Grupo investigador de Problemas en Enfermedades Infecciosas (GRIPE), Universidad de Antioquia, Medellín, Colombia.
Facultad Nacional de Salud Pública, Universidad de Antioquia, Medellín, Colombia.
Eur J Pediatr. 2017 Dec;176(12):1619-1627. doi: 10.1007/s00431-017-3011-z. Epub 2017 Sep 14.
The aim of the study was to explore the frequency and dynamics of acquisition and colonization of Pneumocystis jirovecii among neonates, as well as the epidemiological and genotypic characteristics in mother-child binomial. In a prospective enrolled cohort of women in their third trimester of pregnancy, nasopharyngeal swabs (NPS) and clinical and epidemiological data were collected at four different times: 17 days, 2nd, 4th, and 6th month of life of the newborn. P. jirovecii was detected by nested-PCR for the mtLSU-rRNA gene in each NPS; the genotypes were determined amplifying four genes. Forty-three pairs and 301 NPS were included. During the third trimester, 16.3% of pregnant women were colonized. The rate of colonization in mothers at delivery was 16, 6, 16, and 5% and in their children 28, 43, 42, and 25%, respectively. Within pregnant women, 53% remained negative throughout follow-up, and among these, 91% of their children were positive in at least one of their samples. In both, mothers and children, the most frequent genotype of P. jirovecii was 1.
The frequency of colonization by P. jirovecii was higher in newborns than in their respective progenitors. Colonization of both mothers and children is transitory; however, the mother of the newborn is not necessarily the source of primary infection. What is Known: • We did not find studies comparing P. jirovecii colonization between mothers and children simultaneously, yet the frequency of colonization by serologic and molecular methods in pregnant women has been reported. What is New: • According to our findings, 3/4 of the children had transient colonization during the first 6 months of life, in only half in the mothers, without proof of mother-to-child transmission or vice versa.
本研究旨在探索新生儿中肺孢子菌(Pneumocystis jirovecii)的感染和定植频率及动态,以及母婴二联体中的流行病学和基因型特征。在一项前瞻性纳入的孕妇队列研究中,在妊娠晚期的孕妇中采集鼻咽拭子(NPS)和临床及流行病学数据,在新生儿出生后的第 17 天、第 2、4 和 6 个月进行 4 次采样。通过巢式 PCR 检测每个 NPS 中的 mtLSU-rRNA 基因来检测 P. jirovecii;扩增 4 个基因来确定基因型。共纳入 43 对母婴和 301 个 NPS。在妊娠晚期,16.3%的孕妇定植了 P. jirovecii。分娩时母亲的定植率分别为 16%、6%、16%和 5%,其子女的定植率分别为 28%、43%、42%和 25%。在孕妇中,53%的人在整个随访过程中持续为阴性,其中 91%的子女在至少一个样本中呈阳性。在母亲和儿童中,最常见的 P. jirovecii 基因型均为 1 型。
与母亲相比,新生儿的 P. jirovecii 定植率更高。母亲和儿童的定植均为一过性,但新生儿的母亲不一定是原发性感染的来源。
我们没有找到同时比较母亲和儿童之间 P. jirovecii 定植情况的研究,但已有关于孕妇血清学和分子方法检测 P. jirovecii 定植频率的报道。
根据我们的发现,4/5 的儿童在出生后的前 6 个月有短暂的定植,而母亲中只有一半有短暂的定植,没有证据表明存在母婴传播或反之亦然。