Clinical features of 82 renal transplant recipients complicated with <i>Pneumocystis carinii</i> pneumonia_West China Medical Journal

Authors：

HE Shaoping , YE Yuanxin , WANG Minjin , ZHONG Huiyu , WU Lijuan ,  YING Binwu

Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding?author：

YING Binwu, Email: binwuying@126.com

Keywords：

Kidney transplantation; Pneumocystis carinii pneumonia; Clinical feature; Diagnosis; Therapy

DOI：

10.7507/1002-0179.202010076

Video：

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Objective To analyze the clinical characteristics and measures of diagnosis and treatment of renal transplant recipients complicated with Pneumocystis carinii pneumonia (PCP), in order to provide basis for prevention and treatment.Methods The clinical data of 82 renal transplant recipients complicated with PCP admitted to the West China Hospital of Sichuan University from January 2016 to December 2019 were retrospectively analyzed.Results The median time from transplantation to diagnosis of PCP was 3.50 (2.78, 8.27) months, and 57 cases (69.51%) were occurred within 6 months. The main clinical manifestations were fever, cough and shortness of breath, and chest CT scan mainly showed ground-glass opacity and patchy shadows. The laboratory examination showed a decrease of lymphocyte, increased high-sensitivity C-reactive protein and (1-3)-beta-D glucan. All 82 patients (100%) were complicated with bacterial, virus infections or other fungal infections. The median time of diagnosis, treatment and hospital stay was 6.00 (3.00, 8.25) d, 20.00 (12.75, 32.25) d, 26.50 (20.75, 39.00) d, respectively. Sixty-six cases (80.49%) were discharged with effective treatment, yet 14 cases (17.07%) suffered a failed treatment and 2 cases (2.44%) died.Conclusions The incidence of PCP infection was highest within the first 6 months after renal transplantation, and multiple infections tend to easily occured. Early diagnosis should be made in combined with clinical manifestations, laboratory and imaging examinations, and individualized treatment should be taken early.

Citation： HE Shaoping, YE Yuanxin, WANG Minjin, ZHONG Huiyu, WU Lijuan, YING Binwu. Clinical features of 82 renal transplant recipients complicated with Pneumocystis carinii pneumonia. West China Medical Journal, 2021, 36(3): 374-378. doi: 10.7507/1002-0179.202010076 Copy

1.	宋興勃, 彭武, 王旻晉, 等. 361 例疑似肺孢子菌肺炎患者核酸檢測結果分析. 國際檢驗醫學雜志, 2018, 39(18): 2242-2245.
2.	Catherinot E, Lanternier F, Bougnoux ME, et al. Pneumocystis jirovecii pneumonia. Infect Dis Clin North Am, 2010, 24(1): 107-138.
3.	Maschmeyer G, Helweg-Larsen J, Pagano L, et al. ECIL guidelines for treatment of pneumocystis jirovecii pneumonia in non-HIV-infected haematology patients. J Antimicrob Chemother, 2016, 71(9): 2405-2413.
4.	Liu Y, Su L, Jiang SJ, et al. Risk factors for mortality from Pneumocystis carinii pneumonia (PCP) in non-HIV patients: a meta-analysis. Oncotarget, 2017, 8(35): 59729-59739.
5.	Salzer HJF, Sch?fer G, Hoenigl M, et al. Clinical, diagnostic, and treatment disparities between HIV-infected and Non-HIV-infected immunocompromised patients with pneumocystis jirovecii pneumonia. Respiration, 2018, 96(1): 52-65.
6.	Sarkar S, Dubé MP, Jones BE, et al. Pneumocystis carinii pneumonia masquerading as tuberculosis. Arch Intern Med, 1997, 157(3): 351-355.
7.	李昱霖, 梁志欣, 駱海倫, 等. 77 例腎移植術后患者并發肺部感染的臨床分析. 解放軍醫學院學報, 2014, 35(6): 538-540.
8.	Miller RF, Le Noury J, Corbett EL, et al. Pneumocystis carinii infection: current treatment and prevention. J Antimicrob Chemother, 1996, 37(Suppl B): 33-53.
9.	Kaminski H, Belliere J, Burguet L, et al. Identification of predictive markers and outcomes of late-onset pneumocystis jirovecii pneumonia in kidney transplant recipients. Clin Infect Dis, 2020: ciaa1611.
10.	Kim JE, Han A, Lee H, et al. Impact of pneumocystis jirovecii pneumonia on kidney transplant outcome. BMC Nephrol, 2019, 20(1): 212.
11.	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(7): 673-680.
12.	Radisic M, Lattes R, Chapman JF, et al. Risk factors for Pneumocystis carinii pneumonia in kidney transplant recipients: a case-control study. Transpl Infect Dis, 2003, 5(2): 84-93.
13.	Mulpuru S, Knoll G, Weir C, et al. Pneumocystis pneumonia outbreak among renal transplant recipients at a North American transplant center: risk factors and implications for infection control. Am J Infect Control, 2016, 44(4): 425-431.
14.	Pan J, Fu Y, Cao Y, et al. Single-center retrospective analysis of prophylaxis and treatment of Pneumocystis carinii pneumonia in patients with renal dysfunction after renal transplantation. Ann Transplant, 2020, 25: e925126.
15.	王明明, 楊學敏. 腎移植術后患者肺孢子菌肺炎臨床特征分析. 臨床肺科雜志, 2020, 25(9): 1355-1358.
16.	劉永光, 郭穎, 李民, 等. 腎移植后并發卡氏肺孢子蟲肺炎 36 例資料回顧. 中國組織工程研究與臨床康復, 2010, 14(53): 10063-10066.
17.	Lin D, Li WK, Rieder MJ. Cotrimoxazole for prophylaxis or treatment of opportunistic infections of HIV/AIDS in patients with previous history of hypersensitivity to cotrimoxazole. Cochrane Database Syst Rev, 2007(2): CD005646.
18.	Green H, Paul M, Vidal L, et al. Prophylaxis of pneumocystis pneumonia in immunocompromised non-HIV-infected patients: systematic review and metaanalysis of randomized controlled trials. Mayo Clin Proc, 2007, 82(9): 1052-1059.
19.	Martin SI, Fishman JA, the AST Infectious Diseases Community of Practice. Pneumocystis pneumonia in solid organ transplant recipients. Am J Transplant, 2009(Suppl 4): S227-S233.
20.	Chapman FA, Dickerson JE, Daly C, et al. Impact of increased duration of trimethoprim-sulfamethoxazole prophylaxis for pneumocystis pneumonia after renal transplant. Ann Transplant, 2019, 24: 625-630.
21.	Prasad GVR, Beckley J, Mathur M, et al. Safety and efficacy of prophylaxis for pneumocystis jirovecii pneumonia involving trimethoprim-sulfamethoxazole dose reduction in kidney transplantation. BMC Infect Dis, 2019, 19(1): 311.
22.	Le Gal S, Toubas D, Totet A, et al. Pneumocystis infection outbreaks in organ transplantation units in france: a nation-wide survey. Clin Infect Dis, 2020, 70(10): 2216-2220.
23.	Yazaki H, Goto N, Uchida K, et al. Outbreak of Pneumocystis jiroveci pneumonia in renal transplant recipients: P. jiroveci is contagious to the susceptible host. Transplantation, 2009, 88(3): 380-385.
24.	Faure E, Lionet A, Kipnis E, et al. Risk factors for Pneumocystis pneumonia after the first 6 months following renal transplantation. Transpl Infect Dis, 2017, 19(5).
25.	Lee SH, Huh KH, Joo DJ, et al. Risk factors for pneumocystis jirovecii pneumonia (PJP) in kidney transplantation recipients. Sci Rep, 2017, 7(1): 1571.
26.	Depypere M, Saegeman V, Lagrou K. Typing of pneumocystis jirovecii by multilocus sequencing: evidence of outbreak?. Eur J Clin Microbiol Infect Dis, 2016, 35(6): 911-916.
27.	Ricci G, Santos DW, Kovacs JA, et al. Genetic diversity of pneumocystis jirovecii from a cluster of cases of pneumonia in renal transplant patients: cross-sectional study. Mycoses, 2018, 61(11): 845-852.
28.	Rostved AA, Sassi M, Kurtzhals JA L, et al. Outbreak of pneumocystis pneumonia in renal and liver transplant patients caused by genotypically distinct strains of pneumocystis jirovecii. Transplantation, 2013, 96(9): 834-842.
29.	邱成, 葉劍鋒, 戴帥, 等. 腎移植受者肺孢子菌肺炎流行病學特點分析. 中國醫學前沿雜志(電子版), 2020, 12(7): 138-141.
30.	Christe A, Walti L, Charimo J, et al. Imaging patterns of Pneumocystis jirovecii pneumonia in HIV-positive and renal transplant patients-a multicentre study. Swiss Med Wkly, 2019, 149: w20130.
31.	Chou CW, Chao HS, Lin FC, et al. Clinical usefulness of HRCT in assessing the severity of pneumocystis jirovecii pneumonia: a cross-sectional study. Medicine (Baltimore), 2015, 94: e768.
32.	丘金銘, 吳仁華. 肺孢子菌肺炎的影像學表現. 新發傳染病電子雜志, 2019, 4(4): 235-239.
33.	李晶晶, 鄒洋, 安亦君, 等. 1341 例疑似肺孢子菌肺炎非 HIV 陽性患者病原學診斷分析. 傳染病信息, 2016, 29(5): 272-275.
34.	葉寧, 朱明利, 李茜茜, 等. 肺孢子菌肺炎實驗室診斷研究進展. 中國衛生檢驗雜志, 2017, 27(4): 604-605, 608.
35.	馬興璇, 唐石伏, 陽建伶, 等. (1,3)-β-D-葡聚糖實驗干擾因素的研究進展. 中國當代醫藥, 2020, 27(9): 21-23.
36.	Kinnunen S, Karhap?? P, Juutilainen A, et al. Secular trends in infection-related mortality after kidney transplantation. Clin J Am Soc Nephrol, 2018, 13(5): 755-762.
37.	段智梅, 姜淑娟, 邵楊, 等. 腎移植患者術后肺部感染的臨床特征分析. 中華醫院感染學雜志, 2018, 28(20): 3107-3110.

1. 宋興勃, 彭武, 王旻晉, 等. 361 例疑似肺孢子菌肺炎患者核酸檢測結果分析. 國際檢驗醫學雜志, 2018, 39(18): 2242-2245.
2. Catherinot E, Lanternier F, Bougnoux ME, et al. Pneumocystis jirovecii pneumonia. Infect Dis Clin North Am, 2010, 24(1): 107-138.
3. Maschmeyer G, Helweg-Larsen J, Pagano L, et al. ECIL guidelines for treatment of pneumocystis jirovecii pneumonia in non-HIV-infected haematology patients. J Antimicrob Chemother, 2016, 71(9): 2405-2413.
4. Liu Y, Su L, Jiang SJ, et al. Risk factors for mortality from Pneumocystis carinii pneumonia (PCP) in non-HIV patients: a meta-analysis. Oncotarget, 2017, 8(35): 59729-59739.
5. Salzer HJF, Sch?fer G, Hoenigl M, et al. Clinical, diagnostic, and treatment disparities between HIV-infected and Non-HIV-infected immunocompromised patients with pneumocystis jirovecii pneumonia. Respiration, 2018, 96(1): 52-65.
6. Sarkar S, Dubé MP, Jones BE, et al. Pneumocystis carinii pneumonia masquerading as tuberculosis. Arch Intern Med, 1997, 157(3): 351-355.
7. 李昱霖, 梁志欣, 駱海倫, 等. 77 例腎移植術后患者并發肺部感染的臨床分析. 解放軍醫學院學報, 2014, 35(6): 538-540.
8. Miller RF, Le Noury J, Corbett EL, et al. Pneumocystis carinii infection: current treatment and prevention. J Antimicrob Chemother, 1996, 37(Suppl B): 33-53.
9. Kaminski H, Belliere J, Burguet L, et al. Identification of predictive markers and outcomes of late-onset pneumocystis jirovecii pneumonia in kidney transplant recipients. Clin Infect Dis, 2020: ciaa1611.
10. Kim JE, Han A, Lee H, et al. Impact of pneumocystis jirovecii pneumonia on kidney transplant outcome. BMC Nephrol, 2019, 20(1): 212.
11. 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(7): 673-680.
12. Radisic M, Lattes R, Chapman JF, et al. Risk factors for Pneumocystis carinii pneumonia in kidney transplant recipients: a case-control study. Transpl Infect Dis, 2003, 5(2): 84-93.
13. Mulpuru S, Knoll G, Weir C, et al. Pneumocystis pneumonia outbreak among renal transplant recipients at a North American transplant center: risk factors and implications for infection control. Am J Infect Control, 2016, 44(4): 425-431.
14. Pan J, Fu Y, Cao Y, et al. Single-center retrospective analysis of prophylaxis and treatment of Pneumocystis carinii pneumonia in patients with renal dysfunction after renal transplantation. Ann Transplant, 2020, 25: e925126.
15. 王明明, 楊學敏. 腎移植術后患者肺孢子菌肺炎臨床特征分析. 臨床肺科雜志, 2020, 25(9): 1355-1358.
16. 劉永光, 郭穎, 李民, 等. 腎移植后并發卡氏肺孢子蟲肺炎 36 例資料回顧. 中國組織工程研究與臨床康復, 2010, 14(53): 10063-10066.
17. Lin D, Li WK, Rieder MJ. Cotrimoxazole for prophylaxis or treatment of opportunistic infections of HIV/AIDS in patients with previous history of hypersensitivity to cotrimoxazole. Cochrane Database Syst Rev, 2007(2): CD005646.
18. Green H, Paul M, Vidal L, et al. Prophylaxis of pneumocystis pneumonia in immunocompromised non-HIV-infected patients: systematic review and metaanalysis of randomized controlled trials. Mayo Clin Proc, 2007, 82(9): 1052-1059.
19. Martin SI, Fishman JA, the AST Infectious Diseases Community of Practice. Pneumocystis pneumonia in solid organ transplant recipients. Am J Transplant, 2009(Suppl 4): S227-S233.
20. Chapman FA, Dickerson JE, Daly C, et al. Impact of increased duration of trimethoprim-sulfamethoxazole prophylaxis for pneumocystis pneumonia after renal transplant. Ann Transplant, 2019, 24: 625-630.
21. Prasad GVR, Beckley J, Mathur M, et al. Safety and efficacy of prophylaxis for pneumocystis jirovecii pneumonia involving trimethoprim-sulfamethoxazole dose reduction in kidney transplantation. BMC Infect Dis, 2019, 19(1): 311.
22. Le Gal S, Toubas D, Totet A, et al. Pneumocystis infection outbreaks in organ transplantation units in france: a nation-wide survey. Clin Infect Dis, 2020, 70(10): 2216-2220.
23. Yazaki H, Goto N, Uchida K, et al. Outbreak of Pneumocystis jiroveci pneumonia in renal transplant recipients: P. jiroveci is contagious to the susceptible host. Transplantation, 2009, 88(3): 380-385.
24. Faure E, Lionet A, Kipnis E, et al. Risk factors for Pneumocystis pneumonia after the first 6 months following renal transplantation. Transpl Infect Dis, 2017, 19(5).
25. Lee SH, Huh KH, Joo DJ, et al. Risk factors for pneumocystis jirovecii pneumonia (PJP) in kidney transplantation recipients. Sci Rep, 2017, 7(1): 1571.
26. Depypere M, Saegeman V, Lagrou K. Typing of pneumocystis jirovecii by multilocus sequencing: evidence of outbreak?. Eur J Clin Microbiol Infect Dis, 2016, 35(6): 911-916.
27. Ricci G, Santos DW, Kovacs JA, et al. Genetic diversity of pneumocystis jirovecii from a cluster of cases of pneumonia in renal transplant patients: cross-sectional study. Mycoses, 2018, 61(11): 845-852.
28. Rostved AA, Sassi M, Kurtzhals JA L, et al. Outbreak of pneumocystis pneumonia in renal and liver transplant patients caused by genotypically distinct strains of pneumocystis jirovecii. Transplantation, 2013, 96(9): 834-842.
29. 邱成, 葉劍鋒, 戴帥, 等. 腎移植受者肺孢子菌肺炎流行病學特點分析. 中國醫學前沿雜志(電子版), 2020, 12(7): 138-141.
30. Christe A, Walti L, Charimo J, et al. Imaging patterns of Pneumocystis jirovecii pneumonia in HIV-positive and renal transplant patients-a multicentre study. Swiss Med Wkly, 2019, 149: w20130.
31. Chou CW, Chao HS, Lin FC, et al. Clinical usefulness of HRCT in assessing the severity of pneumocystis jirovecii pneumonia: a cross-sectional study. Medicine (Baltimore), 2015, 94: e768.
32. 丘金銘, 吳仁華. 肺孢子菌肺炎的影像學表現. 新發傳染病電子雜志, 2019, 4(4): 235-239.
33. 李晶晶, 鄒洋, 安亦君, 等. 1341 例疑似肺孢子菌肺炎非 HIV 陽性患者病原學診斷分析. 傳染病信息, 2016, 29(5): 272-275.
34. 葉寧, 朱明利, 李茜茜, 等. 肺孢子菌肺炎實驗室診斷研究進展. 中國衛生檢驗雜志, 2017, 27(4): 604-605, 608.
35. 馬興璇, 唐石伏, 陽建伶, 等. (1,3)-β-D-葡聚糖實驗干擾因素的研究進展. 中國當代醫藥, 2020, 27(9): 21-23.
36. Kinnunen S, Karhap?? P, Juutilainen A, et al. Secular trends in infection-related mortality after kidney transplantation. Clin J Am Soc Nephrol, 2018, 13(5): 755-762.
37. 段智梅, 姜淑娟, 邵楊, 等. 腎移植患者術后肺部感染的臨床特征分析. 中華醫院感染學雜志, 2018, 28(20): 3107-3110.

West China Medical Journal

Clinical features of 82 renal transplant recipients complicated with Pneumocystis carinii pneumonia

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