title: Molecular evidence of nosocomial Pneumocystis jirovecii transmission among 16 patients after kidney transplantation.
abstract: In recent years, clusters of Pneumocystis jirovecii (formerly Pneumocystis carinii) pneumonia (PCP) among immunocompromised individuals have been reported. Mostly, the source of infections was suspected to be within the clinical settings when transplant recipients and PCP patients shared hospital facilities. We report on a cluster of 16 renal transplant recipients positive for P. jirovecii. None of them received anti-Pneumocystis prophylaxis prior to P. jirovecii detection. Epidemiological studies revealed that 15 of them had received kidney transplants at a German university hospital and attended the same inpatient and outpatient clinic from January through September 2006. Multilocus sequence typing (MLST) was performed on the following genes: ITS1, beta-tub, 26S, and mt26S. P. jirovecii DNA was available from 14 patients and showed identical MLST types among these renal transplant recipients. Surprisingly, one patient who was treated at a different nephrological center and reported no personal contact with patients from the renal transplantation cluster harbored an identical P. jirovecii MLST type. Three HIV-positive patients and one bone-marrow-transplanted hematologic malignancy patient--treated at different medical centers--were used as controls, and different MLST types were revealed. Interestingly, in three of the four previously described regions, new alleles were detected, and one new polymorphism was observed in the mt26S region. The epidemiological data and the genotyping results strongly suggest a nosocomial patient-to-patient transmission of P. jirovecii as the predominant transmission route. Therefore, strict segregation and isolation of P. jirovecii-positive/suspected patients in clinical settings seems warranted.
authors.affiliation: Max von Pettenkofer-Institute for Hygiene and Medical Microbiology, University of Munich, Marchioninstrasse 17, 81377 Munich, Germany.
authors.forename: Sabine
authors.initials: S
authors.lastname: Schmoldt
authors.forename: Regina
authors.initials: R
authors.lastname: Schuhegger
authors.forename: Thorsten
authors.initials: T
authors.lastname: Wendler
authors.forename: Ingrid
authors.initials: I
authors.lastname: Huber
authors.forename: Heidelore
authors.initials: H
authors.lastname: Söllner
authors.forename: Michael
authors.initials: M
authors.lastname: Hogardt
authors.forename: Helmut
authors.initials: H
authors.lastname: Arbogast
authors.forename: Jürgen
authors.initials: J
authors.lastname: Heesemann
authors.forename: Lutz
authors.initials: L
authors.lastname: Bader
authors.forename: Andreas
authors.initials: A
authors.lastname: Sing
mesh_terms: D000328:Adult; D000368:Aged; D003428:Cross Infection / Q000382:microbiology / Q000635:transmission*; D004271:DNA, Fungal / Q000032:analysis / Q000235:genetics; D021903:DNA, Ribosomal Spacer / Q000032:analysis / Q000235:genetics; D005260:Female; D005858:Germany; D006785:Hospitals, University; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D045363:Pneumocystis carinii / Q000145:classification / Q000235:genetics / Q000302:isolation & purification; D011020:Pneumonia, Pneumocystis / Q000382:microbiology / Q000635:transmission*; D012335:RNA, Ribosomal / Q000235:genetics; D017422:Sequence Analysis, DNA; D014404:Tubulin / Q000235:genetics
chemical_list: D004271:DNA, Fungal; D021903:DNA, Ribosomal Spacer; D012335:RNA, Ribosomal; C065096:RNA, ribosomal, 26S; D014404:Tubulin