288 lines
27 KiB
XML
288 lines
27 KiB
XML
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<mods:title id="D42021C0BD78E4980685144605F9F042">Prevalence and genotyping of Pneumocystis jirovecii in renal transplant recipients-preliminary report</mods:title>
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<mods:namePart id="A0EB25449B87303C225BFB3DF63CF5F8">Lobo, Maria Luísa</mods:namePart>
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<treatment id="0396CB72157A4843FF0EFF618BAD5BE9" ID-DOI="http://doi.org/10.5281/zenodo.11536579" ID-GBIF-Taxon="232548763" ID-Zenodo-Dep="11536579" LSID="urn:lsid:plazi:treatment:0396CB72157A4843FF0EFF618BAD5BE9" httpUri="http://treatment.plazi.org/id/0396CB72157A4843FF0EFF618BAD5BE9" lastPageNumber="184" pageId="3" pageNumber="184">
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<taxonomicName id="4C3F01E7157A4843FF0EFF6189075EF7" ID-CoL="4KKVL" authority="Frenkel" authorityName="Frenkel" box="[136,258,223,249]" class="Pneumocystomycetes" family="Pneumocystaceae" genus="Pneumocystis" kingdom="Fungi" order="Pneumocystales" pageId="3" pageNumber="184" phylum="Ascomycota" rank="species" species="jirovecii">
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<emphasis id="B94BA676157A4843FF0EFF6189075EF7" bold="true" box="[136,258,223,249]" italics="true" pageId="3" pageNumber="184">P. jirovecii</emphasis>
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prevalence and patients
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</emphasis>
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’
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<emphasis id="B94BA676157A4843FDB1FF618ADA5EF4" bold="true" box="[567,735,223,250]" pageId="3" pageNumber="184">characteristics</emphasis>
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</heading>
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</paragraph>
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<paragraph id="8B807A64157A4843FF0EFE9A8A085DDD" blockId="3.[136,772,292,1909]" pageId="3" pageNumber="184">
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Among all renal transplant recipients tested (
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<emphasis id="B94BA676157A4843FDD2FE9A8A645F35" box="[596,609,292,315]" italics="true" pageId="3" pageNumber="184">n</emphasis>
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= 72, including
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,
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<specimenCount id="9D39B1ED157A4843FF71FEFB896B5F52" box="[247,366,325,348]" count="36" pageId="3" pageNumber="184" type="female">36 females</specimenCount>
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), the mean age was 52.5 ± 13.9 years, range 21–76 years. The mean time after kidney transplantation was 78.7 months, ranging from 5 days to 19 years. Nine patients had undergone the second kidney transplantation, and two had undergone the third transplantation. One patient had undergone both kidney and heart transplantation. Immunosuppressive treatment included prednisone, calcineurin inhibitors (tacrolimus or cyclosporine), proliferation signal inhibitors (sirolimus or everolimus), mycophenolate mofetil, or azathioprine. Forty-four (61.1%) patients were receiving treatment combining three of the above drugs, 25 (34.7%) were receiving a dual combination, and 3 (4.2%) were treated with
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of immunosuppressant only (patients who required dialysis after kidney transplant failure). The routine anti-
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<taxonomicName id="4C3F01E7157A4843FEB4FCA889C55D23" box="[306,448,790,813]" class="Pneumocystomycetes" family="Pneumocystaceae" genus="Pneumocystis" kingdom="Fungi" order="Pneumocystales" pageId="3" pageNumber="184" phylum="Ascomycota" rank="genus">
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<emphasis id="B94BA676157A4843FEB4FCA889C55D23" box="[306,448,790,813]" italics="true" pageId="3" pageNumber="184">Pneumocystis</emphasis>
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prophylaxis regimen contained co-trimoxazole at a dose of
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a day for 6 months after transplantation. Among all patients examined, 13 were receiving co-trimoxazole prophylaxis during sputum collection, and one patient was receiving only trimethoprim due to a previous allergic reaction to sulfamethoxazole.
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</paragraph>
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<paragraph id="8B807A64157A4843FF20FC6389CD5806" blockId="3.[136,772,292,1909]" pageId="3" pageNumber="184">
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Nested
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<collectionCode id="ED2EE2A1157A4843FE84FC6389325DFA" box="[258,311,989,1012]" pageId="3" pageNumber="184">PCR</collectionCode>
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amplifying the
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<emphasis id="B94BA676157A4843FE78FC638A495DFB" box="[510,588,989,1013]" italics="true" pageId="3" pageNumber="184">mtLSU</emphasis>
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rRNA gene of
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<taxonomicName id="4C3F01E7157A4843FF0EFC4188FD5A18" box="[136,248,1023,1046]" class="Pneumocystomycetes" family="Pneumocystaceae" genus="Pneumocystis" kingdom="Fungi" order="Pneumocystales" pageId="3" pageNumber="184" phylum="Ascomycota" rank="species" species="jirovecii">
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<emphasis id="B94BA676157A4843FF0EFC4188FD5A18" box="[136,248,1023,1046]" italics="true" pageId="3" pageNumber="184">P. jirovecii</emphasis>
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</taxonomicName>
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was positive in eight of the 72 (11.11%) patients’ samples. Three of these eight patients showed symptoms compatible of pneumonia (including low-grade fever, dyspnea, and radiological presentation). In samples from only three patients (37.5%),
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<emphasis id="B94BA676157A4843FEC3FB3A89B35A95" box="[325,438,1156,1179]" italics="true" pageId="3" pageNumber="184">P. jirovecii</emphasis>
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presence was confirmed by IF staining, and only in one of these cases the number of cysts observed on the whole microscope slide was above five. That was the only case with both a positive result of IF staining and the presence of respiratory symptoms typical for PcP. Anti-
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<taxonomicName id="4C3F01E7157A4843FF0EFA9489135B4F" box="[136,278,1322,1345]" class="Pneumocystomycetes" family="Pneumocystaceae" genus="Pneumocystis" kingdom="Fungi" order="Pneumocystales" pageId="3" pageNumber="184" phylum="Ascomycota" rank="genus">
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<emphasis id="B94BA676157A4843FF0EFA9489135B4F" box="[136,278,1322,1345]" italics="true" pageId="3" pageNumber="184">Pneumocystis</emphasis>
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</taxonomicName>
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therapy was introduced in this patient, in view of PcP suspicion. Due to the patient’ s allergy to sulfamethoxazole, it consisted of intravenous clindamycin (
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every 8 h on the first day and
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every 6 h afterwards) and primaquine for 29 days. The treatment was completed after the negative result of control
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analysis and pentamidine was introduced for prevention.
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</paragraph>
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<paragraph id="8B807A64157A4843FF20F9AC897B597B" blockId="3.[136,772,292,1909]" pageId="3" pageNumber="184">
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The most important characteristics of
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<taxonomicName id="4C3F01E7157A4843FDBFF9AC8AAC5827" box="[569,681,1554,1577]" class="Pneumocystomycetes" family="Pneumocystaceae" genus="Pneumocystis" kingdom="Fungi" order="Pneumocystales" pageId="3" pageNumber="184" phylum="Ascomycota" rank="species" species="jirovecii">
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<emphasis id="B94BA676157A4843FDBFF9AC8AAC5827" box="[569,681,1554,1577]" italics="true" pageId="3" pageNumber="184">P. jirovecii</emphasis>
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</taxonomicName>
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-positive and
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<taxonomicName id="4C3F01E7157A4843FF30F98D89205844" box="[182,293,1587,1610]" class="Pneumocystomycetes" family="Pneumocystaceae" genus="Pneumocystis" kingdom="Fungi" order="Pneumocystales" pageId="3" pageNumber="184" phylum="Ascomycota" rank="species" species="jirovecii">
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<emphasis id="B94BA676157A4843FF30F98D89205844" box="[182,293,1587,1610]" italics="true" pageId="3" pageNumber="184">P. jirovecii</emphasis>
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</taxonomicName>
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-negative patients are listed in
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<tableCitation id="C6BD4FDF157A4843FDE1F98D8AD35844" box="[615,726,1587,1610]" captionStart="Table 1" captionStartId="4.[136,184,155,175]" captionTargetPageId="4" captionText="Table 1 Comparison of" httpUri="http://table.plazi.org/id/DF402AEC157D4844FF0EFF2589065F14" pageId="3" pageNumber="184" tableUuid="DF402AEC157D4844FF0EFF2589065F14">Table 1. A</tableCitation>
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statistically significant correlation with colonization was observed for the employment of a dual immunosuppressive regimen consisting of calcineurin inhibitors and prednisone (
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<emphasis id="B94BA676157A4843FF17F90688A458C1" box="[145,161,1720,1743]" italics="true" pageId="3" pageNumber="184">P</emphasis>
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= 0.041, Fisher’ s exact test). Moreover, the mean eosinophil level was lower in
|
||
<emphasis id="B94BA676157A4843FE41F9678A4258FE" box="[455,583,1753,1776]" italics="true" pageId="3" pageNumber="184">P. jirovecii-</emphasis>
|
||
positive patients, as compared to negative ones (
|
||
<emphasis id="B94BA676157A4843FD80F9458A13591C" box="[518,534,1787,1810]" italics="true" pageId="3" pageNumber="184">P</emphasis>
|
||
= 0.040, Student’ s
|
||
<emphasis id="B94BA676157A4843FD7AF9458B06591C" box="[764,771,1787,1810]" italics="true" pageId="3" pageNumber="184">t</emphasis>
|
||
test). There were no significant differences in results of basic laboratory tests for other parameters,
|
||
<collectionCode id="ED2EE2A1157A4843FDE7F8838A98595A" box="[609,669,1853,1876]" country="Belgium" httpUri="http://biocol.org/urn:lsid:biocol.org:col:12773" lsid="urn:lsid:biocol.org:col:12773" name="Centre Marie-Victorin" pageId="3" pageNumber="184" type="Herbarium">CMV</collectionCode>
|
||
infection, or other co-morbidities.
|
||
</paragraph>
|
||
<paragraph id="8B807A64157A4843FCB6FF228C045EB9" blockId="3.[816,1025,156,183]" box="[816,1025,156,183]" pageId="3" pageNumber="184">
|
||
<heading id="D0C8CD08157A4843FCB6FF228C045EB9" bold="true" box="[816,1025,156,183]" fontSize="11" level="1" pageId="3" pageNumber="184" reason="1">
|
||
<emphasis id="B94BA676157A4843FCB6FF228C045EB9" bold="true" box="[816,1025,156,183]" pageId="3" pageNumber="184">Multilocus typing</emphasis>
|
||
</heading>
|
||
</paragraph>
|
||
<paragraph id="8B807A64157A4843FCB6FF5C8CA65C0C" blockId="3.[816,1452,225,1511]" pageId="3" pageNumber="184">
|
||
Only
|
||
<emphasis id="B94BA676157A4843FCEDFF5F8BB65EF7" box="[875,947,225,249]" italics="true" pageId="3" pageNumber="184">mtLSU</emphasis>
|
||
rRNA was fully genotyped in all analyzed specimens. The ratios of efficient amplification of the other genetic fragments were 50% for
|
||
<emphasis id="B94BA676157A4843FBB1FE9D8C6F5F35" box="[1079,1130,291,315]" italics="true" pageId="3" pageNumber="184">
|
||
<collectionCode id="ED2EE2A1157A4843FBB1FE9D8C6F5F35" box="[1079,1130,291,315]" pageId="3" pageNumber="184">SOD</collectionCode>
|
||
</emphasis>
|
||
, 62.5% for
|
||
<emphasis id="B94BA676157A4843FB6FFE9D8D295F35" box="[1257,1324,291,315]" italics="true" pageId="3" pageNumber="184">
|
||
<collectionCode id="ED2EE2A1157A4843FB6FFE9D8D295F35" box="[1257,1324,291,315]" pageId="3" pageNumber="184">DHPS</collectionCode>
|
||
</emphasis>
|
||
, and 87.5% for
|
||
<emphasis id="B94BA676157A4843FCD5FEFB8B865F52" box="[851,899,325,348]" italics="true" pageId="3" pageNumber="184">
|
||
<collectionCode id="ED2EE2A1157A4843FCD5FEFB8B865F52" box="[851,899,325,348]" pageId="3" pageNumber="184">CYB</collectionCode>
|
||
</emphasis>
|
||
(
|
||
<tableCitation id="C6BD4FDF157A4843FC09FEFB8BD95F52" box="[911,988,325,348]" captionStart="Table 2" captionStartId="5.[136,184,155,175]" captionTargetPageId="5" captionText="Table 2 Polymorphisms identified at the four studied loci" httpUri="http://table.plazi.org/id/DF402AEC157C4845FF0EFF258A965EA1" pageId="3" pageNumber="184" tableUuid="DF402AEC157C4845FF0EFF258A965EA1">Table 2</tableCitation>
|
||
). Since multilocus genotype is a combination of at least two loci, such complex analysis was not possible due to incomplete data required. Therefore, single genetic fragments were analyzed individually in order to verify the presence of any statistically significant correlations between
|
||
<collectionCode id="ED2EE2A1157A4843FCB6FE558B655C0C" box="[816,864,491,514]" country="Malaysia" httpUri="http://biocol.org/urn:lsid:biocol.org:col:15856" lsid="urn:lsid:biocol.org:col:15856" name="Sabah Parks" pageId="3" pageNumber="184" type="Herbarium">SNP</collectionCode>
|
||
distribution and patients’ data.
|
||
</paragraph>
|
||
<paragraph id="8B807A64157A4843FCC9FDB38CCC5D9F" blockId="3.[816,1452,225,1511]" pageId="3" pageNumber="184">
|
||
Three of the five previously described
|
||
<emphasis id="B94BA676157A4843FB5AFDB28D205C2A" box="[1244,1317,524,548]" italics="true" pageId="3" pageNumber="184">mtLSU</emphasis>
|
||
rRNA genotypes were identified: genotype 1 (wild
|
||
<typeStatus id="5484C4C6157A4843FB66FD908D0B5C4B" box="[1248,1294,558,581]" pageId="3" pageNumber="184">type</typeStatus>
|
||
) was found in four patients’ samples (50%), while genotypes 2 and 3 were detected in one (12.5%) and three (37.5%) other patients, respectively. The most common
|
||
<emphasis id="B94BA676157A4843FBFDFD2F8CAE5CA6" box="[1147,1195,657,680]" italics="true" pageId="3" pageNumber="184">
|
||
<collectionCode id="ED2EE2A1157A4843FBFDFD2F8CAE5CA6" box="[1147,1195,657,680]" pageId="3" pageNumber="184">CYB</collectionCode>
|
||
</emphasis>
|
||
genotypes were
|
||
<emphasis id="B94BA676157A4843FAE2FD2F8D915CA6" box="[1380,1428,657,680]" italics="true" pageId="3" pageNumber="184">
|
||
<collectionCode id="ED2EE2A1157A4843FAE2FD2F8D915CA6" box="[1380,1428,657,680]" pageId="3" pageNumber="184">CYB</collectionCode>
|
||
</emphasis>
|
||
1 and 2, both occurring in two (28.6%) cases. The remaining identified genotypes were
|
||
<emphasis id="B94BA676157A4843FBC0FD6A8C735CE5" box="[1094,1142,724,747]" italics="true" pageId="3" pageNumber="184">
|
||
<collectionCode id="ED2EE2A1157A4843FBC0FD6A8C735CE5" box="[1094,1142,724,747]" pageId="3" pageNumber="184">CYB</collectionCode>
|
||
</emphasis>
|
||
5, 7, and 8, occurring in one case each (14.3%).
|
||
<emphasis id="B94BA676157A4843FB83FD4A8C3D5D02" box="[1029,1080,756,780]" italics="true" pageId="3" pageNumber="184">
|
||
<collectionCode id="ED2EE2A1157A4843FB83FD4A8C3D5D02" box="[1029,1080,756,780]" pageId="3" pageNumber="184">SOD</collectionCode>
|
||
</emphasis>
|
||
polymorphisms were identified in four samples only, half of which referred to wild-type genotype (
|
||
<emphasis id="B94BA676157A4843FCE9FC898BA75D41" box="[879,930,823,847]" italics="true" pageId="3" pageNumber="184">
|
||
<collectionCode id="ED2EE2A1157A4843FCE9FC898BA75D41" box="[879,930,823,847]" pageId="3" pageNumber="184">SOD</collectionCode>
|
||
</emphasis>
|
||
1), and the other half to
|
||
<emphasis id="B94BA676157A4843FB31FC898CEF5D41" box="[1207,1258,823,847]" italics="true" pageId="3" pageNumber="184">
|
||
<collectionCode id="ED2EE2A1157A4843FB31FC898CEF5D41" box="[1207,1258,823,847]" pageId="3" pageNumber="184">SOD</collectionCode>
|
||
</emphasis>
|
||
2. Finally,
|
||
<emphasis id="B94BA676157A4843FAEFFC898DA95D41" box="[1385,1452,823,847]" italics="true" pageId="3" pageNumber="184">
|
||
<collectionCode id="ED2EE2A1157A4843FAEFFC898DA95D41" box="[1385,1452,823,847]" pageId="3" pageNumber="184">DHPS</collectionCode>
|
||
</emphasis>
|
||
typing revealed the presence of genotype 1 (wild-type only) in all five successfully amplified samples.
|
||
</paragraph>
|
||
<paragraph id="8B807A64157A4843FCC9FC258D8E5AD3" blockId="3.[816,1452,225,1511]" pageId="3" pageNumber="184">
|
||
There were no significant differences in
|
||
<collectionCode id="ED2EE2A1157A4843FB7AFC258D295DBC" box="[1276,1324,923,946]" country="Malaysia" httpUri="http://biocol.org/urn:lsid:biocol.org:col:15856" lsid="urn:lsid:biocol.org:col:15856" name="Sabah Parks" pageId="3" pageNumber="184" type="Herbarium">SNP</collectionCode>
|
||
distribution and gender, immunosuppressive regimen, or PcP symptoms. However, it was observed that detection of
|
||
<emphasis id="B94BA676157A4843FB78FC638D2B5DFA" box="[1278,1326,989,1012]" italics="true" pageId="3" pageNumber="184">
|
||
<collectionCode id="ED2EE2A1157A4843FB78FC638D2B5DFA" box="[1278,1326,989,1012]" pageId="3" pageNumber="184">CYB</collectionCode>
|
||
</emphasis>
|
||
2 genotype was significantly correlated with the ongoing prophylaxis regimen (
|
||
<emphasis id="B94BA676157A4843FCF0FB9E8B985A39" box="[886,925,1056,1079]" italics="true" pageId="3" pageNumber="184">P =</emphasis>
|
||
0.047, Fisher’ s exact test). Moreover, both mean age (
|
||
<emphasis id="B94BA676157A4843FCE3FBFF8B895A56" box="[869,908,1089,1112]" italics="true" pageId="3" pageNumber="184">P =</emphasis>
|
||
0.033, Student’ s
|
||
<emphasis id="B94BA676157A4843FBC3FBFF8C495A56" box="[1093,1100,1089,1112]" italics="true" pageId="3" pageNumber="184">t</emphasis>
|
||
test) and time after kidney transplantation (
|
||
<emphasis id="B94BA676157A4843FC20FBDC8BC85A77" box="[934,973,1122,1145]" italics="true" pageId="3" pageNumber="184">P =</emphasis>
|
||
0.028, Student’ s
|
||
<emphasis id="B94BA676157A4843FBF9FBDC8C835A77" box="[1151,1158,1122,1145]" italics="true" pageId="3" pageNumber="184">t</emphasis>
|
||
test) were significantly lower in patients with detected wild-type
|
||
<emphasis id="B94BA676157A4843FB31FB3D8D055A95" box="[1207,1280,1155,1179]" italics="true" pageId="3" pageNumber="184">mtLSU</emphasis>
|
||
rRNA genotype (44.5 years, 58.1 months, respectively) than in those with mutant genotypes (65.8 years, 78.3 months, respectively).
|
||
</paragraph>
|
||
<paragraph id="8B807A64157A4843FCC9FB588BAD5BE9" blockId="3.[816,1452,225,1511]" pageId="3" pageNumber="184">
|
||
<emphasis id="B94BA676157A4843FCC9FB588B975AF0" box="[847,914,1254,1278]" italics="true" pageId="3" pageNumber="184">
|
||
<collectionCode id="ED2EE2A1157A4843FCC9FB588B975AF0" box="[847,914,1254,1278]" pageId="3" pageNumber="184">DHPS</collectionCode>
|
||
</emphasis>
|
||
typing in patients with various pulmonary diseases was possible in 53% of available samples. Similarly, only genotype 1 was detected. Comparison of RTRs and patients with various pulmonary diseases (whose data on demographic, prevalence, and genotype distribution were described previously;
|
||
<bibRefCitation id="EFAE0795157A4843FB95FA338CE15BAA" author="Sokulska M & Kicia M & Wesolowska M & Piesiak P & Kowal A & Lobo ML & Kopacz Z & Hendrich AB & Matos O" box="[1043,1252,1421,1444]" pageId="3" pageNumber="184" pagination="809 - 815" refId="ref8777" refString="Sokulska M, Kicia M, Wesolowska M, Piesiak P, Kowal A, Lobo ML, Kopacz Z, Hendrich AB, Matos O (2017) Genotyping of pneumocystis jirovecii in colonized patients with various pulmonary diseases. Med Mycol 56: 809 - 815. https: // doi. org / 10.1093 / mmy / myx 121" type="journal article" year="2017">Sokulska et al. 2017</bibRefCitation>
|
||
) did not reveal any significant differences in
|
||
<collectionCode id="ED2EE2A1157A4843FBC9FA108C855BCB" box="[1103,1152,1454,1477]" country="Malaysia" httpUri="http://biocol.org/urn:lsid:biocol.org:col:15856" lsid="urn:lsid:biocol.org:col:15856" name="Sabah Parks" pageId="3" pageNumber="184" type="Herbarium">SNP</collectionCode>
|
||
distribution or
|
||
<taxonomicName id="4C3F01E7157A4843FAB2FA108DAE5BCB" box="[1332,1451,1454,1477]" class="Pneumocystomycetes" family="Pneumocystaceae" genus="Pneumocystis" kingdom="Fungi" order="Pneumocystales" pageId="3" pageNumber="184" phylum="Ascomycota" rank="species" species="jirovecii">
|
||
<emphasis id="B94BA676157A4843FAB2FA108DAE5BCB" box="[1332,1451,1454,1477]" italics="true" pageId="3" pageNumber="184">P. jirovecii</emphasis>
|
||
</taxonomicName>
|
||
prevalence.
|
||
</paragraph>
|
||
</subSubSection>
|
||
</treatment>
|
||
</document> |