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Clinical characteristics of hospital-onset Pneumocystis pneumonia and genotypes of Pneumocystis jirovecii in a single tertiary centre in Korea.

Kim T, Lee SO, Hong HL, Lee JY, Kim SH, Choi SH, Kim MN, Kim YS, Woo JH, Sung H - BMC Infect. Dis. (2015)

Bottom Line: There was a trend toward a higher proportion of haematological malignancy (43.8% [7/16] vs. 20.3% [16/79]; P = 0.058) in patients with hospital-onset PCP compared to patients with community-onset PCP. mtLSU genotype 1 was the most common, occurring in 41 (43.2%) patients.There were four possible cases of nosocomial transmission.Mutation in DHPS was not observed in any PCP episode.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Soonchunhyang University Bucheon Hospital 170 Jomaru-ro, Bucheon-si, Gyeonggi-do, 420-767, Republic of Korea. ktocc2@naver.com.

ABSTRACT

Background: Pneumocystis pneumonia (PCP) may develop as a clinical manifestation of nosocomial pneumonia by means of either reactivation of resident P. jirovecii or de novo infection. However, there have been no studies describing the clinical characteristics of hospital-onset PCP.

Methods: A retrospective review of medical records was performed to identify episodes of hospital-onset PCP in a tertiary care centre in Korea between May 2007 and January 2013. We investigated whether human-to-human contact during hospitalisation contributed to PCP development by molecular analysis of the genes encoding mitochondrial large ribosomal subunit (mtLSU) rRNA and dihydropteroate synthase (DHPS) and a review of hospitalisation history.

Results: During the study period, 129 patients (130 episodes) were diagnosed with PCP. Of these, respiratory specimens from 94 patients during 95 PCP episodes were available for analysis. Sixteen episodes (16.8%) were categorised as hospital-onset PCP. There was a trend toward a higher proportion of haematological malignancy (43.8% [7/16] vs. 20.3% [16/79]; P = 0.058) in patients with hospital-onset PCP compared to patients with community-onset PCP. mtLSU genotype 1 was the most common, occurring in 41 (43.2%) patients. There were four possible cases of nosocomial transmission. Mutation in DHPS was not observed in any PCP episode.

Conclusions: PCP can be one of the causes of nosocomial pneumonia, although the mode of acquisition and transmission of P. jirovecii remains uncertain. mtLSU genotype 1 is the predominant P. jirovecii strain in Korea.

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Related in: MedlinePlus

A transmission map for patients withPneumocystispneumonia (PCP) based on mitochondrial large ribosomal subunit (mtLSU) rRNA genotypes. Genotypes were determined by direct sequencing of nucleotides 85 and 248: genotype 1 = 85C/248C, 2 = 85A/248C, 3 = 85T/248C, and 4 = 85C/248T. Patients 49, 58, and 66 with genotype 1 stayed in ward 74 during a similar period, although they did not share the same room. Patient 65, who developed hospital-onset PCP with a mixed mtLSU genotype 1, 2 , stayed in ward 174, in which patient 56 who had a strain with the same mixed genotype was hospitalised. Patients 56 and 65 also did not share the same room
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Fig1: A transmission map for patients withPneumocystispneumonia (PCP) based on mitochondrial large ribosomal subunit (mtLSU) rRNA genotypes. Genotypes were determined by direct sequencing of nucleotides 85 and 248: genotype 1 = 85C/248C, 2 = 85A/248C, 3 = 85T/248C, and 4 = 85C/248T. Patients 49, 58, and 66 with genotype 1 stayed in ward 74 during a similar period, although they did not share the same room. Patient 65, who developed hospital-onset PCP with a mixed mtLSU genotype 1, 2 , stayed in ward 174, in which patient 56 who had a strain with the same mixed genotype was hospitalised. Patients 56 and 65 also did not share the same room

Mentions: We identified four possible cases of nosocomial transmission (Figure 1). Of these, three patients with hospital-onset PCP with mtLSU genotype 1 strains (patients 49, 58, and 66) stayed in ward 74 during a similar period, although they did not share the same room (Figure 2). It was unclear who might be an index patient among them. Patient 65, who developed hospital-onset PCP with a mixed mtLSU genotype 1, 2 , stayed in ward 174, where patient 56 who had a strain with the same mixed genotype was hospitalised. Patients 56 and 65 also did not share the same room (Figure 2).Figure 1


Clinical characteristics of hospital-onset Pneumocystis pneumonia and genotypes of Pneumocystis jirovecii in a single tertiary centre in Korea.

Kim T, Lee SO, Hong HL, Lee JY, Kim SH, Choi SH, Kim MN, Kim YS, Woo JH, Sung H - BMC Infect. Dis. (2015)

A transmission map for patients withPneumocystispneumonia (PCP) based on mitochondrial large ribosomal subunit (mtLSU) rRNA genotypes. Genotypes were determined by direct sequencing of nucleotides 85 and 248: genotype 1 = 85C/248C, 2 = 85A/248C, 3 = 85T/248C, and 4 = 85C/248T. Patients 49, 58, and 66 with genotype 1 stayed in ward 74 during a similar period, although they did not share the same room. Patient 65, who developed hospital-onset PCP with a mixed mtLSU genotype 1, 2 , stayed in ward 174, in which patient 56 who had a strain with the same mixed genotype was hospitalised. Patients 56 and 65 also did not share the same room
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4359516&req=5

Fig1: A transmission map for patients withPneumocystispneumonia (PCP) based on mitochondrial large ribosomal subunit (mtLSU) rRNA genotypes. Genotypes were determined by direct sequencing of nucleotides 85 and 248: genotype 1 = 85C/248C, 2 = 85A/248C, 3 = 85T/248C, and 4 = 85C/248T. Patients 49, 58, and 66 with genotype 1 stayed in ward 74 during a similar period, although they did not share the same room. Patient 65, who developed hospital-onset PCP with a mixed mtLSU genotype 1, 2 , stayed in ward 174, in which patient 56 who had a strain with the same mixed genotype was hospitalised. Patients 56 and 65 also did not share the same room
Mentions: We identified four possible cases of nosocomial transmission (Figure 1). Of these, three patients with hospital-onset PCP with mtLSU genotype 1 strains (patients 49, 58, and 66) stayed in ward 74 during a similar period, although they did not share the same room (Figure 2). It was unclear who might be an index patient among them. Patient 65, who developed hospital-onset PCP with a mixed mtLSU genotype 1, 2 , stayed in ward 174, where patient 56 who had a strain with the same mixed genotype was hospitalised. Patients 56 and 65 also did not share the same room (Figure 2).Figure 1

Bottom Line: There was a trend toward a higher proportion of haematological malignancy (43.8% [7/16] vs. 20.3% [16/79]; P = 0.058) in patients with hospital-onset PCP compared to patients with community-onset PCP. mtLSU genotype 1 was the most common, occurring in 41 (43.2%) patients.There were four possible cases of nosocomial transmission.Mutation in DHPS was not observed in any PCP episode.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Soonchunhyang University Bucheon Hospital 170 Jomaru-ro, Bucheon-si, Gyeonggi-do, 420-767, Republic of Korea. ktocc2@naver.com.

ABSTRACT

Background: Pneumocystis pneumonia (PCP) may develop as a clinical manifestation of nosocomial pneumonia by means of either reactivation of resident P. jirovecii or de novo infection. However, there have been no studies describing the clinical characteristics of hospital-onset PCP.

Methods: A retrospective review of medical records was performed to identify episodes of hospital-onset PCP in a tertiary care centre in Korea between May 2007 and January 2013. We investigated whether human-to-human contact during hospitalisation contributed to PCP development by molecular analysis of the genes encoding mitochondrial large ribosomal subunit (mtLSU) rRNA and dihydropteroate synthase (DHPS) and a review of hospitalisation history.

Results: During the study period, 129 patients (130 episodes) were diagnosed with PCP. Of these, respiratory specimens from 94 patients during 95 PCP episodes were available for analysis. Sixteen episodes (16.8%) were categorised as hospital-onset PCP. There was a trend toward a higher proportion of haematological malignancy (43.8% [7/16] vs. 20.3% [16/79]; P = 0.058) in patients with hospital-onset PCP compared to patients with community-onset PCP. mtLSU genotype 1 was the most common, occurring in 41 (43.2%) patients. There were four possible cases of nosocomial transmission. Mutation in DHPS was not observed in any PCP episode.

Conclusions: PCP can be one of the causes of nosocomial pneumonia, although the mode of acquisition and transmission of P. jirovecii remains uncertain. mtLSU genotype 1 is the predominant P. jirovecii strain in Korea.

Show MeSH
Related in: MedlinePlus