title: Epidemiological Outbreaks of Pneumocystis jirovecii Pneumonia Are Not Limited to Kidney Transplant Recipients: Genotyping Confirms Common Source of Transmission in a Liver Transplantation Unit.
abstract: Over a 5-month period, four liver transplant patients at a single hospital were diagnosed with Pneumocystis jirovecii pneumonia (PCP). This unusually high incidence was investigated using molecular genotyping. Bronchoalveolar lavage fluids (BALF) obtained from the four liver recipients diagnosed with PCP were processed for multilocus sequence typing (MLST) at three loci (SOD, mt26s, and CYB). Twenty-four other BALF samples, which were positive for P. jirovecii and collected from 24 epidemiologically unrelated patients with clinical signs of PCP, were studied in parallel by use of the same method. Pneumocystis jirovecii isolates from the four liver recipients all had the same genotype, which was different from those of the isolates from all the epidemiologically unrelated individuals studied. These findings supported the hypothesis of a common source of contamination or even cross-transmission of a single P. jirovecii clone between the four liver recipients. Hospitalization mapping showed several possible encounters between these four patients, including outpatient consultations on one particular date when they all possibly met. This study demonstrates the value of molecular genotyping of P. jirovecii isolated from clinical samples for epidemiological investigation of PCP outbreaks. It is also the first description of a common source of exposure to a single P. jirovecii clone between liver transplant recipients and highlights the importance of prophylaxis in such a population.
authors.affiliation: CHU de Tours, Service de Parasitologie-Mycologie-Médecine Tropicale, Tours, France Université François-Rabelais, CEPR, INSERM U1100/Équipe 3, Faculté de Médecine, Tours, France guillaume.desoubeaux@univ-tours.fr.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Desoubeaux
authors.affiliation: CHU de Tours, Service de Parasitologie-Mycologie-Médecine Tropicale, Tours, France.
authors.forename: Manon
authors.initials: M
authors.lastname: Dominique
authors.affiliation: CHU de Nantes, Institut de Biologie, Laboratoire de Parasitologie-Mycologie, Nantes, France Département de Parasitologie et Mycologie Médicale, Université de Nantes, Nantes Atlantique Universités, EA1155-IICiMed, Faculté de Pharmacie, Nantes, France.
authors.forename: Florent
authors.initials: F
authors.lastname: Morio
authors.affiliation: Université François-Rabelais, Imagerie et Cerveau, INSERM U930/Équipe 2, Faculté de Médecine, Tours, France.
authors.forename: Rose-Anne
authors.initials: RA
authors.lastname: Thepault
authors.affiliation: CHU de Tours, Service de Parasitologie-Mycologie-Médecine Tropicale, Tours, France.
authors.forename: Claire
authors.initials: C
authors.lastname: Franck-Martel
authors.affiliation: CHU de Tours, Service de Réanimation Chirurgicale, Tours, France.
authors.forename: Anne-Charlotte
authors.initials: AC
authors.lastname: Tellier
authors.affiliation: CHU de Tours, Service de Réanimation Chirurgicale, Tours, France.
authors.forename: Martine
authors.initials: M
authors.lastname: Ferrandière
authors.affiliation: CHU Saint-Antoine, Laboratoire de Parasitologie & Mycologie, Paris, France Université Pierre et Marie Curie-Paris 6, INSERM UMR-S 945, Paris, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Hennequin
authors.affiliation: Université François-Rabelais, CEPR, INSERM U1100/Équipe 3, Faculté de Médecine, Tours, France CHU de Tours, Service de Médecine Interne & Maladies Infectieuses, Tours, France.
authors.forename: Louis
authors.initials: L
authors.lastname: Bernard
authors.affiliation: CHU de Tours, Service de Chirurgie Digestive, Endocrinienne et Transplantation Hépatique, Tours, France.
authors.forename: Ephrem
authors.initials: E
authors.lastname: Salamé
authors.affiliation: CHU de Tours, Service de Parasitologie-Mycologie-Médecine Tropicale, Tours, France.
authors.forename: Éric
authors.initials: É
authors.lastname: Bailly
authors.affiliation: CHU de Tours, Service de Parasitologie-Mycologie-Médecine Tropicale, Tours, France Université François-Rabelais, CEPR, INSERM U1100/Équipe 3, Faculté de Médecine, Tours, France.
authors.forename: Jacques
authors.initials: J
authors.lastname: Chandenier
mesh_terms: D000368:Aged; D001992:Bronchoalveolar Lavage Fluid / Q000382:microbiology; D004196:Disease Outbreaks; D005260:Female; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D017720:Molecular Epidemiology; D058885:Multilocus Sequence Typing; D016533:Mycological Typing Techniques; D045363:Pneumocystis carinii / Q000145:classification / Q000235:genetics / Q000302:isolation & purification*; D011020:Pneumonia, Pneumocystis / Q000453:epidemiology*; D066027:Transplant Recipients