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Interhuman Transmission as a Potential Key Parameter for Geographical Variation in the Prevalence of Pneumocystis jirovecii Dihydropteroate Synthase Mutations

Hauser, Philippe M. ; Nahimana, Aimable ; Taffe, Patrick ; Weber, Rainer ; Francioli, Patrick ; Bille, Jacques ; Rabodonirina, Meja

In: Clinical Infectious Diseases, 2010, vol. 51, no. 4, p. e28-e33

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    Titel
    • Interhuman Transmission as a Potential Key Parameter for Geographical Variation in the Prevalence of Pneumocystis jirovecii Dihydropteroate Synthase Mutations
    Autor
    • Hauser, Philippe M.. Institute of Microbiology, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne
    • Nahimana, Aimable. Hospital Preventive Medicine, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne
    • Taffe, Patrick. Data Center, Swiss HIV Cohort Study, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne
    • Weber, Rainer. Division of Infectious Diseases, University Hospital and University of Zurich, Zurich, Switzerland
    • Francioli, Patrick. Hospital Preventive Medicine, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne
    • Bille, Jacques. Institute of Microbiology, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne
    • Rabodonirina, Meja. Laboratory of Parasitology, Hospices Civils de Lyon and University of Lyon, Unite Mixte Recherche 145 (Institut de Recherche pour le Développement and University of Montpellier), Lyon, France
    Dokumententyp
    • Postprint
    Sprache
    • Englisch
    Veröffentlicht in
    • Clinical Infectious Diseases, 2010, vol. 51, no. 4, p. e28-e33. The University of Chicago Press
    Andere elektronische Ausgabe
    Klassifikation
    • Gesundheit
    OAI-PMH-ID
    • oai:doc.rero.ch:294158
    Summary
    Background. Pneumocystis jirovecii dihydropteroate synthase (DHPS) mutations are associated with failure of prophylaxis with sulfa drugs. This retrospective study sought to better understand the geographical variation in the prevalence of these mutations. Methods. DHPS polymorphisms in 394 clinical specimens from immunosuppressed patients who received a diagnosis of P. jirovecii pneumonia and who were hospitalized in 3 European cities were examined using polymerase chain reaction (PCR) single-strand conformation polymorphism. Demographic and clinical characteristics were obtained from patients' medical charts. Results. Of the 394 patients, 79 (20%) were infected with a P. jirovecii strain harboring one or both of the previously reported DHPS mutations. The prevalence of DHPS mutations was significantly higher in Lyon than in Switzerland (33.0% vs 7.5%; P<.001). The proportion of patients with no evidence of sulfa exposure who harbored a mutant P. jirovecii DHPS genotype was significantly higher in Lyon than in Switzerland (29.7% vs 3.0%; P<.001). During the study period in Lyon, in contrast to the Swiss hospitals, measures to prevent dissemination of P. jirovecii from patients with P. jirovecii pneumonia were generally not implemented, and most patients received suboptimal prophylaxis, the failure of which was strictly associated with mutated P. jirovecii. Thus, nosocomial interhuman transmission of mutated strains directly or indirectly from other individuals in whom selection of mutants occurred may explain the high proportion of mutations without sulfa exposure in Lyon. Conclusions. Interhuman transmission of P. jirovecii, rather than selection pressure by sulfa prophylaxis, may play a predominant role in the geographical variation in the prevalence in the P. jirovecii DHPS mutations