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11 Molecular Epidemiology of Pneumocystis Outbreaks

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Human Fungal Pathogens

Part of the book series: The Mycota ((MYCOTA,volume 12))

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Abstract

Studies reporting molecular analysis of nosocomial outbreaks of Pneumocystis jirovecii pneumonia (PCP) are reviewed. Although the methods currently used for typing detect only the most abundant co-infecting genotypes, these studies have consistently identified a single P. jirovecii genotype as responsible for most or all PCP cases in a given outbreak. A single genotype was responsible for three separate outbreaks in Germany and Switzerland. Together with transmission maps compatible with potential infectious encounters, these results strongly suggest that inter-human transmission was involved. However, infection from a common source or by indirect transmission by asymptomatic carriers of the fungus could not be excluded. The following conditions favoring outbreaks were seen in all settings: (i) anti-PCP prophylaxis was not administered or was inadequate, (ii) there was potential contact between source and susceptible patients, and (iii) there was no isolation of patients with PCP. One study suggested that hospitalized immunosuppressed patients colonized by P. jirovecii might be a potential source of nosocomial infection. Underlying pulmonary disease, transplanted organ dysfunction, and lower CD4 lymphocyte counts were identified as new clinical risk factors for PCP. At present, two non-mutually exclusive hypotheses can explain the selection of the Pneumocystis genotypes that were responsible for the outbreaks: (i) the genotype represented the predominant genotype in the geographical area, or (ii) the genotype has developed pathogenic factors that facilitate infection. Perspectives on further investigation and prevention of outbreaks are discussed.

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Acknowledgments

Work in PMH’s laboratory is supported by the Swiss National Science Foundation grants 310030-124998 and 310030-146135. Supported in part by the Intramural Research Program of the NIH Clinical Center, National Institutes of Health, Bethesda, MD, USA.

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  1. Institute of Microbiology, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland

    Philippe M. Hauser

  2. Critical Care Medicine Department, NIH Clinical Center, National Institutes of Health, Bethesda, MD, USA

    Joseph A. Kovacs

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Correspondence to Philippe M. Hauser .

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  1. Friedrich Schiller University of Jena, Jena, Germany

    Oliver Kurzai

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Hauser, P.M., Kovacs, J.A. (2014). 11 Molecular Epidemiology of Pneumocystis Outbreaks. In: Kurzai, O. (eds) Human Fungal Pathogens. The Mycota, vol 12. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-39432-4_11

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