title: Pneumocystis jiroveci outbreak in a renal transplant center: Lessons learnt.
abstract: Pneumocystis jiroveci pneumonia (PJP) is an important opportunistic infection in immunosuppressed hosts. At our center, nine transplant recipients developed PJP over a 4-month period. The median time from transplant was 56 months and none of them was on cotrimoxazole prophylaxis at the time of developing the infection. Over half had been admitted to the renal transplant ward for unrelated indications and contracted the infection in-hospital. Diagnosis was based on microbiological demonstration of P. jiroveci in sputum and/or bronchoalveolar lavage in symptomatic patients. Atypical clinical and radiological signs were common with poor correlation of symptoms to computed tomography findings. Cotrimoxazole therapy was effective; however, patients with pre-existing graft dysfunction developed hyperkalemia commonly (50%). Alternative treatment with clindamycin and primaquine combination was equally effective. Early diagnosis and prompt treatment resulted in low mortality rate (11%). The outbreak was halted after universal use of cotrimoxazole prophylaxis to all patients admitted to the renal transplant ward. We report the first ever outbreak of PJP in Indian renal transplant recipients with possible inter-human transmission of infection in admitted patients.
authors.affiliation: Department of Nephrology, Army Hospital (R and R), Delhi Cantt, Delhi, India.
authors.forename: A
authors.initials: A
authors.lastname: Jairam
authors.affiliation: Department of Nephrology, Army Hospital (R and R), Delhi Cantt, Delhi, India.
authors.forename: M
authors.initials: M
authors.lastname: Dassi
authors.affiliation: Department of Microbiology, Army Hospital (R and R), Delhi Cantt, Delhi, India.
authors.forename: P
authors.initials: P
authors.lastname: Chandola
authors.affiliation: Department of Microbiology, Army Hospital (R and R), Delhi Cantt, Delhi, India.
authors.forename: M
authors.initials: M
authors.lastname: Lall
authors.affiliation: Department of Nephrology, Army Hospital (R and R), Delhi Cantt, Delhi, India.
authors.forename: D
authors.initials: D
authors.lastname: Mukherjee
authors.affiliation: Department of Nephrology, Army Hospital (R and R), Delhi Cantt, Delhi, India.
authors.forename: A K
authors.initials: AK
authors.lastname: Hooda
keywords: Epidemic; Pneumocystis jiroveciii; pneumonia; renal transplant antation