Molecular Demonstration of a Pneumocystis Outbreak in Stem Cell Transplant Patients: Evidence for Transmission in the Daycare Center

Frontiers in Microbiology

卷:8

Cécile Pautas¹  Andrea Toma¹  Giulia la Martire¹  Stéphane Bretagne²  Alexandre Alanio²  Françoise Botterel³  Cécile Angebault³  Maud Gits-Muselli⁵  Rabah Redjoul⁶  Florence Beckerich⁶  Sébastien Maury⁶  Christine Robin⁶  Mathieu Leclerc⁶  Catherine Cordonnier⁶  Frédéric Schlemmer⁷ 

[1] Department of Hematology, Assistance Publique-Hôpitaux de Paris, Henri Mondor Teaching HospitalCréteil, France;

[2] Molecular Mycology Unit, National Reference Center of Invasive Mycosis and Antifungals, Centre National de la Recherche Scientifique, Institut Pasteur, URA3012Paris, France;

[3] Parasitology-Mycology Laboratory, Assistance Publique-Hôpitaux de Paris, Henri Mondor Teaching HospitalCréteil, France;

[4] Parasitology-Mycology Laboratory, Assistance Publique-Hôpitaux de Paris, Lariboisière Saint-Louis Fernand Widal HospitalParis, France;

[5] Paris-Diderot, Sorbonne Paris Cité UniversityParis, France;

[6] Paris-Est Créteil UniversityCréteil, France;

[7] Unit of Pneumology, Intensive Care Department, Assistance Publique-Hôpitaux de Paris, Henri Mondor Teaching Hospital, DHU A-TVBCréteil, France;

关键词: Pneumocystis jirovecii;    genotyping;    microsatellite;    short tandem repeat;    nosocomial infection;   

DOI  :  10.3389/fmicb.2017.00700

来源: DOAJ

【 摘 要 】

Pneumocystis jirovecii pneumonia (PCP) is a life-threatening infection in hematology. Although occasionally reported, the role of interhuman transmission of P. jirovecii in PCP, compared to that of reactivation, remains an unresolved question; the recommendation to isolate PCP patients in the hematology ward are not well evidence-based. Following an unexpected increase in the number of febrile pneumonia patients with P. jirovecii DNA detected in respiratory samples in our hematology ward, we explored 12 consecutive patients from November 2015 to May 2016. Genotyping of P jirovecii was performed using microsatellite markers. The frequency of simultaneous occupancy of these 12 patients in the same unit on the same day from 4 months prior to the first diagnosis was recorded. In three patients, the P. jirovecii genotype could not be determined because DNA was insufficient. One rare single genotype (Gt2) was found in four of the other nine, all allogeneic stem cell transplant recipients. The transmission map showed that these 4 patients had multiple opportunities to meet on the same day (median, 6.5; range, 4–10) at the daycare center. It was much less among the eight non-Gt2 patients (median, 1; range, 0–9; P = 0.048). This study, based on modern molecular technics, strongly suggests that interhuman transmission of P. jirovecii between allogeneic stem cell transplant recipients is possible. P. jirovecii DNA detected in respiratory specimens supports that isolation and respiratory precautions be recommended in such cases in the hematology ward.

【 授权许可】

Unknown