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Pneumocystis pneumonia (PCP) and Pneumocystis jirovecii carriage in renal transplantation patients: a single-centre experience

Pneumocystis Pneumonie (PCP) und Pneumocystis jirovecii Besiedlung bei Patienten nach Nierentransplantation – Erfahrungen aus einem Transplantationszentrum

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Summary

Background

The Pneumocystis pneumonia is an increasing problem in transplanted patients: up to 25 % suffer from Pneumocystis pneumonia, occurring during the first 6 months after transplantation.

Methods

From 2001 to 2009, we investigated 21 patients with pneumonia after renal transplantation for the presence of Pneumocystis jirovecii. The laboratory diagnosis was established by Grocott and Giemsa staining methods and Pneumocystis-specific mitochondrial transcribed large subunit nested polymerase chain reaction (PCR). The PCR was also used for the differentiation of Pneumocystis pneumonia from Pneumocystis carriage.

Results

Of 21 patients, 7 had a Pneumocystis pneumonia, 6 were Pneumocystis carriers and 8 patients were negative. Four out of seven Pneumocystis pneumonia patients and two out of six patients with Pneumocystis carriage had a delayed graft function. An acute cytomegalovirus infection after transplantation was not detectable in the patients with Pneumocystis pneumonia, but in three patients with Pneumocystis carriage.

Conclusions

Pneumocystis pneumonia was present in 33.3 % of transplanted patients with suspected pneumonia. An association between acute rejection or co-infections and Pneumocystis pneumonia or carriage in patients after renal transplantation cannot be excluded. In three out of seven Pneumocystis pneumonia patients, an overlapping of hospitalisation times and an onset of Pneumocystis pneumonia 6 months after transplantation was found. Thus, person-to-person transmission seems probable in these cases.

Zusammenfassung

Hintergrund

Die Pneumocystis Pneumonie stellt in zunehmendem Maße ein Problem bei Patienten nach Transplantationen dar: bis zu 25 % der Patienten erkranken an einer Pneumocystis Pneumonie, die innerhalb der ersten sechs Monate nach Transplantation auftritt.

Methodik

Von 2001 bis 2009 wurde bei 21 Patienten nach Nierentransplantation eine Pneumonie durch Pneumocystis jirovecii vermutet. Die Labordiagnostik erfolgte mittels Grocott- und Giemsa-Färbungen sowie Pneumocystis-spezifischer „mitochondrial transcribed large subunit“ nested PCR. Diese PCR wurde zusätzlich zur Differenzierung zwischen einer Pneumocystis Pneumonie und einer Pneumocystis Besiedelung genutzt.

Ergebnisse

Bei 7/21 Patienten wurde eine Pneumocystis Pneumonie nachgewiesen, 6 waren mit Pneumocystis besiedelt und 8 Patienten waren negativ. 4/7 Pneumocystis Pneumonie Patienten sowie 2/6 Patienten mit Pneumocystis Besiedlung hatten eine verzögerte Transplantat-Funktion. Eine akute Cytomegalie-Virus-Infektion nach Transplantation trat bei keinem der Pneumocystis Pneumonie-Fälle und bei drei Patienten mit Pneumocystis Besiedelung auf.

Schlussfolgerungen

Eine Pneumocystis Pneumonie konnte bei 33,3 % der Patienten nach Nierentransplantation und Verdacht auf Pneumonie nachgewiesen werden. Eine Assoziation zwischen akuter Rejektion oder Koinfektionen und dem Auftreten einer PCP bzw. Besiedelung war nicht auszuschließen. Bei 3/7 Pneumocystis Pneumonie Patienten wurde eine Überschneidung der Hospitalisierungs-Zeiträume mit gleichzeitigem Beginn der Pneumocystis Pneumonie sechs Monate nach Transplantation festgestellt. Eine Übertragung von Person zu Person scheint in diesen Fällen sehr wahrscheinlich.

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Conflict of interest

There are no commercial relationships or conflicts of interests. The authors declare that they did not receive any funding or grants.

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Authors and Affiliations

  1. Department of Urology, University of Rostock Medical School, Rostock, Germany

    Matthias Maruschke MD & Oliver W. Hakenberg MD

  2. Department of Tropical Medicine and Infectious Diseases, University of Rostock Medical School, Ernst-Heydemann-Str. 6, 18055, Rostock, Germany

    Diana Riebold PhD, Martha Charlotte Holtfreter PhD, Martina Sombetzki PhD, Micha Loebermann MD & Emil Christian Reisinger MD

  3. Department of Nephrology, University of Rostock Medical School, Rostock, Germany

    Steffen Mitzner MD

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  1. Matthias Maruschke MD
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  2. Diana Riebold PhD
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Correspondence to Diana Riebold PhD.

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Maruschke, M., Riebold, D., Holtfreter, M. et al. Pneumocystis pneumonia (PCP) and Pneumocystis jirovecii carriage in renal transplantation patients: a single-centre experience. Wien Klin Wochenschr 126, 762–766 (2014). https://doi.org/10.1007/s00508-014-0608-3

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