Management of Pneumonia in Kidney Transplantation to Prevent Further Outbreak
The outbreak of Pneumocystis jirovecii pneumonia (PJP) among kidney transplant recipients is emerging worldwide. It is important to control nosocomial PJP infection. A delay in diagnosis and treatment increases the number of reservoir patients and the number of cases of respiratory failure and death...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
SAGE Publishing
2015-01-01
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| Series: | Clinical Medicine Insights: Circulatory, Respiratory and Pulmonary Medicine |
| Online Access: | https://doi.org/10.4137/CCRPM.S23317 |
| _version_ | 1830227752684355584 |
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| author | Norihiko Goto Kenta Futamura Manabu Okada Takayuki Yamamoto Makoto Tsujita Takahisa Hiramitsu Shunji Narumi Yoshihiko Watarai |
| author_facet | Norihiko Goto Kenta Futamura Manabu Okada Takayuki Yamamoto Makoto Tsujita Takahisa Hiramitsu Shunji Narumi Yoshihiko Watarai |
| author_sort | Norihiko Goto |
| collection | DOAJ |
| description | The outbreak of Pneumocystis jirovecii pneumonia (PJP) among kidney transplant recipients is emerging worldwide. It is important to control nosocomial PJP infection. A delay in diagnosis and treatment increases the number of reservoir patients and the number of cases of respiratory failure and death. Owing to the large number of kidney transplant recipients compared to other types of organ transplantation, there are greater opportunities for them to share the same time and space. Although the use of trimethoprim-sulfamethoxazole (TMP-SMX) as first choice in PJP prophylaxis is valuable for PJP that develops from infections by trophic forms, it cannot prevent or clear colonization, in which cysts are dominant. Colonization of P. jirovecii is cleared by macrophages. While recent immunosuppressive therapies have decreased the rate of rejection, over-suppressed macrophages caused by the higher levels of immunosuppression may decrease the eradication rate of colonization. Once a PJP cluster enters these populations, which are gathered in one place and uniformly undergoing immunosuppressive therapy for kidney transplantation, an outbreak can occur easily. Quick actions for PJP patients, other recipients, and medical staff of transplant centers are required. In future, lifelong prophylaxis may be required even in kidney transplant recipients. |
| first_indexed | 2024-12-18T09:59:58Z |
| format | Article |
| id | doaj.art-346499bee71b4d18acf0e643f661a32c |
| institution | Directory Open Access Journal |
| issn | 1179-5484 |
| language | English |
| last_indexed | 2024-12-18T09:59:58Z |
| publishDate | 2015-01-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | Clinical Medicine Insights: Circulatory, Respiratory and Pulmonary Medicine |
| spelling | doaj.art-346499bee71b4d18acf0e643f661a32c2022-12-21T21:11:41ZengSAGE PublishingClinical Medicine Insights: Circulatory, Respiratory and Pulmonary Medicine1179-54842015-01-019s110.4137/CCRPM.S23317Management of Pneumonia in Kidney Transplantation to Prevent Further OutbreakNorihiko Goto0Kenta Futamura1Manabu Okada2Takayuki Yamamoto3Makoto Tsujita4Takahisa Hiramitsu5Shunji Narumi6Yoshihiko Watarai7Department of Transplant Surgery, Nagoya Daini Red Cross Hospital, Nagoya, Japan.Department of Transplant Surgery, Nagoya Daini Red Cross Hospital, Nagoya, Japan.Department of Transplant Surgery, Nagoya Daini Red Cross Hospital, Nagoya, Japan.Department of Transplant Surgery, Nagoya Daini Red Cross Hospital, Nagoya, Japan.Department of Transplant Surgery, Nagoya Daini Red Cross Hospital, Nagoya, Japan.Department of Transplant Surgery, Nagoya Daini Red Cross Hospital, Nagoya, Japan.Department of Transplant Surgery, Nagoya Daini Red Cross Hospital, Nagoya, Japan.Department of Transplant Surgery, Nagoya Daini Red Cross Hospital, Nagoya, Japan.The outbreak of Pneumocystis jirovecii pneumonia (PJP) among kidney transplant recipients is emerging worldwide. It is important to control nosocomial PJP infection. A delay in diagnosis and treatment increases the number of reservoir patients and the number of cases of respiratory failure and death. Owing to the large number of kidney transplant recipients compared to other types of organ transplantation, there are greater opportunities for them to share the same time and space. Although the use of trimethoprim-sulfamethoxazole (TMP-SMX) as first choice in PJP prophylaxis is valuable for PJP that develops from infections by trophic forms, it cannot prevent or clear colonization, in which cysts are dominant. Colonization of P. jirovecii is cleared by macrophages. While recent immunosuppressive therapies have decreased the rate of rejection, over-suppressed macrophages caused by the higher levels of immunosuppression may decrease the eradication rate of colonization. Once a PJP cluster enters these populations, which are gathered in one place and uniformly undergoing immunosuppressive therapy for kidney transplantation, an outbreak can occur easily. Quick actions for PJP patients, other recipients, and medical staff of transplant centers are required. In future, lifelong prophylaxis may be required even in kidney transplant recipients.https://doi.org/10.4137/CCRPM.S23317 |
| spellingShingle | Norihiko Goto Kenta Futamura Manabu Okada Takayuki Yamamoto Makoto Tsujita Takahisa Hiramitsu Shunji Narumi Yoshihiko Watarai Management of Pneumonia in Kidney Transplantation to Prevent Further Outbreak Clinical Medicine Insights: Circulatory, Respiratory and Pulmonary Medicine |
| title | Management of Pneumonia in Kidney Transplantation to Prevent Further Outbreak |
| title_full | Management of Pneumonia in Kidney Transplantation to Prevent Further Outbreak |
| title_fullStr | Management of Pneumonia in Kidney Transplantation to Prevent Further Outbreak |
| title_full_unstemmed | Management of Pneumonia in Kidney Transplantation to Prevent Further Outbreak |
| title_short | Management of Pneumonia in Kidney Transplantation to Prevent Further Outbreak |
| title_sort | management of pneumonia in kidney transplantation to prevent further outbreak |
| url | https://doi.org/10.4137/CCRPM.S23317 |
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