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1 May 2007

Volume 44, Number 9
Clinical Infectious Diseases 2007;44:1143–1149
© 2007 by the Infectious Diseases Society of America. All rights reserved.
1058-4838/2007/4409-0001$15.00
DOI: 10.1086/513198
MAJOR ARTICLE

An Outbreak of Pneumocystis jiroveci Pneumonia with 1 Predominant Genotype among Renal Transplant Recipients: Interhuman Transmission or a Common Environmental Source?

Mark G. J. de Boer,1

Lesla E. S. Bruijnesteijn van Coppenraet,2

Andre Gaasbeek,3

Stefan P. Berger,3

Luc B. S. Gelinck,1

Hans C. van Houwelingen,4

Peterhans van den Broek,1

Ed J. Kuijper,2

Frank P. Kroon,1 and

Jan P. Vandenbroucke5

Departments of 1Infectious Diseases and 2Medical Microbiology, Centre for Infectious Diseases, and Departments of 3Nephrology, 4Medical Statistics, and 5Clinical Epidemiology, Leiden University Medical Centre, Leiden, The Netherlands

Background.An outbreak of Pneumocystis jiroveci pneumonia (PCP) occurred among renal transplant recipients attending the outpatient department at the Leiden University Medical Centre (Leiden, The Netherlands) from 1 March 2005 through 1 February 2006. Clinical, epidemiological, and molecular data were analyzed to trace the outbreak's origin.

Methods.Renal transplant recipients with a clinical suspected diagnosis of PCP were included in the study. The diagnosis had to be confirmed by direct microscopy or real‐time polymerase chain reaction of the dihydropteroate synthase gene in a bronchoalveolar fluid specimen. To detect contacts between patients, a transmission map was constructed. A case‐control analysis was performed to asses whether infection was associated with certain wardrooms. Genotyping of Pneumocystis isolates was performed by sequence analysis of the internal transcribed spacer (ITS) number 1 and 2 gene regions.

Results.Twenty‐two confirmed PCP cases were identified; approximately 0–1 would have been expected over the same time period. No risk factor was predominantly present, and standard immunosuppressive regimens had not changed. Liver transplant recipients who used the same outpatient facilities had not acquired PCP. The transmission map findings were compatible with interhuman transmission on multiple occasions. The case‐control study did not point to wardrooms as a common source. Genotyping by sequencing of the ITS1 and ITS2 gene regions revealed type Ne in 12 of 16 successfully typed samples. Genotype Ne was found in only 2 of 12 reference samples.

Conclusions.The clinical data and genotyping results are compatible with either interhuman transmission or an environmental source of infection. More complex models may account for PCP clusters.

Received 16 September 2006; accepted 28 December 2006; electronically published 26 March 2007.

  • (See the editorial commentary by Hughes on pages 1150–1)

Reprints or correspondence: Dr. Mark G. J. de Boer, Dept. of Infectious Diseases, Centre for Infectious Diseases, LUMC, PO Box 9600, 2300 RC Leiden, The Netherlands ().

Cited by

Herbert Hof, Peter Schnülle. (2008) Pneumocystis jiroveci pneumonia in a patient with Wegener’s granulomatosis treated efficiently with caspofungin. Mycoses 51:s1, 65-67
Online publication date: 1-Aug-2008.
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H. Hof. (2008) Developments in the epidemiolgy of invasive fungal infections – implications for the empiric and targeted antifungal therapy. Mycoses 51:s1, 1-6
Online publication date: 1-Aug-2008.
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Jae-Seok Kim, Yong-Kyun Kim, Ji Young Park, Eun Kyung Mo, Han Sung Kim, Wonkeun Song, Hyoun Chan Cho, Kyu Man Lee. (2008) Analysis of Internal Transcribed Spacer 1 Sequences of Pneumocystis jiroveci from Clinical Specimens. Chonnam Medical Journal 44:2, 82
Online publication date: 1-Feb-2008.
CrossRef
Walter T. Hughes. (2007) Editorial Commentary: Transmission of Pneumocystis Species among Renal Transplant Recipients. Clinical Infectious Diseases 44:9, 1150-1151
Online publication date: 1-May-2007.
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