Pneumocystis jiroveci in solid organ transplantation: Guidelines from the American Society of Transplantation Infectious Diseases Community of Practice
Top Cited Papers
- 11 May 2019
- journal article
- research article
- Published by Wiley in Clinical Transplantation
- Vol. 33 (9), e13587
- https://doi.org/10.1111/ctr.13587
Abstract
These updated guidelines from the Infectious Diseases Community of Practice of the American Society of Transplantation review the diagnosis, prevention and management of Pneumocystis jiroveci fungal infection transplant recipients. Pneumonia (PJP) may develop via airborne transmission or reactivation of prior infection. Nosocomial clusters of infection have been described among transplant recipients. PJP should not occur during prophylaxis with trimethoprim‐sulfamethoxazole (TMP‐SMX). Without prophylaxis, PJP risk is greatest in the first 6 months after organ transplantation but may develop later. Risk factors include low lymphocyte counts, cytomegalovirus infection (CMV), hypogammaglobulinemia, treated graft rejection or corticosteroids, and advancing patient age (> 65). Presentation typically includes fever, dyspnea with hypoxemia, and cough. Chest radiographic patterns generally reveal diffuse interstitial processes best seen by CT scans. Patients generally have PO2<60 mmHg, elevated serum lactic dehydrogenase (LDH), and elevated serum (1→3) β‐D‐glucan assay. Specific diagnosis uses respiratory specimens with direct immunofluorescent staining; invasive procedures may be required. Quantitative PCR is a useful adjunct to diagnosis. TMP‐SMX is the drug of choice for therapy; drug allergy should be documented before resorting to alternative therapies. Adjunctive corticosteroids may be useful early. Routine PJP prophylaxis is recommended for at least 6‐12 months posttransplant, preferably with TMP‐SMX.Keywords
This publication has 104 references indexed in Scilit:
- Evaluation of PCR in Bronchoalveolar Lavage Fluid for Diagnosis of Pneumocystis jirovecii Pneumonia: A Bivariate Meta-Analysis and Systematic ReviewPLOS ONE, 2013
- IncreasingPneumocystisPneumonia, England, UK, 2000–2010Emerging Infectious Diseases, 2013
- Outbreaks of Pneumocystis Pneumonia in 2 Renal Transplant Centers Linked to a Single Strain of Pneumocystis: Implications for Transmission and VirulenceClinical Infectious Diseases, 2012
- Clinical Significance of Quantifying Pneumocystis jirovecii DNA by Using Real-Time PCR in Bronchoalveolar Lavage Fluid from Immunocompromised PatientsJournal of Clinical Microbiology, 2012
- Nosocomial Pneumocystis jirovecii Pneumonia: Lessons From a Cluster in Kidney Transplant RecipientsTransplantation, 2011
- PCR Diagnosis of Pneumocystis Pneumonia: a Bivariate Meta-AnalysisJournal of Clinical Microbiology, 2011
- Molecular Evidence of Nosocomial Pneumocystis jirovecii Transmission among 16 Patients after Kidney TransplantationJournal of Clinical Microbiology, 2008
- The Utility of Sputum Induction for Diagnosis of Pneumocystis Pneumonia in Immunocompromised Patients without Human Immunodeficiency VirusClinical Infectious Diseases, 2003
- Should Prophylaxis for Pneumocystis carinii Pneumonia in Solid Organ Transplant Recipients Ever Be Discontinued?Clinical Infectious Diseases, 1999
- Diagnosis ofPneumocystis cariniiPneumonia: Improved Detection in Sputum with Use of Monoclonal AntibodiesThe New England Journal of Medicine, 1988