monoclonal antibody study on paraffin sections. J Pathol 1988;154:365–370.Google Scholar
12.Perera, DR, Western, KA, Johnson, HD, Johnson, WW, Schultz, MG, Akers, PV. Pneumocystis carinii pneumonia in a hospital for children. Epidemiologic aspects. JAMA 1970;214:1074–1078Google Scholar
13.Singer, C, Armstrong, D, Rosen, PP, Schottenfeld, D. Pneumocystis carinii pneumonia: a cluster of eleven cases. Ann Intern Med 1975;82:772–777.Google Scholar
14.Hennequin, C, Page, B, Roux, P, Legendre, C, Kreis, H. Outbreak of Pneu-mocystis carinii pneumonia in a renal transplant unit. Eur J Clin Microbiol Infect Dis 1995;14:122–126.Google Scholar
15.Branten, AJ, Beckers, PJ, Tiggeler, RG, Hoitsma, AJ. Pneumocystis carinii pneumonia in renal transplant recipients. Nephrol Dial Transplant 1995;10:1194–1197.Google Scholar
16.Chave, JP, David, S, Wauters, JP, Van Melle, G, Francioli, P. Transmission of Pneumocystis carinii from AIDS patients to other Immunosuppressed patients: a cluster of Pneumocystis carinii pneumonia in renal transplant recipients. AIDS 1991;5:927–932.Google Scholar
17.Cheung, YF, Chan, CF, Lee, CW, Lau, YL. An outbreak of Pneumocystis carinii pneumonia in children with malignancy. J Paediatr Child Health 1994;30:173–175.Google Scholar
18.Varthalitis, I, Aoun, M, Daneau, D, Meunier, F. Pneumocystis carinii pneumonia in patients with cancer. An increasing incidence. Cancer 1993;71:481–485.Google Scholar
19.Mounib, B, Cabane, J, Blum, L, Picard, O, Wattiaux, MJ, Imbert, JC. Risk of nosocomial Pneumocystis carinii pneumonia in immunosuppressed patients non-infected by human immunodeficiency viruses. Rev Med Interne 1994;15:95–100.Google Scholar
20.Harmsen, AG, Chen, W, Gigliotti, F. Active immunity to Pneumocystis carinii reinfection in T-cell-depleted mice. Infect Immun 1995;63:2391–2395.Google Scholar
21.Lundgren, B, Kovacs, JA, Mathiesen, L, Nielsen, JO, Lundgren, JD. IgM response to a human Pneumocystis carinii surface antigen in HIV- infected patients with pulmonary symptoms. Scand J Infect Dis 1993;25:515–520.Google Scholar
22.Leigh, TR, Millett, MJ, Jameson, B, Collins, JV. Serum titres of Pneumo-cystis carinii antibody in health care workers caring for patients with AIDS. Thorax 1993;48:619–621.Google Scholar
23.Lidman, C, Olsson, M, Bjorkman, A, Elvin, K. No evidence of nosocomial Pneumocystis carinii infection via health care personnel. Scand J Infect Dis 1997;29:63–64.Google Scholar
24.Lundgren, B, Elvin, K, Rothman, LP, Ljungstrom, I, Lidman, C, Lundgren, JD. Transmission of Pneumocystis carinii from patients to hospital staff. Thorax 1997;52:422–424.Google Scholar
25.Margutti, P, Visconti, E, Mencarini, P, Zolfo, M, Marinaci, S, Tamburrini, E, et al.Typing with ITS regions of P carinii from AIDS patients with recurrent pneumonia. J Eukaryot Microbiol 1997;44:50S.Google Scholar
26.Tsolaki, AG, Miller, RF, Underwood, AP, Banerji, S, Wakefield, AE. Genetic diversity at the internal transcribed spacer regions of the rRNA oper-on among isolates of Pneumocystis carinii from AIDS patients with recurrent pneumonia. J Infect Dis 1996;174:141–156.Google Scholar
27.Keely, SP, Stringer, JR. Sequences of Pneumocystis carinii f. sp. hominis strains associated with recurrent pneumonia vary at multiple loci. J Clin Microbiol 1997;35:2745–2747.Google Scholar
28.Beard, CB, Navin, TR. Molecular epidemiology of Pneumocystis carinii pneumonia. Emerging Infectious Diseases 1996;2:147–150.Google Scholar
29.Centers for Disease Control and Prevention. Report of the NIH panel to define principles of therapy of HIV infection and guidelines for the use of antiretroviral agents for HIV-infected adults and adolescents. MMWR 1998;47:1–91.Google Scholar
30.Bloch, K, Pletcher, M, Zwerling, L, Gerberding, J, Ostroff, S, Reingold, S. A Population-Based Study of the Emergence of M. kansasii. Program and Abstracts of the 35th Annual Meeting of the Infectious Diseases Society of America; San Francisco, CA; 10 1998.Google Scholar
31.Sanchez, V, Vazquez, JA, Barth-Jones, D, Dembry, L, Sobel, JD, Zervos, MJ. Nosocomial acquisition of Candida parapsilosis: an epidemiologic study. Am J Med 1993;94:577–582.Google Scholar