Pneumocystis jiroveci outbreak in a renal transplant center: Lessons learnt

Area of Science:

• Nephrology
• Infectious Diseases
• Transplantation Immunology

Background:

• Pneumocystis jiroveci pneumonia (PJP) is a significant opportunistic infection in immunocompromised individuals, particularly transplant recipients.
• An unusual cluster of PJP cases was observed among renal transplant recipients at a single center.

Purpose of the Study:

• To investigate an outbreak of PJP in renal transplant recipients.
• To identify risk factors, diagnostic challenges, treatment outcomes, and control measures for PJP in this population.

Main Methods:

• Retrospective analysis of nine renal transplant recipients diagnosed with PJP over a four-month period.
• Microbiological confirmation of PJP via sputum and/or bronchoalveolar lavage.
• Review of clinical presentation, radiological findings, treatment regimens, and outcomes.

Main Results:

• The median time from transplant to PJP diagnosis was 56 months; none received cotrimoxazole prophylaxis.
• Over half of the patients acquired PJP nosocomially while admitted for other reasons.
• Cotrimoxazole was effective, though hyperkalemia was common in patients with graft dysfunction; clindamycin-primaquine was an alternative.
• Early diagnosis and treatment led to an 11% mortality rate.

Conclusions:

• This study reports the first PJP outbreak in Indian renal transplant recipients, suggesting possible inter-human transmission within the ward.
• Atypical clinical and radiological presentations were noted, complicating diagnosis.
• Implementing universal cotrimoxazole prophylaxis effectively controlled the outbreak, emphasizing its importance for infection prevention in this vulnerable group.