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Atypical pneumonia testing in transplant recipients.

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Atypical pneumonia testing in transplant recipients showed a very low positivity rate. Targeted diagnostic strategies could improve yield and reduce costs for immunocompromised patients.

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Area of Science:

  • Infectious Diseases
  • Transplant Medicine
  • Clinical Diagnostics

Background:

  • Atypical pneumonia diagnosis is challenging in immunocompromised patients.
  • The incidence and diagnostic yield of atypical pneumonia in transplant recipients are not well understood.
  • This study investigates atypical pneumonia in solid organ, hematopoietic stem cell transplant (HSCT), and CAR T-cell recipients.

Purpose of the Study:

  • To assess the test positivity rate of atypical pneumonia in transplant recipients.
  • To evaluate the incidence of specific atypical pathogens (Legionella, Mycoplasma, Chlamydia, Bordetella) in this population.
  • To analyze the cost-effectiveness of diagnostic testing for atypical pneumonia.

Main Methods:

  • Retrospective cohort study at Yale New Haven Health System (January 2016 - August 2022).
  • Included adults with solid organ transplant, HSCT, or CAR T-cell therapy who underwent atypical pneumonia pathogen testing.
  • Positive results were adjudicated clinically; a cost analysis was performed.

Main Results:

  • 1021 tests were performed on 481 transplant recipients, with a 0.7% positivity rate (7 positive tests).
  • Three cases of proven Legionella and one possible Mycoplasma infection were identified after adjudication.
  • Legionellosis cases occurred within 1 year post-transplant with augmented immunosuppression and lymphopenia.

Conclusions:

  • The positivity rate for atypical pneumonia testing in transplant recipients is very low.
  • An algorithmic approach to testing, considering clinical factors, may enhance diagnostic yield.
  • Targeted testing strategies could lead to significant cost savings in this patient population.