Single-center outbreak of Pneumocystis jirovecii pneumonia in heart transplant recipients

G Veronese, E Ammirati, MC Moioli, R Baldan, CA Orcese, G De Rezende, Silvio Veronese, Gabriella Masciocco, Enrico Perna, G Travi, Massimo Puoti, Manlio Cipriani, Simon Tiberi, D Cirillo, Maria Frigerio

Research output: Contribution to journalArticle

Abstract

Background: Pneumocystis jirovecii pneumonia (PJP) outbreaks are described in solid organ transplant recipients. Few reports suggest interhuman transmission with important infection control implications. We described a large PJP outbreak in heart transplant (HTx) recipients. Methods: Six cases of PJP occurred in HTx recipients within 10 months in our hospital. Demographics, clinical characteristics, treatment and outcomes were described. To identify contacts among individuals a review of all dates of out-patient visits and patient hospitalizations was performed. Cross exposure was also investigated using genotyping on PJ isolates. Results: At the time of PJP-related hospitalization, patients' mean age was 49 ± standard deviation 4 years, median time from HTx was 8 (25%-75% interquartile range [Q1-Q3] 5-12) months and none of the cases were on prophylaxis. At PJP-related admission, 5 patients had CMV reactivation, of whom 4 were on antiviral preemptive treatment. Median in-hospital stay was 30 (Q1-Q3, 28-48) days; and 2 cases required intensive care unit admission. All patients survived beyond 2 years. Transmission map analysis suggested interhuman transmission in all cases (presumed incubation period, median 90 [Q1-Q3, 64-91] days). Genotyping was performed in 4 cases, demonstrating the same PJ strain in 3 cases. Conclusions: We described a large PJP cluster among HTx recipients, supporting the nosocomial acquisition of PJP through interhuman transmission. Based on this experience, extended prophylaxis for more than 6 months after HTx could be considered in specific settings. Further work is required to understand its optimal duration and timing based on individual risk factor profiles and to define standardized countermeasures to prevent and limit PJP outbreaks. © 2018 Wiley Periodicals, Inc.
Original languageEnglish
Article numbere12880
JournalTransplant Infectious Disease
Volume20
Issue number3
DOIs
Publication statusPublished - 2018

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Pneumocystis carinii
Pneumocystis Pneumonia
Disease Outbreaks
Hospitalization
Transplant Recipients
Infection Control
Antiviral Agents
Intensive Care Units
Length of Stay
Outpatients
Demography
Transplants

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Veronese, G., Ammirati, E., Moioli, MC., Baldan, R., Orcese, CA., De Rezende, G., ... Frigerio, M. (2018). Single-center outbreak of Pneumocystis jirovecii pneumonia in heart transplant recipients. Transplant Infectious Disease, 20(3), [e12880]. https://doi.org/10.1111/tid.12880

Single-center outbreak of Pneumocystis jirovecii pneumonia in heart transplant recipients. / Veronese, G; Ammirati, E; Moioli, MC; Baldan, R; Orcese, CA; De Rezende, G; Veronese, Silvio; Masciocco, Gabriella; Perna, Enrico; Travi, G; Puoti, Massimo; Cipriani, Manlio; Tiberi, Simon; Cirillo, D; Frigerio, Maria.

In: Transplant Infectious Disease, Vol. 20, No. 3, e12880, 2018.

Research output: Contribution to journalArticle

Veronese, G, Ammirati, E, Moioli, MC, Baldan, R, Orcese, CA, De Rezende, G, Veronese, S, Masciocco, G, Perna, E, Travi, G, Puoti, M, Cipriani, M, Tiberi, S, Cirillo, D & Frigerio, M 2018, 'Single-center outbreak of Pneumocystis jirovecii pneumonia in heart transplant recipients', Transplant Infectious Disease, vol. 20, no. 3, e12880. https://doi.org/10.1111/tid.12880
Veronese, G ; Ammirati, E ; Moioli, MC ; Baldan, R ; Orcese, CA ; De Rezende, G ; Veronese, Silvio ; Masciocco, Gabriella ; Perna, Enrico ; Travi, G ; Puoti, Massimo ; Cipriani, Manlio ; Tiberi, Simon ; Cirillo, D ; Frigerio, Maria. / Single-center outbreak of Pneumocystis jirovecii pneumonia in heart transplant recipients. In: Transplant Infectious Disease. 2018 ; Vol. 20, No. 3.
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abstract = "Background: Pneumocystis jirovecii pneumonia (PJP) outbreaks are described in solid organ transplant recipients. Few reports suggest interhuman transmission with important infection control implications. We described a large PJP outbreak in heart transplant (HTx) recipients. Methods: Six cases of PJP occurred in HTx recipients within 10 months in our hospital. Demographics, clinical characteristics, treatment and outcomes were described. To identify contacts among individuals a review of all dates of out-patient visits and patient hospitalizations was performed. Cross exposure was also investigated using genotyping on PJ isolates. Results: At the time of PJP-related hospitalization, patients' mean age was 49 ± standard deviation 4 years, median time from HTx was 8 (25{\%}-75{\%} interquartile range [Q1-Q3] 5-12) months and none of the cases were on prophylaxis. At PJP-related admission, 5 patients had CMV reactivation, of whom 4 were on antiviral preemptive treatment. Median in-hospital stay was 30 (Q1-Q3, 28-48) days; and 2 cases required intensive care unit admission. All patients survived beyond 2 years. Transmission map analysis suggested interhuman transmission in all cases (presumed incubation period, median 90 [Q1-Q3, 64-91] days). Genotyping was performed in 4 cases, demonstrating the same PJ strain in 3 cases. Conclusions: We described a large PJP cluster among HTx recipients, supporting the nosocomial acquisition of PJP through interhuman transmission. Based on this experience, extended prophylaxis for more than 6 months after HTx could be considered in specific settings. Further work is required to understand its optimal duration and timing based on individual risk factor profiles and to define standardized countermeasures to prevent and limit PJP outbreaks. {\circledC} 2018 Wiley Periodicals, Inc.",
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AU - Veronese, G

AU - Ammirati, E

AU - Moioli, MC

AU - Baldan, R

AU - Orcese, CA

AU - De Rezende, G

AU - Veronese, Silvio

AU - Masciocco, Gabriella

AU - Perna, Enrico

AU - Travi, G

AU - Puoti, Massimo

AU - Cipriani, Manlio

AU - Tiberi, Simon

AU - Cirillo, D

AU - Frigerio, Maria

PY - 2018

Y1 - 2018

N2 - Background: Pneumocystis jirovecii pneumonia (PJP) outbreaks are described in solid organ transplant recipients. Few reports suggest interhuman transmission with important infection control implications. We described a large PJP outbreak in heart transplant (HTx) recipients. Methods: Six cases of PJP occurred in HTx recipients within 10 months in our hospital. Demographics, clinical characteristics, treatment and outcomes were described. To identify contacts among individuals a review of all dates of out-patient visits and patient hospitalizations was performed. Cross exposure was also investigated using genotyping on PJ isolates. Results: At the time of PJP-related hospitalization, patients' mean age was 49 ± standard deviation 4 years, median time from HTx was 8 (25%-75% interquartile range [Q1-Q3] 5-12) months and none of the cases were on prophylaxis. At PJP-related admission, 5 patients had CMV reactivation, of whom 4 were on antiviral preemptive treatment. Median in-hospital stay was 30 (Q1-Q3, 28-48) days; and 2 cases required intensive care unit admission. All patients survived beyond 2 years. Transmission map analysis suggested interhuman transmission in all cases (presumed incubation period, median 90 [Q1-Q3, 64-91] days). Genotyping was performed in 4 cases, demonstrating the same PJ strain in 3 cases. Conclusions: We described a large PJP cluster among HTx recipients, supporting the nosocomial acquisition of PJP through interhuman transmission. Based on this experience, extended prophylaxis for more than 6 months after HTx could be considered in specific settings. Further work is required to understand its optimal duration and timing based on individual risk factor profiles and to define standardized countermeasures to prevent and limit PJP outbreaks. © 2018 Wiley Periodicals, Inc.

AB - Background: Pneumocystis jirovecii pneumonia (PJP) outbreaks are described in solid organ transplant recipients. Few reports suggest interhuman transmission with important infection control implications. We described a large PJP outbreak in heart transplant (HTx) recipients. Methods: Six cases of PJP occurred in HTx recipients within 10 months in our hospital. Demographics, clinical characteristics, treatment and outcomes were described. To identify contacts among individuals a review of all dates of out-patient visits and patient hospitalizations was performed. Cross exposure was also investigated using genotyping on PJ isolates. Results: At the time of PJP-related hospitalization, patients' mean age was 49 ± standard deviation 4 years, median time from HTx was 8 (25%-75% interquartile range [Q1-Q3] 5-12) months and none of the cases were on prophylaxis. At PJP-related admission, 5 patients had CMV reactivation, of whom 4 were on antiviral preemptive treatment. Median in-hospital stay was 30 (Q1-Q3, 28-48) days; and 2 cases required intensive care unit admission. All patients survived beyond 2 years. Transmission map analysis suggested interhuman transmission in all cases (presumed incubation period, median 90 [Q1-Q3, 64-91] days). Genotyping was performed in 4 cases, demonstrating the same PJ strain in 3 cases. Conclusions: We described a large PJP cluster among HTx recipients, supporting the nosocomial acquisition of PJP through interhuman transmission. Based on this experience, extended prophylaxis for more than 6 months after HTx could be considered in specific settings. Further work is required to understand its optimal duration and timing based on individual risk factor profiles and to define standardized countermeasures to prevent and limit PJP outbreaks. © 2018 Wiley Periodicals, Inc.

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DO - 10.1111/tid.12880

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VL - 20

JO - Transplant Infectious Disease

JF - Transplant Infectious Disease

SN - 1398-2273

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M1 - e12880

ER -