Yazaki Hirohisa, Goto Norihiko, Uchida Kazuharu, Kobayashi Takaaki, Gatanaga Hiroyuki, Oka Shinichi
AIDS Clinical Center, International Medical Center of Japan, Tokyo, Japan.
Transplantation. 2009 Aug 15;88(3):380-5. doi: 10.1097/TP.0b013e3181aed389.
Prophylaxis against Pneumocystis jiroveci pneumonia (PCP) is only recommended during some periods after renal transplantation. Recent advances in immunosuppressive therapy have considerably reduced acute rejection. However, the reported PCP outbreaks are increasing in renal transplant recipients.
Only three sporadic PCP cases had occurred since 1976 in our Renal Transplant Unit until the index case in July 2004. A PCP outbreak of 27 cases occurred mainly in the outpatient clinic within 1 year, followed by six additional cases during the next 3 years. Molecular analysis of P. jiroveci and surveys of reservoir were performed.
Molecular analysis documented that all cases were caused by the same strain. Among 27 cases of the outbreak, human-to-human transmissions were traceable in 22 cases based on dates of outpatient clinic visits and in four cases during hospitalization. Based on the confirmed cases, airborne transmission was suspected with an estimated median PCP incubation period of 53 days (range 7-188 days). Surveys for reservoir of P. jiroveci identified asymptomatic carriers and environmental contamination. Some sporadic cases might be caused by reservoirs. Among the 33 cases, none had received PCP prophylaxis, 22 cases had PCP over 12 months, and six cases over 10 years after renal transplantation.
On documentation of a PCP case, we recommend PCP prophylaxis for a maximum period of 6 months (upper limit of incubation period) in all renal transplant recipients including those on regular maintenance immunosuppressive therapy.
仅在肾移植后的某些时期推荐预防耶氏肺孢子菌肺炎（PCP）。免疫抑制治疗的最新进展已大幅降低急性排斥反应。然而，肾移植受者中报告的PCP暴发事件正在增加。
在我们的肾移植科，自1976年至2004年7月的首例病例期间仅发生了3例散发性PCP病例。1年内主要在门诊发生了27例PCP暴发，随后的3年中又出现了6例。对耶氏肺孢子菌进行了分子分析并对储存宿主进行了调查。
分子分析证明所有病例均由同一菌株引起。在暴发的27例病例中，根据门诊就诊日期可追溯到22例人传人情况，住院期间有4例。根据确诊病例，怀疑存在空气传播，估计PCP的中位潜伏期为53天（范围7 - 188天）。对耶氏肺孢子菌储存宿主的调查发现了无症状携带者和环境污染。一些散发病例可能由储存宿主引起。在这33例病例中，无一例接受过PCP预防，22例在肾移植后12个月以上发生PCP，6例在肾移植后10年以上发生。
在记录到PCP病例时，我们建议对所有肾移植受者，包括接受常规维持免疫抑制治疗的患者，进行最长6个月（潜伏期上限）的PCP预防。
