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Volume 15, Number 3—March 2009
Letter

Hypothetical Pneumocystis jirovecii Transmission from Immunocompetent Carriers to Infant

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To the Editor

The recent dispatch article by Rivero et al. reports the transmission of Pneumocystis jirovecii from immunocompetent grandparents to their granddaughter (1). The authors’ conclusion was based on 2 facts: the grandparents were carriers but neither the parents nor the child’s brother was a carrier, and the P. jirovecii genotype observed in the grandparents was identical to that found in the infant. In our opinion, the data provided by the authors do not support the conclusion that transmission has occurred. First, the 2 markers used for typing show a small number of alleles and thus provide low discrimination among isolates (2). Consequently, the P. jirovecii isolates present in the grandparents and in the infant may have been epidemiologically unrelated. Second, the frequency of occurrence of the different genotypes obtained was not investigated. The presence of the same genotype in the grandparents and in the infant may result from a high frequency of this genotype in the geographic area where the family lived. In fact, the use of a validated typing method and the analysis of unlinked control patients have proven necessary in other studies to demonstrate transmission of P. jirovecii (37). We believe that the reported transmission event remains a hypothesis.

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Philippe HauserComments to Author , Meja Rabodonirina, and Gilles Nevez

Author affiliations: Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland (P. Hauser); Université Claude-Bernard, Hospices Civils de Lyon, Lyon, France (M. Rabodonirina); Université de Brest, Brest, France (G. Nevez)

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References

  1. Rivero  L, de la Horra  C, Montes-Cano  MA, Rodríguez-Herrera  A, Respaldiza  N, Friaza  V, Pneumocystis jirovecii transmission from immunocompetent carriers to infant. Emerg Infect Dis. 2008;14:11168. DOIPubMed
  2. Beard  CB, Roux  P, Nevez  G, Hauser  PM, Kovacs  JA, Unnasch  TR, Strain typing methods and molecular epidemiology of Pneumocystis pneumonia. Emerg Infect Dis. 2004;10:172935.PubMed
  3. de Boer  MG, Bruijnesteijn van Coppenraet  LE, Gaasbeek  A, Berger  SP, Gelinck  LB, van Houwelingen  HC, 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;44:11439. DOIPubMed
  4. Höcker  B, Wendt  C, Nahimana  A, Tönshoff  B, Hauser  PM. Molecular evidence of Pneumocystis transmission in pediatric transplant unit. Emerg Infect Dis. 2005;11:3302.PubMed
  5. Rabodonirina  M, Vanhems  P, Couray-Targe  S, Gillibert  RP, Ganne  C, Nizard  N, Molecular evidence of interhuman transmission of Pneumocystis pneumonia among renal transplant recipients hospitalized with HIV-infected patients. Emerg Infect Dis. 2004;10:176673.PubMed
  6. Schmoldt  S, Schuhegger  R, Wendler  T, Huber  I, Söllner  H, Hogardt  M, Molecular evidence of nosocomial Pneumocystis jirovecii transmission among 16 patients after kidney transplantation. J Clin Microbiol. 2008;46:96671. DOIPubMed
  7. Nevez  G, Chabé  M, Rabodonirina  M, Virmaux  M, Dei-Cas  E, Hauser  PM, Nosocomial Pneumocystis jirovecii infections. Parasite. 2008;15:35965.PubMed

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Cite This Article

DOI: 10.3201/eid1503.081350

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Table of Contents – Volume 15, Number 3—March 2009

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Please use the form below to submit correspondence to the authors or contact them at the following address:

Philippe Hauser, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Institute of Microbiology, Rue Bugnon 48 Lausanne 1011, Switzerland

Enrique J. Calderón, CIBER en Epidemiología y Salud Pública, Servicio de Medicina Interna, Hospital Universitario Virgen del Rocío, Avda, Manuel Siurot s/n, 41013 Seville, Spain

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Page created: December 07, 2010
Page updated: December 07, 2010
Page reviewed: December 07, 2010
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.
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