William Vindrios1, Nicolas Argy2,3,4, Solène Le Gal5,6, François-Xavier Lescure1,7, Laurent Massias7,8, Minh Patrick Le7,8, Michel Wolff7,9, Yazdan Yazdanpanah1,7, Gilles Nevez5,6, Sandrine Houze2,3,4, Richard Dorent10, Jean-Christophe Lucet7,11. 1. Service des Maladies Infectieuses et Tropicales and. 2. Laboratoire de Parasitologie, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Bichat-Claude Bernard. 3. Faculté de Pharmacie, Université Paris Descartes, COMUE Sorbonne Paris Cité, and. 4. Institut de Recherche pour le Développement, MERIT UMR 216, Paris. 5. Laboratoire de Parasitologie, Centre Hospitalo-Universitaire de Brest and. 6. GEIHP EA 3142, Université de Bretagne Occidentale, Brest. 7. IAME, UMR 1137, INSERM, Université Paris Diderot, COMUE Sorbonne Paris Cité. 8. Laboratoire de Pharmacologie-Toxicologie. 9. Service de Réanimation Médicale. 10. Service de Chirurgie Cardiovasculaire, and. 11. Unité d'Hygiène et de Lutte contre l'Infection Nosocomiale, AP-HP, Hôpital Bichat-Claude Bernard, Paris, France.
Abstract
Background: An outbreak of Pneumocystis jirovecii pneumonia (PCP) occurred among heart transplant recipients (HTR) at the outpatient clinic of a university hospital, from March to September 2015. Clinical, therapeutic, biological, and molecular data were analyzed to determine its origin and control the outbreak. Methods: Clinical and biological data regarding all HTR followed in the outpatient clinic were collected. PCP diagnosis was based on microscopy and real-time polymerase chain reaction (PCR). Investigations were performed by building a transmission map, completed by genotyping Pneumocystis isolates and by a control of chemoprophylaxis observance. Asymptomatic exposed patients were screened for colonization using real-time PCR. Results: Among 124 HTR, 7 PCP cases were confirmed. Screening identified 3 additional patients colonized by P. jirovecii. All patients were cured, and no further cases were identified after trimethoprim-sulfamethoxazole prophylaxis was introduced in the entire cohort. Genotyping demonstrated the same strain in all PCP cases and colonized patients. All cases were linked with possible transmission chains from 2 possible index patients. Interhuman transmission was significantly associated with more frequent visits in the outpatient clinic. Six cases were receiving atovaquone as a prophylaxis. The occurrence of PCP was significantly associated with atovaquone prophylaxis. Conclusions: This is the first outbreak with detailed molecular analysis in HTR so far. Genotyping and transmission chain confirmed interhuman transmission in all colonized/infected PCP cases. Outpatient clinic layout and high encounters probably caused this PCP cluster, which was controlled after systematic trimethoprim-sulfamethoxazole prophylaxis in exposed patients.
Background: An outbreak of Pneumocystis jirovecii pneumonia (PCP) occurred among heart transplant recipients (HTR) at the outpatient clinic of a university hospital, from March to September 2015. Clinical, therapeutic, biological, and molecular data were analyzed to determine its origin and control the outbreak. Methods: Clinical and biological data regarding all HTR followed in the outpatient clinic were collected. PCP diagnosis was based on microscopy and real-time polymerase chain reaction (PCR). Investigations were performed by building a transmission map, completed by genotyping Pneumocystis isolates and by a control of chemoprophylaxis observance. Asymptomatic exposed patients were screened for colonization using real-time PCR. Results: Among 124 HTR, 7 PCP cases were confirmed. Screening identified 3 additional patients colonized by P. jirovecii. All patients were cured, and no further cases were identified after trimethoprim-sulfamethoxazole prophylaxis was introduced in the entire cohort. Genotyping demonstrated the same strain in all PCP cases and colonized patients. All cases were linked with possible transmission chains from 2 possible index patients. Interhuman transmission was significantly associated with more frequent visits in the outpatient clinic. Six cases were receiving atovaquone as a prophylaxis. The occurrence of PCP was significantly associated with atovaquone prophylaxis. Conclusions: This is the first outbreak with detailed molecular analysis in HTR so far. Genotyping and transmission chain confirmed interhuman transmission in all colonized/infected PCP cases. Outpatient clinic layout and high encounters probably caused this PCP cluster, which was controlled after systematic trimethoprim-sulfamethoxazole prophylaxis in exposed patients.
Authors: Marwan M Azar; Elizabeth Cohen; Liang Ma; Ousmane H Cissé; Geliang Gan; Yanhong Deng; Kristen Belfield; William Asch; Matthew Grant; Shana Gleeson; Alan Koff; David C Gaston; Jeffrey Topal; Shelly Curran; Sanjay Kulkarni; Joseph A Kovacs; Maricar Malinis Journal: Clin Infect Dis Date: 2022-03-01 Impact factor: 9.079
Authors: Pierre L Bonnet; Solène Le Gal; Claire V Hoffmann; Florent Morio; Fouleymata Diabira; Athéna de Quélen; Guillaume Curral; Steven Negri; Virginie Cogulet; Jean-François Huon; Matthieu Grégoire; Nicolas Papon; Patrice Le Pape; Jean-Philippe Bouchara; Gilles Nevez Journal: Antimicrob Agents Chemother Date: 2021-11-01 Impact factor: 5.938