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Volume 18, Number 5—May 2012
Letter

Possible Nosocomial Transmission of Pneumocystis jirovecii

Céline Damiani, Firas Choukri, Solène Le Gal, Jean Menotti, Claudine Sarfati, Gilles Nevez, Francis Derouin, and Anne TotetComments to Author 
Author affiliations: Centre Hospitalier Universitaire d’Amiens, Amiens, France (C. Damiani, A. Totet); Université de Picardie-Jules Verne, Amiens (C. Damiani, A. Totet); Hôpital Saint Louis, Paris, France (F. Choukri, J. Menotti, C. Sarfati, F. Derouin); Université Paris Diderot, Paris (F. Choukri, J. Menotti, C. Sarfati, F. Derouin); Centre Hospitalier Universitaire de Brest, Brest, France (S. Le Gal, G. Nevez); Université de Brest, Brest (S. Le Gal, G. Nevez)

Main Article

Table

Genotyping of Pneumocystis jirovecii in pairs of pulmonary and air samples from 15 patients with Pneumocystis pneumonia*

Patient no.† No. days between pulmonary and air sampling ITS genotype (no. sequenced clones)‡

DHPS genotype§
Pulmonary sample Air sample Pulmonary sample Air sample
1 6 Gg, Fg (3)¶ ND Wild ND
2 1 Ih (3) Eg (3) Wild ND
4 0 Gg (3) Gg (3) Wild Wild
5 0 Eg (3) Ec, Eg (3)¶ Wild Wild
6 0 Eg (3) Eg (3) Mutant 171# Mutant 171
7 1 Eg (3) ND Wild Wild
8 0 Eg (2) Eg (1) Wild ND
10 0 Eg (3) ND Mutant 171 ND
11 0 Be, Ec (3¶) Ec (3) Mutant 165** Mutant 165
13 2 Eg (3) ND Wild ND
15 0 Eg, Fg (3)¶ ND Wild + mutant 171 ND
16 0 Eg (3) ND Wild Wild
17 1 Ie, Ih (2) ND Wild ND
18 1 Bl (3) Bl (3) Wild + mutant 165 ND
19 0 Eg, Bl (3¶) ND Wild + mutant 165 ND

*ITS, internal transcribed spacers; DHPS, dihydropteroate synthase; ND, not determined.
†Patients are numbered as described in (6). Pulmonary samples were bronchoalveloar lavage specimens for patients 2, 4, 6, 7, 8, 10, 11, 18, and 19 and induced sputum specimens for patients 1, 5, 13, 15, 16, and 17.
P. jirovecii ITS genotype identification using sequence analysis with a prior cloning step and applying the score by Lee et al. (2).
§P. jirovecii DHPS genotype identification using a PCR restriction fragment length polymorphism assay (8).
¶Major ITS genotype, as identified in 2 of 3 clones.
#Mutant genotype with the mutation at position 171.
**Mutant genotype with the mutation at position 165.

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References
  1. 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
  2. Lee  CH, Helweg-Larsen  J, Tang  X, Jin  S, Li  B, Bartlett  MS, Update on Pneumocystis carinii f. sp. hominis typing based on nucleotide sequence variations in internal transcribed spacer regions of rRNA genes. J Clin Microbiol. 1998;36:73441.PubMed
  3. Iliades  P, Meshnick  SR, Macreadie  IG. Mutations in the Pneumocystis jirovecii DHPS gene confer cross-resistance to sulfa drugs. Antimicrob Agents Chemother. 2005;49:7418. DOIPubMed
  4. Nevez  G, Chabe  M, Rabodonirina  M, Virmaux  M, Dei-Cas  E, Hauser  PM, Nosocomial Pneumocystis jirovecii infections. Parasite. 2008;15:35965.PubMed
  5. de Boer  MG, de Fijter  JW, Kroon  FP. Outbreaks and clustering of Pneumocystis pneumonia in kidney transplant recipients: a systematic review. Med Mycol. 2011;49:67380.PubMed
  6. Choukri  F, Menotti  J, Sarfati  C, Lucet  JC, Nevez  G, Garin  YJ, Quantification and spread of Pneumocystis jirovecii in the surrounding air of patients with Pneumocystis pneumonia. Clin Infect Dis. 2010;51:25965. DOIPubMed
  7. Totet  A, Pautard  JC, Raccurt  C, Roux  P, Nevez  G. Genotypes at the internal transcribed spacers of the nuclear rRNA operon of Pneumocystis jiroveci in nonimmunosuppressed infants without severe pneumonia. J Clin Microbiol. 2003;41:117380. DOIPubMed
  8. Totet  A, Latouche  S, Lacube  P, Pautard  JC, Jounieaux  V, Raccurt  C, Pneumocystis jirovecii dihydropteroate synthase genotypes in immunocompetent infants and immunosuppressed adults, Amiens, France. Emerg Infect Dis. 2004;10:66773.PubMed

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Page updated: April 06, 2012
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