Robin Christine, Alanio Alexandre, Gits-Muselli Maud, la Martire Giulia, Schlemmer Frédéric, Botterel Françoise, Angebault Cécile, Leclerc Mathieu, Beckerich Florence, Redjoul Rabah, Pautas Cécile, Toma Andrea, Maury Sébastien, Bretagne Stéphane, Cordonnier Catherine
Department of Hematology, Assistance Publique-Hôpitaux de Paris, Henri Mondor Teaching HospitalCréteil, France.
Paris-Est Créteil UniversityCréteil, France.
Front Microbiol. 2017 Apr 24;8:700. doi: 10.3389/fmicb.2017.00700. eCollection 2017.
pneumonia (PCP) is a life-threatening infection in hematology. Although occasionally reported, the role of interhuman transmission of in PCP, compared to that of reactivation, remains an unresolved question; the recommendation to isolate PCP patients in the hematology ward are not well evidence-based. Following an unexpected increase in the number of febrile pneumonia patients with DNA detected in respiratory samples in our hematology ward, we explored 12 consecutive patients from November 2015 to May 2016. Genotyping of was performed using microsatellite markers. The frequency of simultaneous occupancy of these 12 patients in the same unit on the same day from 4 months prior to the first diagnosis was recorded. In three patients, the genotype could not be determined because DNA was insufficient. One rare single genotype (Gt2) was found in four of the other nine, all allogeneic stem cell transplant recipients. The transmission map showed that these 4 patients had multiple opportunities to meet on the same day (median, 6.5; range, 4-10) at the daycare center. It was much less among the eight non-Gt2 patients (median, 1; range, 0-9; = 0.048). This study, based on modern molecular technics, strongly suggests that interhuman transmission of between allogeneic stem cell transplant recipients is possible. DNA detected in respiratory specimens supports that isolation and respiratory precautions be recommended in such cases in the hematology ward.
肺孢子菌肺炎（PCP）是血液学中一种危及生命的感染。尽管偶尔有报道，但与再激活相比，PCP人际传播的作用仍是一个未解决的问题；在血液科病房隔离PCP患者的建议缺乏充分的循证依据。在我们血液科病房呼吸道样本中检测到肺孢子菌DNA的发热肺炎患者数量意外增加后，我们对2015年11月至2016年5月期间的12例连续患者进行了研究。使用微卫星标记对肺孢子菌进行基因分型。记录了这12例患者在首次诊断前4个月内同一天在同一病房的同时入住频率。3例患者因DNA不足无法确定肺孢子菌基因型。在其他9例患者中的4例中发现了一种罕见的单一基因型（Gt2），这些患者均为异基因干细胞移植受者。传播图谱显示，这4例患者在日间护理中心有多次同一天见面的机会（中位数为6.5；范围为4 - 10）。在8例非Gt2患者中这种情况要少得多（中位数为1；范围为0 - 9；P = 0.048）。这项基于现代分子技术的研究强烈表明，异基因干细胞移植受者之间肺孢子菌的人际传播是可能的。呼吸道标本中检测到的肺孢子菌DNA支持在血液科病房此类病例中建议进行隔离和采取呼吸道防护措施。
