Meyer, Andreas Mårten Johannes (2019). Frequent occurrence of late-onset pneumocystis pneumonia in renal transplant recipients with recurrence in the absence of secondary prophylaxis. (Thesis). Universität Bern, Bern
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Abstract
Background: Pneumocystis jirovecii pneumonia (PCP) is a potentially life-threatening infection in renal transplant recipients (RTRS), usually occurring early after transplantation. A high proportion Of late-onset PCP was observed at our centre. The aim of this study was to evaluate risk factors for late PCP after kidney transplantation. Materials/methods: Thirty-six PCP cases were identified in our cohort between 01/2009-12/2014. We analysed clinical, laboratory and radiological data from all confirmed PCP cases. Molecular genotyping of PCP was performed in a subset of patients. Results: Among 36 cases (26/36, 72% males) of PCP 30 showed late/onset presentation (30/36, 84% >6 months, 25/36, 69% <12 months after transplantation), with a median indwelling time of 27 months (range 3—205 months). Clinical symptoms were rather unspecific (cough/dyspnoea ~70%, SpO2 <90% ~60%, and fever ~30%), but radiological findings (>r85%) and biochemical pattern at PCP diagnosis were rather specific: a significantly lower total lymphocyte count and lower serum sodium together with higher lactate dehydrogenase (LDH) and serum calcium levels than before diagnosis. None of the patients were on PCP prophylaxis at diagnosis. No specific risk factors (e.g. increased daily prednisone dose) for PCP reactivation were found in two-thirds (23/36, 64%) of the late-onset cases. The outpatient consultations map showed several possible encounters between PCP and RTR patients, including 26 cases (72%) with at least one contact before diagnosis, suggestive of interhuman transmission, and the same genotype in a subset of cases tested. Secondary prophylaxis was established in 32/36 patients for a median duration of 15.7 months. Conclusion: In conclusion, we confirm that under the current immunosuppression regiments PCP manifests late after transplantation with distinct laboratory and radiological patterns. Interhuman transmission seems to be the major driver in patients without prophylaxis. Interventions covering the entire population at risk are therefore needed.
| Item Type: | Thesis |
|---|---|
| Dissertation Type: | Single |
| Date of Defense: | 11 September 2019 |
| Subjects: | 600 Technology > 610 Medicine & health |
| Institute / Center: | 04 Faculty of Medicine > Department of Dermatology, Urology, Rheumatology, Nephrology, Osteoporosis (DURN) > Clinic of Nephrology and Hypertension |
| Depositing User: | Hammer Igor |
| Date Deposited: | 30 Oct 2020 10:23 |
| Last Modified: | 25 Nov 2020 20:46 |
| URI: | https://boristheses.unibe.ch/id/eprint/2285 |
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