Quantification and Spread of Pneumocystis jirovecii in the Surrounding Air of Patients with Pneumocystis Pneumonia

被引:110
作者
Choukri, Firas [1 ]
Menotti, Jean [1 ]
Sarfati, Claudine [1 ]
Lucet, Jean-Christophe [2 ]
Nevez, Gilles [3 ]
Garin, Yves J. F. [1 ]
Derouin, Francis [1 ]
Totet, Anne [4 ,5 ]
机构
[1] Paris Diderot Univ, St Louis Hosp, APHP, Paris, France
[2] Paris Diderot Univ, Bichat Claude Bernard Hosp, APHP, Paris, France
[3] Univ Brest, CHU Brest, Brest, France
[4] Univ Picardy, Amiens, France
[5] Univ Hosp, Amiens, France
关键词
RENAL-TRANSPLANT RECIPIENTS; CARINII-PNEUMONIA; MOLECULAR EVIDENCE; INTERHUMAN TRANSMISSION; DNA; OUTBREAK; INFECTION; CONTACT;
D O I
10.1086/653933
中图分类号
R392 [医学免疫学]; Q939.91 [免疫学];
学科分类号
100102 ;
摘要
Background. Airborne transmission of Pneumocystis has been demonstrated in animal models and is highly probable in humans. However, information concerning burdens of Pneumocystis jirovecii (human-derived Pneumocystis) in exhaled air from infected patients is lacking. Our objective is to evaluate P. jirovecii air diffusion in patients with Pneumocystis pneumonia. Methods. Patients admitted with Pneumocystis pneumonia were prospectively enrolled from 9 January 2008 to 21 July 2009. Air samples (1.5 m(3)) were collected on liquid medium with a commercial sampler at 1-, 3-, 5-, and 8-m distances from patients' heads. Air control samples were collected away from Pneumocystis pneumonia patient wards and outdoors. Samples were examined for P. jirovecii detection and quantification using a real-time polymerase chain reaction assay targeting the mitochondrial large subunit ribosomal RNA gene. Results. Forty patients were diagnosed as having Pneumocystis pneumonia. Air sampling was performed in the environment for 19 of them. At a 1-m distance from patients' heads, P. jirovecii DNA was detected in 15 (79.8%) of 19 patients, with fungal burdens ranging from 7.5 x 10(3) to 4.5 x 10(6) gene copies/m(3). These levels decreased with distance from the patients (P<.002). Nevertheless, 4 (33.3%) of the 12 samples taken at 8 m, in the corridor adjacent to their room, were still positive. Forty control samples were collected and remained negative. Conclusion. This study provides the first quantitative data on the spread of P. jirovecii in exhaled air from infected patients. It sustains the risk of P. jirovecii direct transmission in close contact with patients with Pneumocystis pneumonia and leads the way for initiating a quantitative risk assessment for airborne transmission of P. jirovecii.
引用
收藏
页码:259 / 265
页数:7
相关论文
共 30 条
[1]   Expression and complexity of the PRT1 multigene family of Pneumocystis carinii [J].
Ambrose, HE ;
Keely, SP ;
Aliouat, EM ;
Dei-Cas, E ;
Wakefield, AE ;
Miller, RF ;
Stringer, JR .
MICROBIOLOGY-SGM, 2004, 150 :293-300
[2]   Detection of Pneumocystis carinii DNA in air samples: Likely environmental risk to susceptible persons [J].
Bartlett, MS ;
Vermund, SH ;
Jacobs, R ;
Durant, PJ ;
Shaw, MM ;
Smith, JW ;
Tang, X ;
Lu, JJ ;
Li, BZ ;
Jin, SL ;
Lee, CH .
JOURNAL OF CLINICAL MICROBIOLOGY, 1997, 35 (10) :2511-2513
[3]   Performance of the Coriolis air sampler, a high-volume aerosol-collection system for quantification of airborne spores and pollen grains [J].
Carvalho, E. ;
Sindt, C. ;
Verdier, A. ;
Galan, C. ;
O'Donoghue, L. ;
Parks, S. ;
Thibaudon, M. .
AEROBIOLOGIA, 2008, 24 (04) :191-201
[4]   An outbreak of Pneumocystis jiroveci pneumonia with 1 predominant genotype among renal transplant recipients:: Interhuman transmission or a common environmental source? [J].
de Boer, Mark G. J. ;
van Coppenraet, Lesla E. S. Bruijnesteijn ;
Gaasbeek, Andre ;
Berger, Stefan P. ;
Gelinck, Luc B. S. ;
van Houwelingen, Hans C. ;
van den Broek, Peterhans ;
Kuijper, Ed J. ;
Kroon, Frank P. ;
Vandenbroucke, Jan P. .
CLINICAL INFECTIOUS DISEASES, 2007, 44 (09) :1143-1149
[5]   Molecular evidence of interhuman transmission in an outbreak of Pneumocystis jirovecii pneumonia among renal transplant recipients [J].
Gianella, S. ;
Haeberli, L. ;
Joos, B. ;
Ledergerber, B. ;
Wuethrich, R. P. ;
Weber, R. ;
Kuster, H. ;
Hauser, P. M. ;
Fehr, T. ;
Mueller, N. J. .
TRANSPLANT INFECTIOUS DISEASE, 2010, 12 (01) :1-10
[6]   Clusters of Pneumocystis carinii pneumonia:: analysis of person-to-person transmission by genotyping [J].
Helweg-Larsen, J ;
Tsolaki, AG ;
Miller, RF ;
Lundgren, B ;
Wakefield, AE .
QJM-AN INTERNATIONAL JOURNAL OF MEDICINE, 1998, 91 (12) :813-820
[7]  
Höcker B, 2005, EMERG INFECT DIS, V11, P330
[9]  
HUGHES WT, 1983, J INFECT DIS, V147, P595, DOI 10.1093/infdis/147.3.595
[10]  
Jacques G, 1999, J EUKARYOT MICROBIOL, V46, p94S