Department of Nephrology, Johann Wolfgang Goethe University, Frankfurt/M., Germany.
Eur J Clin Microbiol Infect Dis. 2012 Sep;31(9):2429-37. doi: 10.1007/s10096-012-1586-x. Epub 2012 Mar 9.
Pneumocystis jirovecii pneumonia (PCP) and cytomegalovirus (CMV) infection represent possible complications of medical immunosuppression. Between 2005 and 2010, non-human immunodeficiency virus (HIV) PCP patients admitted to a nephrology unit were analyzed for outcome, CMV comorbidity, and patient-to-patient contacts prior to PCP. In contrast to 2002-2004 (no cases) and 2008-2010 (10 cases), a PCP outbreak of 29 kidney-transplant recipients and one patient with anti-glomerular basement membrane disease occurred between 2005 and 2007. None of the patients were on PCP chemoprophylaxis. In four PCP patients, the genotyping data of bronchoalveolar lavage specimen showed an identical Pneumocystis strain. PCP cases had a higher incidence of CMV infection (12 of 30 PCP patients) and CMV disease (four patients) when compared to matched PCP-free controls (p < 0.05). Cotrimoxazole and, if applicable, ganciclovir were started 2.0 ± 4.0 days following admission, and immunosuppressive medication was reduced. In-hospital mortality was 10% and the three-year mortality was 20%. CMV co-infection did not affect mortality. CMV co-infection more frequently occurred during a cluster outbreak of non-HIV PCP in comparison to PCP-free controls. Here, CMV awareness and specific therapy of both CMV infection and PCP led to a comparatively favorable patient outcome. The role of patient isolation should be further investigated in incident non-HIV PCP.
卡氏肺孢子虫肺炎（PCP）和巨细胞病毒（CMV）感染是医学免疫抑制的可能并发症。2005 年至 2010 年间，对入住肾病科的非人类免疫缺陷病毒（HIV）PCP 患者进行了结局、CMV 合并症以及 PCP 发生前患者间接触情况分析。与 2002-2004 年（无病例）和 2008-2010 年（10 例）相比，2005-2007 年发生了 29 例肾移植受者和 1 例抗肾小球基底膜病患者的 PCP 暴发。这些患者均未接受 PCP 化学预防。在 4 例 PCP 患者中，支气管肺泡灌洗液标本的基因分型数据显示存在相同的卡氏肺孢子虫株。与匹配的无 PCP 对照组相比，PCP 患者中 CMV 感染（30 例 PCP 患者中有 12 例）和 CMV 疾病（4 例）的发生率更高（p<0.05）。在入院后第 2.0±4.0 天开始使用复方磺胺甲噁唑和（如有必要）更昔洛韦，并减少免疫抑制药物。院内死亡率为 10%，三年死亡率为 20%。CMV 合并感染未影响死亡率。与无 PCP 对照组相比，CMV 合并感染更常发生在非 HIV PCP 的集群暴发中。在此，CMV 意识和 CMV 感染和 PCP 的特异性治疗导致了相对有利的患者结局。患者隔离的作用应在非 HIV PCP 的发生中进一步研究。
