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Pneumocystis Pneumonia in Solid Organ Transplant Recipients

  • Epidemiology of Fungal Infections (T Chiller and JW Baddley, Section Editors)
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Abstract

Pneumocystis pneumonia (PCP) remains an important opportunistic infection among solid organ transplant (SOT) recipients. The diagnosis of PCP should be considered in patients with new onset of fever, pulmonary symptoms, and hypoxemia. The introduction of PCP prophylaxis for SOT recipients has dramatically modified the epidemiological landscape of this infection; we are currently experiencing the era of “late PCP,” where the majority of cases occur more than 12 months after transplantation in patients with PCP risk factors in whom prophylaxis has been discontinued. Despite remarkable advancement in our understanding of the biology, mode of transmission, epidemiology, and clinical manifestations of PCP, there remains a paucity of data regarding the performance of contemporary diagnostic tools for PCP in transplant recipients. Although there is a low incidence of PCP in this population, associated morbidity and mortality may be high, necessitating additional studies aimed at diagnosis.

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References

  1. Fishman JA, Rubin RH. Infection in organ-transplant recipients. N Engl J Med. 1998;338(24):1741–51.

    Article  CAS  PubMed  Google Scholar 

  2. Rodriguez M, Fishman JA. Prevention of infection due to Pneumocystis spp. in human immunodeficiency virus-negative immunocompromised patients. Clin Microbiol Rev. 2004;17(4):770–82.

    Article  PubMed Central  PubMed  Google Scholar 

  3. Colombo JL, Sammut PH, Langnas AN, et al. The spectrum of Pneumocystis carinii infection after liver transplantation in children. Transplantation. 1992;54(4):621–4.

    Article  CAS  PubMed  Google Scholar 

  4. Hayes MJ, Torzillo PJ, Sheil AG, et al. Pneumocystis carinii pneumonia after liver transplantation in adults. Clin Transplant. 1994;8(6):499–503.

    CAS  PubMed  Google Scholar 

  5. Paya CV, Hermans PE, Washington 2nd JA, et al. Incidence, distribution, and outcome of episodes of infection in 100 orthotopic liver transplantations. Mayo Clin Proc. 1989;64(5):555–64.

    Article  CAS  PubMed  Google Scholar 

  6. Gryzan S, Paradis IL, Zeevi A, et al. Unexpectedly high incidence of Pneumocystis carinii infection after lung-heart transplantation. Implications for lung defense and allograft survival. Am Rev Respir Dis. 1988;137(6):1268–74.

    Article  CAS  PubMed  Google Scholar 

  7. Janner D, Bork J, Baum M, et al. Pneumocystis carinii pneumonia in infants after heart transplantation. J Heart Lung Transplant. 1996;15(8):758–63.

    CAS  PubMed  Google Scholar 

  8. Muñoz P, Muñoz RM, Palomo J. Pneumocystis carinii infection in heart transplant recipients. efficacy of a weekend prophylaxis schedule. Medicine (Baltimore). 1997;76(6):415–22.

    Article  Google Scholar 

  9. Dummer JS, Montero CG, Griffith BP, et al. Infections in heart-lung transplant recipients. Transplantation. 1986;41(6):725–9.

    Article  CAS  PubMed  Google Scholar 

  10. Lufft V, Kliem V, Behrend M, et al. Incidence of Pneumocystis carinii pneumonia after renal transplantation. Impact Immunosuppress Transplant. 1996;62(3):421–3.

    CAS  Google Scholar 

  11. Arend SM, Westendorp RG, Kroon FP, et al. Rejection treatment and cytomegalovirus infection as risk factors for Pneumocystis carinii pneumonia in renal transplant recipients. Clin Infect Dis. 1996;22(6):920–5.

    Article  CAS  PubMed  Google Scholar 

  12. Hardy AM, Wajszczuk CP, Suffredini AF, et al. Pneumocystis carinii pneumonia in renal-transplant recipients treated with cyclosporine and steroids. J Infect Dis. 1984;149(2):143–7.

    Article  CAS  PubMed  Google Scholar 

  13. Fishman JA. Prevention of infection caused by Pneumocystis carinii in transplant recipients. Clin Infect Dis. 2001;33(8):1397–405.

    Article  CAS  PubMed  Google Scholar 

  14. Ballardie FW, Winearls CG, Williams G. Cyclosporin and steroids in renal transplantation: risk of Pneumocystis carinii pneumonia [letter]? Lancet. 1984;2:638–9.

    Article  CAS  PubMed  Google Scholar 

  15. Franson TR, Kauffman Jr HM, Adams MB. Cyclosporine therapy and refractory Pneumocystis carinii pneumonia: a potential association. Arch Surg. 1987;122:1034–5.

    Article  CAS  PubMed  Google Scholar 

  16. Martin SI, Fishman JA, AST Infectious Diseases Community of Practice. Pneumocystis pneumonia in solid organ transplantation. Am J Transplant. 2013;13 Suppl 4:272–9.

    Article  CAS  PubMed  Google Scholar 

  17. Gordon SM, LaRosa SP, Kalmadi S, et al. Should prophylaxis for Pneumocystis carinii pneumonia in solid organ transplant recipients ever be discontinued? Clin Infect Dis. 1999;28(2):240–6.

    Article  CAS  PubMed  Google Scholar 

  18. Branten AJ, Beckers PJ, Tiggeler RG, et al. Pneumocystis carinii pneumonia in renal transplant recipients. Nephrol Dial Transplant. 1995;10(7):1194–7.

    CAS  PubMed  Google Scholar 

  19. Olsen SL, Renlund DG, O’Connell JB, et al. Prevention of Pneumocystis carinii pneumonia in cardiac transplant recipients by trimethoprim sulfamethoxazole. Transplantation. 1993;56(2):359–62.

    Article  CAS  PubMed  Google Scholar 

  20. Torre-Cisneros J, de la Mata M, Lopez-Cillero P, et al. Effectiveness of daily low-dose cotrimoxazole prophylaxis for Pneumocystis carinii pneumonia in liver transplantation—an open clinical trial. Transplantation. 1996;62(10):1519–21.

    Article  CAS  PubMed  Google Scholar 

  21. Saah AJ, Hoover DR, Peng Y, et al. Predictors for failure of Pneumocystis carinii pneumonia prophylaxis. Multicenter AIDS Cohort Study. JAMA. 1995;273(15):1197–202.

    Article  CAS  PubMed  Google Scholar 

  22. Pappas PG, Alexander BD, Andes DR, et al. Invasive fungal infections among organ transplant recipients: results of the Transplant-Associated Infection Surveillance Network (TRANSNET). Clin Infect Dis. 2010;50(8):1101–11.

    Article  PubMed  Google Scholar 

  23. Borstnar S, Lindic J, Tomazic J, et al. Pneumocystis jirovecii pneumonia in renal transplant recipients: a national center experience. Transplant Proc. 2013;45(4):1614–7.

    Article  CAS  PubMed  Google Scholar 

  24. Choi YI, Hwang S, Park GC, et al. Clinical outcomes of Pneumocystis carinii pneumonia in adult liver transplant recipients. Transplant Proc. 2013;45(8):3057–60.

    Article  PubMed  Google Scholar 

  25. Wang EH, Partovi N, Levy RD, et al. Pneumocystis pneumonia in solid organ transplant recipients: not yet an infection of the past. Transpl Infect Dis. 2012;14(5):519–25.

    Article  CAS  PubMed  Google Scholar 

  26. Perez-Ordoño L, Hoyo I, Sanclemente G, et al. Late-onset Pneumocystis jirovecii pneumonia in solid organ transplant recipients. Transpl Infect Dis. 2014;16(2):324–8.

    Article  PubMed  Google Scholar 

  27. Hennequin C, Page B, Roux P, et al. Outbreak of Pneumocystis carinii pneumonia in a renal transplant unit. Eur J Clin Microbiol Infect Dis. 1995;14(2):122–6.

    Article  CAS  PubMed  Google Scholar 

  28. Rabodonirina M, Vanhems P, Couray-Targe S, et al. Molecular evidence of interhuman transmission of Pneumocystis pneumonia among renal transplant recipients hospitalized with HIV-infected patients. Emerg Infect Dis. 2004;10(10):1766–73.

    Article  PubMed Central  PubMed  Google Scholar 

  29. de Boer MG, Bruijnesteijn van Coppenraet LE. An outbreak of Pneumocystis jiroveci pneumonia with 1 predominant genotype among renal transplant recipients: interhuman transmission or a common environmental source? Clin Infect Dis. 2007;44(9):1143–9.

    Article  PubMed  Google Scholar 

  30. Schmoldt S, Schuhegger R, Wendler T, et al. Molecular evidence of nosocomial Pneumocystis jirovecii transmission among 16 patients after kidney transplantation. J Clin Microbiol. 2008;46(3):966–71.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  31. Yazaki H, Goto N, Uchida K, et al. Outbreak of Pneumocystis jiroveci pneumonia in renal transplant recipients: P. jiroveci is contagious to the susceptible host. Transplantation. 2009;88(3):380–5.

    Article  PubMed  Google Scholar 

  32. Arichi N, Kishikawa H, Mitsui Y, et al. Cluster outbreak of Pneumocystis pneumonia among kidney transplant patients within a single center. Transplant Proc. 2009;41(1):170–2.

    Article  CAS  PubMed  Google Scholar 

  33. de Boer MG, de Fijter JW, Kroon FP. Outbreaks and clustering of Pneumocystis pneumonia in kidney transplant recipients: a systematic review. Med Mycol. 2011;49(7):673–80.

    PubMed  Google Scholar 

  34. Le Gal S, Damiani C, Rouillé A, et al. A cluster of Pneumocystis infections among renal transplant recipients: molecular evidence of colonized patients as potential infectious sources of Pneumocystis jirovecii. Clin Infect Dis. 2012;54(7):e62–71.

    Article  PubMed  Google Scholar 

  35. Sassi M, Ripamonti C, Mueller NJ, et al. Outbreaks of Pneumocystis pneumonia in 2 renal transplant centers linked to a single strain of Pneumocystis: implications for transmission and virulence. Clin Infect Dis. 2012;54(10):1437–44.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  36. Rostved AA, Sassi M, Kurtzhals JA, et al. Outbreak of pneumocystis pneumonia in renal and liver transplant patients caused by genotypically distinct strains of Pneumocystis jirovecii. Transplantation. 2013;96(9):834–42.

    Article  PubMed  Google Scholar 

  37. Nahimana A, Blanc DS, Francioli P, Bille J, Hauser PM. Typing of Pneumocystis carinii f. sp. hominis by PCR-SSCP to indicate a high frequency of co-infections. J Med Microbiol. 2000;49(8):753–8.

    Article  CAS  PubMed  Google Scholar 

  38. Hauser PM, Blanc DS, Sudre P, et al. Genetic diversity of Pneumocystis carinii in HIV-positive and -negative patients as revealed by PCR-SSCP typing. AIDS. 2001;15(4):461–6.

    Article  CAS  PubMed  Google Scholar 

  39. Ma L, Kutty G, Jia Q, et al. Analysis of variation in tandem repeats in the intron of the major surface glycoprotein expression site of the human form of Pneumocystis carinii. J Infect Dis. 2002;186(11):1647–54.

    Article  CAS  PubMed  Google Scholar 

  40. Kovacs JA, Gill VJ, Meshnick S, et al. New insights into transmission, diagnosis and drug treatment of Pneymocystis carinii pneumonia. JAMA. 2001;286:2450–60.

    Article  CAS  PubMed  Google Scholar 

  41. Meuwissen JH, Tauber I, Leeuwenberg AD, et al. Parasitologic and serologic observations of infection with Pneumocystis in humans. J Infect Dis. 1977;136(1):43–9.

    Article  CAS  PubMed  Google Scholar 

  42. Ripamonti C, Orenstein A, Kutty G, et al. Restriction fragment length polymorphism typing demonstrates substantial diversity among Pneumocystis jirovecii isolates. J Infect Dis. 2009;200(10):1616–22.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  43. Siegel JD, Rhinehart E, Jackson M, Chiarello L, Health Care Infection Control Practices Advisory Committee. 2007 guideline for isolation precautions: preventing transmission of infectious agents in health care settings. Am J Infect Control. 2007;35(10 Suppl 2):S65–164.

    Article  PubMed  Google Scholar 

  44. Tomblyn M, Chiller T, Einsele H, et al. Guidelines for preventing infectious complications among hematopoietic cell transplantation recipients: a global perspective. Biol Blood Marrow Transplant. 2009;15(10):1143–238.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  45. Hiemenz JW, Groll AH, Walsh TJ. Infections caused by uncommon fungi in patients undergoing hematopoietic stem cell or solid organ transplantation. In: Bowden RA, Ljungman P, Snydman DR, editors. Transplant infections. 3rd ed. Phildelphia: Lippincott Williams & Wilkins; 2010.

    Google Scholar 

  46. Kovacs JA, Masur H. Evolving health effect of Pneumocystis: one hundred years of progress in diagnosis and treatment. JAMA. 2009;301(24):2578–85.

    Article  CAS  PubMed  Google Scholar 

  47. Kovacs HJW, Macher AM, et al. Pneumocystic carinii Pneumonia: a comparison between patients with the acquired immunodeficiency syndrome and patients with other immunodeficiencies. Ann Intern Med. 1984;100(5):666–71.

    Article  Google Scholar 

  48. Nüesch R, Bellini C, Zimmerli W. Pneumocystis carinii pneumonia in human immunodeficiency virus (HIV)-positive and HIV-negative immunocompromised patients. Clin Infect Dis. 1999;29(6):1519–23.

    Article  PubMed  Google Scholar 

  49. McKinnell JA, Cannella AP, Kunz DF, et al. Pneumocystis pneumonia in hospitalized patients: a detailed examination of symptoms, management, and outcomes in human immunodeficiency virus (HIV)-infected and HIV-uninfected persons. Transpl Infect Dis. 2012;14(5):510–8.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  50. Roux A, Canet E, Valade S, Gangneux-Robert F, et al. Pneumocystis jirovecii pneumonia in patients with or without AIDS. France Emerg Infect Dis. 2014;20(9):1490–7.

    Article  PubMed  Google Scholar 

  51. Ng VL, Yajko DM, Hadley WK. Extrapulmonary Pneumocystosis. Clin Microbiol Rev. 1997;10(3):401–18.

    PubMed Central  CAS  PubMed  Google Scholar 

  52. Opravil M, Marincek B, Fuchs WA, et al. Shortcomings of chest radiography in detecting Pneumocystis carinii pneumonia. J Acquir Immune Defic Syndr. 1994;7(1):39–45.

    CAS  PubMed  Google Scholar 

  53. Fujii T, Nakamura T, Iwamoto A. Pneumocystis pneumonia in patients with HIV infection: clinical manifestations, laboratory findings, and radiological features. J Infect Chemother. 2007;13(1):1–7.

    Article  PubMed  Google Scholar 

  54. Gruden JF, Huang L, Turner J, et al. High-resolution CT in the evaluation of clinically suspected Pneumocystis carinii pneumonia in AIDS patients with normal, equivocal, or nonspecific radiographic findings. AJR Am J Roentgenol. 1997;169(4):967–75.

    Article  CAS  PubMed  Google Scholar 

  55. Jules-Elysee KM, Stover DE, Zaman MB, et al. Aerosolized pentamidine: effect on diagnosis and presentation of Pneumocystis carinii pneumonia. Ann Intern Med. 1990;112(10):750–7.

    Article  CAS  PubMed  Google Scholar 

  56. Ewig S, Schäfer H, Rockstroh JK, et al. Effect of long-term primary aerosolized pentamidine prophylaxis on breakthrough Pneumocystis carinii pneumonia. Eur Respir J. 1996;9(5):1006–12.

    Article  CAS  PubMed  Google Scholar 

  57. Kovacs JA, Ng VL, Masur H, et al. Diagnosis of Pneumocystis carinii pneumonia: improved detection in sputum with use of monoclonal antibodies. N Engl J Med. 1988;318(10):589–93.

    Article  CAS  PubMed  Google Scholar 

  58. Bondoc AY, White DA. Granulomatous Pneumocystis carinii pneumonia in patients with malignancy. Thorax. 2002;57:435–7.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  59. Studemeister A, Dass S. A patient with dyspnea, cough, and fever. Clin Infect Dis. 2006;43:1461–2. 1490–1461.

    Article  PubMed  Google Scholar 

  60. Procop GW, Haddad S, Quinn J, et al. Detection of Pneumocystis jiroveci in respiratory specimens by four staining methods. J Clin Microbiol. 2004;42(7):3333–5.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  61. Caliendo AM, Hewitt PL, Allega. Performance of a PCR assay for detection of Pneumocystis carinii from respiratory specimens. J Clin Microbiol. 1998;36(4):979–82.

    PubMed Central  CAS  PubMed  Google Scholar 

  62. Larsen HH, Huang L, Kovacs JA, et al. A prospective, blinded study of quantitative touch-down polymerase chain reaction using oral-wash samples for diagnosis of Pneumocystis pneumonia in HIV-infected patients. J Infect Dis. 2004;189(9):1679–83.

    Article  CAS  PubMed  Google Scholar 

  63. Linssen CF, Jacobs JA, Beckers P, et al. Inter-laboratory comparison of three different real-time PCR assays for the detection of Pneumocystis jiroveci in bronchoalveolar lavage fluid samples. J Med Microbiol. 2006;55(Pt 9):1229–35.

    Article  CAS  PubMed  Google Scholar 

  64. Arcenas RC, Uhl JR, Buckwalter SP, et al. A real-time polymerase chain reaction assay for detection of Pneumocystis from bronchoalveolar lavage fluid. Diagn Microbiol Infect Dis. 2006;54(3):169–75.

    Article  CAS  PubMed  Google Scholar 

  65. Azoulay E, Bergeron A, Chevret S, et al. Polymerase chain reaction for diagnosing pneumocystis pneumonia in non-HIV immunocompromised patients with pulmonary infiltrates. Chest. 2009;135(3):655–61.

    Article  CAS  PubMed  Google Scholar 

  66. Alanio A, Desoubeaux G, Sarfati C, et al. Real-time PCR assay-based strategy for differentiation between active Pneumocystis jirovecii pneumonia and colonization in immunocompromised patients. Clin Microbiol Infect. 2011;17(10):1531–7.

    Article  CAS  PubMed  Google Scholar 

  67. Botterel F, Cabaret O, Foulet F, et al. Clinical significance of quantifying Pneumocystis jirovecii DNA by using real-time PCR in bronchoalveolar lavage fluid from immunocompromised patients. J Clin Microbiol. 2012;50(2):227–31.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  68. Tasaka S, Hasegawa N, Kobayashi S, et al. Serum indicators for the diagnosis of pneumocystis pneumonia. Chest. 2007;131(4):1173–80.

    Article  CAS  PubMed  Google Scholar 

  69. Sax PE, Komarow L, Finkelman MA, et al. Blood (1->3)-beta-D-glucan as a diagnostic test for HIV-related Pneumocystis jirovecii pneumonia. Clin Infect Dis. 2011;53(2):197–202.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  70. Morris AM, Masur H. A serologic test to diagnose pneumocystis pneumonia: are we there yet? Clin Infect Dis. 2011;53(2):203–4.

    Article  PubMed  Google Scholar 

  71. Karageorgopoulos DE, Vouloumanou EK, Ntziora F, et al. β-D-glucan assay for the diagnosis of invasive fungal infections: a meta-analysis. Clin Infect Dis. 2011;52(6):750–70.

    Article  CAS  PubMed  Google Scholar 

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Conflict of Interest

Ricardo M. La Hoz declares that he has no conflict of interest. John W. Baddley has served as a consultant for Merck, Pfizer, and Astellas.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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Authors and Affiliations

  1. Division of Infectious Diseases, Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-9113, USA

    Ricardo M. La Hoz

  2. Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL, USA

    John W. Baddley

  3. Birmingham Veterans Affairs Medical Center, Birmingham, AL, USA

    John W. Baddley

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  1. Ricardo M. La Hoz
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Correspondence to Ricardo M. La Hoz.

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This article is part of the Topical Collection on Epidemiology of Fungal Infections

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La Hoz, R.M., Baddley, J.W. Pneumocystis Pneumonia in Solid Organ Transplant Recipients. Curr Fungal Infect Rep 9, 285–291 (2015). https://doi.org/10.1007/s12281-015-0244-z

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