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Mahmoud DE, Herivaux A, Morio F, Briard B, Vigneau C, Desoubeaux G, Bouchara JP, Gangneux JP, Nevez G, Gal SLE, Papon N. The epidemiology of fungal infections in transplant patients. Biomed J 2024:100719. [PMID: 38580051 DOI: 10.1016/j.bj.2024.100719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 03/21/2024] [Accepted: 03/24/2024] [Indexed: 04/07/2024] Open
Abstract
Transplant patients, including solid-organ transplant (SOT) and hematopoietic stem cell transplant (HSCT) recipients, are exposed to various types of complications, particularly rejection. To prevent these outcomes, transplant recipients commonly receive long-term immunosuppressive regimens that in turn make them more susceptible to a wide array of infectious diseases, notably those caused by opportunistic pathogens. Among these, invasive fungal infections (IFIs) remain a major cause of mortality and morbidity in both SOT and HSCT recipients. Despite the continuing improvement in early diagnostics and treatments of IFIs, the management of these infections in transplant patients is still complicated. Here, we provide an overview concerning the most recent trends in the epidemiology of IFIs in SOT and HSCT recipients by describing the prominent yeasts and molds species involved, the timing of post-transplant IFIs and the risk factors associated with their occurrence in these particularly weak populations. We also give special emphasis into basic research advances in the field that recently suggested a role of the global and long-term prophylactic regimen in orchestrating various biological disturbances in the organism and conditioning the emergence of the most adapted fungal strains to the particular physiological profiles of transplant patients.
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Affiliation(s)
| | - Anaïs Herivaux
- Univ Angers, Univ Brest, IRF, SFR, ICAT, 49000, Angers, France
| | - Florent Morio
- Nantes Université, CHU Nantes, Cibles et Médicaments des Infections et de L'Immunité, UR1155, Nantes, France
| | - Benoit Briard
- INSERM, Centre D'Etude des Pathologies Respiratoires (CEPR), UMR 1100, Université de Tours, Faculté de Médecine de Tours, Tours, France; CHRU Tours, Parasitologie-Mycologie Médicale-Médecine Tropicale, 37044, Tours, France
| | - Cécile Vigneau
- Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail), UMR_S 1085, F-35000, Rennes, France; Division of Nephrology, Rennes University Hospital, Rennes, France
| | - Guillaume Desoubeaux
- INSERM, Centre D'Etude des Pathologies Respiratoires (CEPR), UMR 1100, Université de Tours, Faculté de Médecine de Tours, Tours, France; CHRU Tours, Parasitologie-Mycologie Médicale-Médecine Tropicale, 37044, Tours, France
| | | | - Jean-Pierre Gangneux
- Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail), UMR_S 1085, F-35000, Rennes, France; Laboratory of Parasitology and Medical Mycology, European Confederation of Medical Mycology (ECMM) Excellence Center, Centre National de Référence Aspergilloses Chroniques, Rennes University Hospital, F-35000, Rennes, France
| | - Gilles Nevez
- Laboratory of Parasitology and Mycology, Brest University Hospital, 29609, Brest, France; Univ Brest, Univ Angers, IRF, SFR, ICAT, Brest, France
| | - Soléne LE Gal
- Laboratory of Parasitology and Mycology, Brest University Hospital, 29609, Brest, France; Univ Brest, Univ Angers, IRF, SFR, ICAT, Brest, France
| | - Nicolas Papon
- Univ Angers, Univ Brest, IRF, SFR, ICAT, 49000, Angers, France.
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Nevez G, Guillerm G, Talarmin JP, Quinio D, Iriart X, Lissillour PL, Rezig S, Fangous MS, Ranty M, Bodenes L, Aubron C, Couturier MA, Le Gal S. Hormographiella aspergillata pulmonary infections: Detection and identification of the fungus using pan-fungal PCR assays and DNA sequencing. J Mycol Med 2024; 34:101463. [PMID: 38342037 DOI: 10.1016/j.mycmed.2024.101463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 01/29/2024] [Accepted: 01/30/2024] [Indexed: 02/13/2024]
Abstract
Hormographiella aspergillata is a basidiomycete exceptionally involved in invasive fungal infections (IFI). We report a case of H. aspergillata pulmonary infection in a 30-year-old female in a context of pancytopenia and relapsed of acute myeloid leukemia (AML). She presented with fever, thoracic pain, left pleural effusion and pneumonia, diagnosed on chest X-ray and CT-scan. Direct examination of a bronchoalveolar lavage (BAL) specimen performed on day (d) 10 was negative, while the culture was positive on d30. H. aspergillata was suspected, considering macroscopic and microscopic examination. Its identification was confirmed using Microflex® Bruker mass spectrometry and pan-fungal (PF)-PCR assay followed by DNA sequencing. After this initial diagnosis, the patient was monitored for 2.8 years. She was treated with liposomal amphotericin B and/or voriconazole until switching to isavuconazole on d298 due to side-effects. This antifungal treatment was maintained until d717 and then discontinued, the patient being considered as cured. Over this follow-up period, the patient was submitted to recurrent pulmonary sampling. Each time, cultures were negative, while PF - PCR assays and DNA sequencing confirmed the presence of H. aspergillata. The present case-report is the 32nd observation of H. aspergillata invasive infection showing that this IFI is still infrequent. Fifteen have occurred in patients with AML, which appears as the most frequent underlying disease favoring this IFI. Six recent case-reports in addition to ours highlight PF-PCR assays and DNA sequencing as relevant diagnostic tools that must be included in routine diagnosis and monitoring of IFI, specifically those due to rare basidiomycetes.
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Affiliation(s)
- Gilles Nevez
- Laboratory of Parasitology and Mycology, Brest University Hospital, F-29609 Brest, France; Fungal Respiratory Infections (FRI) Research Unit, UNIV Angers, UNIV Brest, F-29238 Brest, France.
| | - Gaelle Guillerm
- Hematology, Brest University Hospital, F-29609 Brest, France
| | - Jean-Philippe Talarmin
- Infectious Diseases and Tropical Medicine, Cornouaille Hospital, Quimper, France, F-29000 Quimper, France
| | - Dorothée Quinio
- Laboratory of Parasitology and Mycology, Brest University Hospital, F-29609 Brest, France; Fungal Respiratory Infections (FRI) Research Unit, UNIV Angers, UNIV Brest, F-29238 Brest, France
| | - Xavier Iriart
- Parasitology and Mycology Unit, Toulouse University Hospital, F-31059 Toulouse, France; Toulouse Institute for Infectious and Inflammatory Diseases (UMR "Infinity" Inserm/ CNRS/ Toulouse III University), F-31024 Toulouse, France
| | | | - Schéhérazade Rezig
- Infectious Diseases and Tropical Medicine, Brest University Hospital, F-29609 Brest, France
| | | | - Marion Ranty
- Pneumology, Brest University Hospital, F-29609 Brest, France
| | - Laetitia Bodenes
- Intensive care unit, Brest University Hospital, F-29609 Brest, France
| | - Cécile Aubron
- Intensive care unit, Brest University Hospital, F-29609 Brest, France
| | | | - Solène Le Gal
- Laboratory of Parasitology and Mycology, Brest University Hospital, F-29609 Brest, France; Fungal Respiratory Infections (FRI) Research Unit, UNIV Angers, UNIV Brest, F-29238 Brest, France
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Meier CS, Pagni M, Richard S, Mühlethaler K, Almeida JMGCF, Nevez G, Cushion MT, Calderón EJ, Hauser PM. Publisher Correction: Fungal antigenic variation using mosaicism and reassortment of subtelomeric genes' repertoires. Nat Commun 2023; 14:7928. [PMID: 38040716 PMCID: PMC10692138 DOI: 10.1038/s41467-023-43993-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2023] Open
Affiliation(s)
- Caroline S Meier
- Institute of Microbiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Marco Pagni
- Vital-IT Group, SIB Swiss Institute of Bioinformatics, Lausanne, Switzerland
| | - Sophie Richard
- Institute of Microbiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Konrad Mühlethaler
- Institute for Infectious Diseases, University of Bern, Bern, Switzerland
| | - João M G C F Almeida
- UCIBIO, Applied Molecular Biosciences Unit, Department of Life Sciences, NOVA School of Science and Technology, Universidade NOVA de Lisboa, 2829-516, Caparica, Portugal
| | - Gilles Nevez
- Laboratoire de Parasitologie et Mycologie, Hôpital de La Cavale Blanche, CHU de Brest, Brest, France
- Infections respiratoires fongiques (IFR), Université d'Angers, Université de Brest, Brest, France
| | - Melanie T Cushion
- Department of Internal Medicine, Division of Infectious Diseases, College of Medicine, University of Cincinnati, Cincinnati, OH, 45267, USA
- Cincinnati VAMC, Medical Research Service, Cincinnati, OH, 45220, USA
| | - Enrique J Calderón
- Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocίo/Consejo Superior de Investigaciones Cientίficas/Universidad de Sevilla, Seville, Spain
- Centro de Investigación Biomédica en Red de Epidemiologίa y Salud Pública, Servicio de Medicina Interna, Hospital Universitario Virgen del Rocίo, Departamento de Medicina, Facultad de Medicina, Seville, Spain
| | - Philippe M Hauser
- Institute of Microbiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
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Meier CS, Pagni M, Richard S, Mühlethaler K, Almeida JMGCF, Nevez G, Cushion MT, Calderón EJ, Hauser PM. Fungal antigenic variation using mosaicism and reassortment of subtelomeric genes' repertoires. Nat Commun 2023; 14:7026. [PMID: 37919276 PMCID: PMC10622565 DOI: 10.1038/s41467-023-42685-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 10/18/2023] [Indexed: 11/04/2023] Open
Abstract
Surface antigenic variation is crucial for major pathogens that infect humans. To escape the immune system, they exploit various mechanisms. Understanding these mechanisms is important to better prevent and fight the deadly diseases caused. Those used by the fungus Pneumocystis jirovecii that causes life-threatening pneumonia in immunocompromised individuals remain poorly understood. Here, though this fungus is currently not cultivable, our detailed analysis of the subtelomeric sequence motifs and genes encoding surface proteins suggests that the system involves the reassortment of the repertoire of ca. 80 non-expressed genes present in each strain, from which single genes are retrieved for mutually exclusive expression. Dispersion of the new repertoires, supposedly by healthy carrier individuals, appears very efficient because identical alleles are observed in patients from different countries. Our observations reveal a unique strategy of antigenic variation. They also highlight the possible role in genome rearrangements of small imperfect mirror sequences forming DNA triplexes.
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Affiliation(s)
- Caroline S Meier
- Institute of Microbiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Marco Pagni
- Vital-IT Group, SIB Swiss Institute of Bioinformatics, Lausanne, Switzerland
| | - Sophie Richard
- Institute of Microbiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Konrad Mühlethaler
- Institute for Infectious Diseases, University of Bern, Bern, Switzerland
| | - João M G C F Almeida
- UCIBIO, Applied Molecular Biosciences Unit, Department of Life Sciences, NOVA School of Science and Technology, Universidade NOVA de Lisboa, 2829-516, Caparica, Portugal
| | - Gilles Nevez
- Laboratoire de Parasitologie et Mycologie, Hôpital de La Cavale Blanche, CHU de Brest, Brest, France
- Infections respiratoires fongiques (IFR), Université d'Angers, Université de Brest, Brest, France
| | - Melanie T Cushion
- Department of Internal Medicine, Division of Infectious Diseases, College of Medicine, University of Cincinnati, Cincinnati, OH, 45267, USA
- Cincinnati VAMC, Medical Research Service, Cincinnati, OH, 45220, USA
| | - Enrique J Calderón
- Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocίo/Consejo Superior de Investigaciones Cientίficas/Universidad de Sevilla, Seville, Spain
- Centro de Investigación Biomédica en Red de Epidemiologίa y Salud Pública, Servicio de Medicina Interna, Hospital Universitario Virgen del Rocίo, Departamento de Medicina, Facultad de Medicina, Seville, Spain
| | - Philippe M Hauser
- Institute of Microbiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
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Coste A, Conrad A, Porcher R, Poirée S, Peterlin P, Defrance C, Letscher-Bru V, Morio F, Gastinne T, Bougnoux ME, Suarez F, Nevez G, Dupont D, Ader F, Halfon-Domenech C, Ducastelle-Leprêtre S, Botterel F, Millon L, Guillerm G, Ansart S, Boutoille D, Ledoux MP, Herbrecht JE, Robin C, Melica G, Danion F, Blanchard E, Paccoud O, Garcia-Hermoso D, Lortholary O, Herbrecht R, Lanternier F. Improving Diagnosis of Pulmonary Mucormycosis: Leads From a Contemporary National Study of 114 Cases. Chest 2023; 164:1097-1107. [PMID: 37419276 DOI: 10.1016/j.chest.2023.06.039] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 06/04/2023] [Accepted: 06/29/2023] [Indexed: 07/09/2023] Open
Abstract
BACKGROUND Pulmonary mucormycosis (PM) is a life-threatening invasive mold infection. Diagnosis of mucormycosis is challenging and often delayed, resulting in higher mortality. RESEARCH QUESTION Are the disease presentation of PM and contribution of diagnosis tools influenced by the patient's underlying condition? STUDY DESIGN AND METHODS All PM cases from six French teaching hospitals between 2008 and 2019 were retrospectively reviewed. Cases were defined according to updated European Organization for Research and Treatment of Cancer/Mycoses Study Group criteria with the addition of diabetes and trauma as host factors and positive serum or tissue PCR as mycologic evidence. Thoracic CT scans were reviewed centrally. RESULTS A total of 114 cases of PM were recorded, including 40% with disseminated forms. Main underlying conditions were hematologic malignancy (49%), allogeneic hematopoietic stem cell transplantation (21%), and solid organ transplantation (17%). When disseminated, main dissemination sites were the liver (48%), spleen (48%), brain (44%), and kidneys (37%). Radiologic presentation included consolidation (58%), pleural effusion (52%), reversed halo sign (26%), halo sign (24%), vascular abnormalities (26%), and cavity (23%). Serum quantitative polymerase chain reaction (qPCR) was positive in 42 (79%) of 53 patients and BAL in 46 (50%) of 96 patients. Results of transthoracic lung biopsy were diagnostic in 8 (73%) of 11 patients with noncontributive BAL. Overall 90-day mortality was 59%. Patients with neutropenia more frequently displayed an angioinvasive presentation, including reversed halo sign and disseminated disease (P < .05). Serum qPCR was more contributive in patients with neutropenia (91% vs 62%; P = .02), and BAL was more contributive in patients without neutropenia (69% vs 41%; P = .02). Serum qPCR was more frequently positive in patients with a > 3 cm main lesion (91% vs 62%; P = .02). Overall, positive qPCR was associated with an early diagnosis (P = .03) and treatment onset (P = .01). INTERPRETATION Neutropenia and radiologic findings influence disease presentation and contribution of diagnostic tools during PM. Serum qPCR is more contributive in patients with neutropenia and BAL examination in patients without neutropenia. Results of lung biopsies are highly contributive in cases of noncontributive BAL.
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Affiliation(s)
- Anne Coste
- Infectious Diseases Department, La Cavale Blanche Hospital, Brest University Hospital, Brest, France; UMR 1101, Laboratoire de Traitement de l'Information Médicale, Université de Bretagne Occidentale, Brest, France
| | - Anne Conrad
- Infectious Diseases Department, Croix Rousse Hospital, Hospices Civils de Lyon, Lyon, France; Centre International de Recherche en Infectiologie (CIRI), INSERM U1111, Université Claude Bernard Lyon 1, CNRS, UMR 5308, Ecole Normale Supérieure de Lyon, Univ Lyon, Lyon, France
| | - Raphaël Porcher
- Centre d'Epidémiologie Clinique, Hôtel-Dieu Hospital, AP-HP, Paris, France
| | - Sylvain Poirée
- Radiology Department, Necker-Enfants Malades Hospital, AP-HP, Paris, France
| | - Pierre Peterlin
- Clinical Hematology Department, Nantes University Hospital, Nantes, France
| | - Claire Defrance
- Radiology Department, Nantes University Hospital, Nantes, France
| | - Valérie Letscher-Bru
- Parasitology and Medical Mycology Laboratory, Strasbourg University Hospital, Strasbourg, France; Institut de Parasitologie et Pathologie Tropicale, UR 7292, Strasbourg University, Strasbourg, France
| | - Florent Morio
- Parasitology and Mycology Laboratory, Nantes University Hospital, Nantes, France; UR 1155 IICiMed, Nantes University, Nantes, France
| | - Thomas Gastinne
- Clinical Hematology Department, Nantes University Hospital, Nantes, France
| | - Marie-Elisabeth Bougnoux
- Mycology and Parasitology Laboratory, Necker-Enfants Malades Hospital, AP-HP, Paris, France; Unité Biologie et Pathogénicité Fongiques, Institut Pasteur, Paris, France
| | - Felipe Suarez
- Hematology Department, Necker-Enfants Malades Hospital, AP-HP, Paris, France
| | - Gilles Nevez
- Mycology and Parasitology Department, La Cavale Blanche University Hospital, Brest, France
| | - Damien Dupont
- Medical Mycology and Parasitology Department, Institut des Agents Infectieux, Hospices Civils de Lyon, Lyon, France
| | - Florence Ader
- Infectious Diseases Department, Croix Rousse Hospital, Hospices Civils de Lyon, Lyon, France; Centre International de Recherche en Infectiologie (CIRI), INSERM U1111, Université Claude Bernard Lyon 1, CNRS, UMR 5308, Ecole Normale Supérieure de Lyon, Univ Lyon, Lyon, France
| | | | | | - Françoise Botterel
- Mycology and Parasitology Unit, Henri Mondor University Hospital, AP-HP, Créteil, France; EA DYNAMYC 1380, Université Paris-Est Créteil, Créteil, France
| | - Laurence Millon
- Mycology and Parasitology Laboratory, Besançon University Hospital, Besançon, France; UMR 6249, CNRS Chrono-Environnement, Université de Bourgonne Franche-Comté, Besançon, France
| | - Gaelle Guillerm
- Hematology Department, Morvan Hospital, Brest University Hospital, Brest, France
| | - Séverine Ansart
- Infectious Diseases Department, La Cavale Blanche Hospital, Brest University Hospital, Brest, France; UMR 1101, Laboratoire de Traitement de l'Information Médicale, Université de Bretagne Occidentale, Brest, France
| | - David Boutoille
- Infectious Diseases Department, Nantes University Hospital, Nantes, France; Centre d'Investigation Clinique, INSERM 1413, Nantes University Hospital, Nantes, France
| | - Marie-Pierre Ledoux
- Hematology Department, European Strasbourg Cancer Institute, Strasbourg, France
| | | | - Christine Robin
- Hematology Department, Henri Mondor Hospital, AP-HP, Créteil, France
| | - Giovanna Melica
- Infectious Diseases Department, Henri Mondor Hospital, AP-HP, Créteil, France
| | - François Danion
- Infectious Diseases Department, Strasbourg University Hospital, Strasbourg, France; UMR_S 1109, INSERM, ImmunoRhumatologie Moléculaire, Strasbourg University, Strasbourg, France
| | - Elodie Blanchard
- Pneumology Department, Bordeaux University Hospital, Bordeaux, France
| | - Olivier Paccoud
- Infectious Diseases Department, Necker-Enfants Malades Hospital, Paris-Cité University, AP-HP, Paris, France
| | - Dea Garcia-Hermoso
- Institut Pasteur, Université Paris Cité, National Reference Center for Invasive Mycoses and Antifungals, Translational Mycology Research Group, Mycology Department, Paris, France
| | - Olivier Lortholary
- Infectious Diseases Department, Necker-Enfants Malades Hospital, Paris-Cité University, AP-HP, Paris, France; Institut Pasteur, Université Paris Cité, National Reference Center for Invasive Mycoses and Antifungals, Translational Mycology Research Group, Mycology Department, Paris, France
| | - Raoul Herbrecht
- Hematology Department, European Strasbourg Cancer Institute, Strasbourg, France
| | - Fanny Lanternier
- Infectious Diseases Department, Necker-Enfants Malades Hospital, Paris-Cité University, AP-HP, Paris, France; Institut Pasteur, Université Paris Cité, National Reference Center for Invasive Mycoses and Antifungals, Translational Mycology Research Group, Mycology Department, Paris, France.
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Nevez G, Hoffmann C, Le Gal S. Comment on " Pneumocystis jirovecii Pneumonia in a HIV-Infected Patient with a CD4 Count Greater Than 400 Cells/ μL and Atovaquone Prophylaxis". Case Rep Infect Dis 2023; 2023:9793264. [PMID: 37908307 PMCID: PMC10615577 DOI: 10.1155/2023/9793264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 03/29/2023] [Indexed: 11/02/2023] Open
Affiliation(s)
- Gilles Nevez
- Université de Brest, Université d'Angers, IRF, Brest, France
- Laboratory of Parasitology and Mycology, Brest University Hospital, Brest, France
| | - Claire Hoffmann
- Université de Brest, Université d'Angers, IRF, Brest, France
- Laboratory of Parasitology and Mycology, Brest University Hospital, Brest, France
| | - Solène Le Gal
- Université de Brest, Université d'Angers, IRF, Brest, France
- Laboratory of Parasitology and Mycology, Brest University Hospital, Brest, France
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Bonnet PL, Hoffmann CV, Le Nan N, Bellamy L, Hoarau G, Flori P, Demar M, Argy N, Morio F, Le Gal S, Nevez G. Atovaquone exposure and Pneumocystis jirovecii cytochrome b mutations: French data and review of the literature. Med Mycol 2023; 61:myad095. [PMID: 37656874 DOI: 10.1093/mmy/myad095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 08/18/2023] [Accepted: 08/29/2023] [Indexed: 09/03/2023] Open
Abstract
Pneumocystis jirovecii is a transmissible fungus responsible for severe pneumonia (Pneumocystis pneumonia [PCP]) in immunocompromised patients. Missense mutations due to atovaquone selective pressure have been identified on cytochrome b (CYB) gene of P. jirovecii. It was recently shown that atovaquone prophylaxis can lead to the selection of specific P. jirovecii CYB mutants potentially resistant to atovaquone among organ transplant recipients. In this context, our objectives were to provide data on P. jirovecii CYB mutants and the putative selective pressure exerted by atovaquone on P. jirovecii organisms in France. A total of 123 patients (124 P. jirovecii specimens) from four metropolitan hospitals and two overseas hospitals were retrospectively enrolled. Fourteen patients had prior exposure to atovaquone, whereas 109 patients did not at the time of P. jirovecii detection. A 638 base-pair fragment of the CYB gene of P. jirovecii was amplified and sequenced. A total of 10 single nucleotide polymorphisms (SNPs) were identified. Both missense mutations C431T (Ala144Val) and C823T (Leu275Phe), located at the Qo active site of the enzyme, were significantly associated with prior atovaquone exposure, these mutations being conversely incidental in the absence of prior atovaquone exposure (P < 0.001). Considering that the aforementioned hospitals may be representative of the national territory, these findings suggest that the overall presence of P. jirovecii CYB mutants remains low in France.
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Affiliation(s)
- Pierre L Bonnet
- Laboratory of Parasitology and Mycology, Brest University Hospital, 29609 Brest, France
- Fungal Respiratory Infections Research Unit (FRI), University of Angers, University of Western Brittany, 29238 Brest, France
| | - Claire V Hoffmann
- Fungal Respiratory Infections Research Unit (FRI), University of Angers, University of Western Brittany, 29238 Brest, France
| | - Nathan Le Nan
- Fungal Respiratory Infections Research Unit (FRI), University of Angers, University of Western Brittany, 29238 Brest, France
| | - Lorenn Bellamy
- Clinical Data Center, Brest University Hospital, 29609 Brest, France
| | - Gautier Hoarau
- Ophthalmology Department, OPHTARA Network, Bicêtre Paris Saclay University Hospital, AP-HP, 94276 Le Kremlin-Bicêtre, France
| | - Pierre Flori
- Laboratory of Infectious Agents, Parasitology Section, GIMAP, Faculty of Medicine, 42055 Saint-Etienne, France
| | - Magalie Demar
- University Hospital Laboratory of Parasitology-Mycology, Cayenne Hospital Center, 97306 Cayenne, French Guiana
| | - Nicolas Argy
- IRD, MERIT, University of Paris Cité, 75006 Paris, France
| | - Florent Morio
- Laboratory of Parasitology and Medical Mycology, Nantes University Hospital, 44000 Nantes, France
| | - Solène Le Gal
- Laboratory of Parasitology and Mycology, Brest University Hospital, 29609 Brest, France
- Fungal Respiratory Infections Research Unit (FRI), University of Angers, University of Western Brittany, 29238 Brest, France
| | - Gilles Nevez
- Laboratory of Parasitology and Mycology, Brest University Hospital, 29609 Brest, France
- Fungal Respiratory Infections Research Unit (FRI), University of Angers, University of Western Brittany, 29238 Brest, France
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Guegan H, Roojee M, Gal SL, Artus M, Nevez G, Gangneux JP, Robert-Gangneux F. Evaluation of the PneumoGenius® PCR assay for the diagnosis of Pneumocystis pneumonia and the detection of Pneumocystis dihydropteroate synthase mutations in respiratory samples. Med Mycol 2023; 61:7110982. [PMID: 37028929 DOI: 10.1093/mmy/myad032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 03/08/2023] [Accepted: 04/05/2023] [Indexed: 04/09/2023] Open
Abstract
Pneumocystis pneumonia (PCP) is the most frequent fungal opportunistic infection defining AIDS in HIV-infected patients, and is of growing importance in HIV-negative patients. In this latter category of patients, the diagnosis mainly relies on real-time PCR (qPCR) detection of Pneumocystis jirovecii (Pj) on respiratory samples. The PneumoGenius®kit (PathoNostics) allows the simultaneous detection of Pj mtLSU and dihydropteroate synthase (DHPS) polymorphisms, which could be of interest to anticipate therapeutic failure. This study aimed at evaluating its clinical performance on 251 respiratory specimens (239 patients), (i) for P. jirovecii detection in clinical samples, and (ii) for DHPS polymorphisms detection in circulating strains. Patients were classified according to modified EORTC-MSG criteria, as having proven PCP (n = 62), probable PCP (n = 87), Pneumocystis colonization (n = 37), and no PCP (n = 53). Compared to in-house qPCR, the sensitivity of PneumoGenius® assay for P. jirovecii detection' reached 91.9% (182/198), the specificity was excellent (100%, 53/53) and the global concordance was 93.6% (235/253). Four diagnoses of proven/probable PCP were missed by the PneumoGenius® assay, reaching a 97.5% sensitivity (157/161) in this sub-group. The 12 other 'false- negative' results were obtained in patients diagnosed as colonized using the in-house PCR. DHPS genotyping was successful for 147/182 samples with PneumoGenius® and revealed dhps mutation in 8 samples, which were all confirmed by sequencing. In conclusion, PneumoGenius® assay missed the detection of low-burden PCP. This lower sensitivity for PCP diagnosis can be balanced by a higher specificity (P.jirovecii colonization less frequently detected) and the efficient detection of DHPS hot spot mutations.
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Affiliation(s)
- Hélène Guegan
- Université de Rennes, CHU de Rennes, EHESP, Institut de Recherche en Santé, Environnement et travail, Inserm UMR_S 1085, Rennes, France
| | - Maël Roojee
- Laboratoire de Parasitologie-Mycologie, CHU de Rennes, Rennes, France
| | - Solène Le Gal
- Centre Hospitalier Universitaire Brest, Brest, France; Infections Respiratoires Fongiques, Université Brest, Université Angers, Brest/Angers, France
| | - Mathilde Artus
- Centre Hospitalier Universitaire Brest, Brest, France; Infections Respiratoires Fongiques, Université Brest, Université Angers, Brest/Angers, France
| | - Gilles Nevez
- Centre Hospitalier Universitaire Brest, Brest, France; Infections Respiratoires Fongiques, Université Brest, Université Angers, Brest/Angers, France
| | - Jean-Pierre Gangneux
- Université de Rennes, CHU de Rennes, EHESP, Institut de Recherche en Santé, Environnement et travail, Inserm UMR_S 1085, Rennes, France
| | - Florence Robert-Gangneux
- Université de Rennes, CHU de Rennes, EHESP, Institut de Recherche en Santé, Environnement et travail, Inserm UMR_S 1085, Rennes, France
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9
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Blez D, Bronnimann D, Rammaert B, Zeller V, Delhaes L, Hustache L, Grenouillet F, Traversier N, Bonhomme J, Chouaki T, Perpoint T, Persat F, Bougnoux ME, Bayle S, Quaesaet L, Nevez G, Boutoille D, Morio F, Pougnet L, Queyrel-Moranne V, Heym BE, Guillemain R, Dannaoui É, Roux A, Garcia-Hermoso D, Lanternier F. Invasive bone and joint infections from the French Scedosporiosis/lomentosporiosis Observational Study (SOS) cohort: no mortality with long-term antifungal treatment and surgery. Med Mycol 2023; 61:7051228. [PMID: 36813259 DOI: 10.1093/mmy/myad023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 02/06/2023] [Accepted: 02/16/2023] [Indexed: 02/24/2023] Open
Abstract
Little is known about localized osteoarticular Scedosporiosis (LOS). Most data come from case reports and small case series. Here we present an ancillary study of the nationwide French Scedosporiosis Observational Study (SOS), describing 15 consecutive cases of LOS diagnosed between January 2005 and March 2017. Adult patients diagnosed with LOS defined by osteoarticular involvement without distant foci reported in SOS were included. Fifteen LOS were analyzed. Seven patients had underlying disease. Fourteen patients had prior trauma as potential inoculation. Clinical presentation was arthritis (n = 8), osteitis (n = 5), and thoracic wall infection (n = 2). The most common clinical manifestation was pain (n = 9), followed by localized swelling (n = 7), cutaneous fistulization (n = 7), and fever (n = 5). The species involved were Scedosporium apiospermum (n = 8), S. boydii (n = 3), S. dehoogii (n = 1), and Lomentospora prolificans (n = 3). The species distribution was unremarkable except for S. boydii, which was associated with healthcare-related inoculations. Management was based on medical and surgical treatment for 13 patients. Fourteen patients received antifungal treatment for a median duration of 7 months. No patients died during follow-up. LOS exclusively occurred in the context of inoculation or systemic predisposing factors. It has a non-specific clinical presentation and is associated with an overall good clinical outcome, provided there is a prolonged course of antifungal therapy and adequate surgical management.
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Affiliation(s)
- Damien Blez
- Service de Maladies Infectieuses et Tropicales, Hôpital universitaire Necker-Enfants malades, Paris, France
| | - Didier Bronnimann
- Service des pathologies infectieuses et tropicales, Université de Paris, Paris, Île-de-France, France
- Médecine interne et maladies infectieuses, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, Aquitaine, France
| | - Blandine Rammaert
- Service de médecine interne et maladies infectieuses et tropicales, CHU Poitiers, Poitiers, France
- Université de Poitiers, INSERM U1070, Poitiers, Nouvelle-Aquitaine, France
| | - Valérie Zeller
- Osteoarticular Reference Center, GH Diaconesses Croix St Simon, Paris, Île-de-France, France
| | - Laurence Delhaes
- INSERM U1045, Bordeaux, Aquitaine, France
- Service de parasitologie-mycologie, Université de Bordeaux, Talence, France
| | - Laurent Hustache
- Service de Maladies Infectieuses et Tropicales, Hôpital Jean Minjoz, Besancon, France
| | - Frédéric Grenouillet
- Chrono-Environment, UFR Santé-Pharmacie et UMR 6249 UBFC-CNRS, Besancon, Bourgogne-Franche-Comté, France
- Mycology Parasitology, University Hospital Centre Besancon, Besancon, France
| | - Nicolas Traversier
- Microbiology Saint-Denis, Felix Guyon University Hospital Center, La Réunion, France
| | - Julie Bonhomme
- Microbiology Laboratory, University Hospital Centre Caen, ToxEMAC-ABTE, Unicaen, Caen, Basse-Normandie, France
| | - Taieb Chouaki
- Mycology, University Hospital Centre Amiens-Picardie, Amiens, Hauts-de-France, France
| | - Thomas Perpoint
- Maladies Infectieuses et Tropicales, Hospices Civils de Lyon, Lyon, Auvergne-Rhône-Alpes, France
| | - Florence Persat
- Service de Parasitologie et Mycologie Médicale, Hospices Civils de Lyon, Lyon, France
- EA7426 PI3-Inflammation and Immunity of the Respiratory Epithelium, Université Claude Bernard Lyon 1, Pierre-Bénite, France
| | - Marie Elisabeth Bougnoux
- Mycology, Hopital universitaire Necker-Enfants malades, Paris, Île-de-France, France
- National Reference Center for Invasive Mycoses and Antifungals, Translational Mycology research group, Mycology Department, Institut Pasteur, Université Paris Cité, Paris, France
| | - Sophie Bayle
- Medecine interne et infectiologie aiguë polyvalente, Hospital Centre Avignon, Avignon, Provence-Alpes-Côte d'Azu, France
| | - Luc Quaesaet
- Service de Maladies Infectieuses et Tropicales, Cavale Blanche Hospital, Brest, Bretagne, France
| | - Gilles Nevez
- Parasitologie et Mycologie, Centre Hospitalier Universitaire de Brest, Brest, Bretagne, France
- Infections Respiratoires Fongiques (IRF), UFR Médecine science de la santé, Brest, France
| | - David Boutoille
- Service de Maladies Infectieuses et Tropicales, Centre Hospitalier Universitaire de Nantes, Nantes, Pays de la Loire, France
- Centre d'Investigation Clinique-Unité d'Investigation Clinique 1413 INSERM, CHU Nantes, France
| | - Florent Morio
- Centre d'Investigation Clinique-Unité d'Investigation Clinique 1413 INSERM, CHU Nantes, France
- Laboratory of Parasitology and Medical Mycology, Cibles et médicaments des infections et de l'immunité, University Hospital Centre Nantes, IICiMed, UR1155, F-44000, Nantes, Pays de la Loire, France
| | - Laurence Pougnet
- Laboratoire de biologie médicale, HIA Clermont-Tonnerre, CC41, Brest, Bretagne, France
| | - Viviane Queyrel-Moranne
- Service de rhumatologie, Hôpital Pasteur 2, CHU Nice, Nice, Provence-Alpes-Côte d'Azur, France
| | - B Eate Heym
- Osteoarticular Reference Center, GH Diaconesses Croix St Simon, Paris, Île-de-France, France
| | | | - Éric Dannaoui
- Service de parasitologie-mycologie, Hopital Européen Georges Pompidou, Paris,Île-de-France, France
- CRCM-Centre de Transplantation Pulmonaire, Service de pneumologie, Hôpital Foch, Suresnes, France
| | - Antoine Roux
- Service de parasitologie-mycologie, Hopital Européen Georges Pompidou, Paris,Île-de-France, France
| | - Dea Garcia-Hermoso
- National Reference Center for Invasive Mycoses and Antifungals, Translational Mycology research group, Mycology Department, Institut Pasteur, Université Paris Cité, Paris, France
| | - Fanny Lanternier
- Service de Maladies Infectieuses et Tropicales, Hôpital universitaire Necker-Enfants malades, Paris, France
- National Reference Center for Invasive Mycoses and Antifungals, Translational Mycology research group, Mycology Department, Institut Pasteur, Université Paris Cité, Paris, France
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Papon N, Govic YL, Havlíček V, Capilla J, Luptáková D, Dumas D, Gal SL, Nevez G, Vandeputte P, Bouchara JP. S10.5c Insight into the role of secondary metabolism in the pathogenesis of Scedosporium apiospermum. Med Mycol 2022. [PMCID: PMC9554670 DOI: 10.1093/mmy/myac072.s10.5c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
S10.5 Fungal respiratory infections in Cystic Fibrosis, September 24, 2022, 10:30 AM - 12:00 PM Secondary metabolism is a general term defining biosynthetic pathways that occur in plants, bacteria, and fungi and lead to the production of highly diversified molecular structures. Among the diverse functions that were attributed to these molecules, it is now obvious that they are predominantly involved in chemical warfare with competitors in their environments. In fungi, the two main classes of fungal secondary metabolites are polyketides (PKs) and nonribosomal peptides (NRPs). The biosynthesis of such bioactive molecules is performed by large multifunctional enzymes (NRP synthases, NRPS, and polyketide synthases, PKS) encoded by genes usually located within clusters. Conversely to Aspergillus fumigatus, only a few data are currently available for other pathogenic fungi. In this context, our research group is interested in delineating the role of secondary metabolism in Scedosporium apiospermum, a multi-resistant mold known to colonize chronically the airways of patients with cystic fibrosis (CF). Taking advantage of the availability of the S. apiospermum genome sequence, we first conducted an in silico analysis aiming at exploring the PKs and NRPs battery of the fungus. A total of 9 genes encoding PKs, 9 encoding NRPs, and 5 encoding hybrid NRPs/PKs enzymes were identified. All 3 of the PKs gene clusters presented homologies with those involved in the biosynthesis of pseurotin A. transbergamotene, and ovalicin, or the tremorgenic toxin b-aflatrem while a fourth one is involved in the biosynthesis of melanin. Among the NRPs encoding genes, 6 exhibited sufficient similarity scores with other fungal NRPs to predict the class of the generated peptide: siderophores (2), epidithiodioxopiperazines (2), and cyclopeptides (2). Nevertheless, substrate prediction methods for NRPs domains failed, thus questioning about the nature of the produced peptides. We thus focused our attention on the characterization of some NRP and PK biosynthetic pathways. Since iron acquisition is known to be crucial for the survival of microorganisms as for the virulence of numerous pathogens, we first investigated clusters predicted to be responsible for the biosynthesis of siderophores in S. apiospermum. For instance, we disrupted the SAPIO_CDS2806 gene, an ortholog of sidD which drives the production of the extracellular hydroxamate-type siderophore fusarinin C in Aspergillus fumigatus. A comparison of culture supernatants from sidD mutants and their parent strain revealed that S. apiospermum secretes a unique extracellular siderophore, namely Nα‐methylcoprogen B and that sidD gene was essential for the biosynthesis of this siderophore. sidD mutation resulted in the lack of growth under iron limiting conditions. Interestingly, pyoverdine supported the growth of the parent strain only, suggesting that Nα‐methylcoprogen B is required for iron acquisition from this Pseudomonas aeruginosa siderophore. Finally, the deletion of sidD resulted in the loss of virulence in a murine model of scedosporiosis. Altogether, our results demonstrate that S. apiospermum sidD gene drives the synthesis of a unique extracellular siderophore, namely Nα‐methylcoprogen B, which is essential for fungal growth and virulence. Above all, we also provide unprecedented data suggesting that this fungal siderophore scavenges iron from pyoverdine, which might explain the antagonism between S. apiospermum and P. aeruginosa in CF.
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Affiliation(s)
- Nicolas Papon
- ‘Fungal Respiratory Infections’ Research Unit , University of Angers, Angers , France
| | - Yohann Le Govic
- ‘Infectious Agents , Resistance and Chemotherapy’, UR 4294, University of Picardy Jules Verne, Amiens , France
- Parasitology-Mycology Department , Center for Human Biology, University Hospital of Amiens, Amiens , France
| | - Vladimir Havlíček
- Institute of Microbiology of the Czech Academy of Sciences , Prague , Czech Republic
| | - Javier Capilla
- Unitat de Microbiologia , Facultat de Medicina i Ciències de la Salut, Universitat Rovira i Virgili and Institut d'Investigació Sanitària Pere Virgili, Reus, Tarragona , Spain
| | - Dominika Luptáková
- Institute of Microbiology of the Czech Academy of Sciences , Prague , Czech Republic
| | - Dayana Dumas
- Unitat de Microbiologia , Facultat de Medicina i Ciències de la Salut, Universitat Rovira i Virgili and Institut d'Investigació Sanitària Pere Virgili, Reus, Tarragona , Spain
| | - Solène Le Gal
- ‘Fungal Respiratory Infections’ Research Unit , University of Angers, Angers , France
- Parasitology-Mycology Department , University Hospital of Brest, Brest , France
| | - Gilles Nevez
- ‘Fungal Respiratory Infections’ Research Unit , University of Angers, Angers , France
- Parasitology-Mycology Department , University Hospital of Brest, Brest , France
| | - Patrick Vandeputte
- ‘Fungal Respiratory Infections’ Research Unit , University of Angers, Angers , France
| | - J-P Bouchara
- ‘Fungal Respiratory Infections’ Research Unit , University of Angers, Angers , France
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11
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Coste A, Conrad A, Porcher R, Poirée S, Peterlin P, Defrance C, Letscher-Bru V, Morio F, Gastinne T, Bougnoux ME, Suarez F, Nevez G, Dupont D, Ader F, Halfon-Domenech C, Ducastelle-Duprêtre S, Botterel F, Millon L, Guillerm G, Ansart S, Boutoille D, Ledoux MP, Robin C, Herbrecht JE, Melica G, Danion F, Paccoud O, Lortholary O, Herbrecht R, Lanternier F. P397 Influence of underlying conditions on disease presentation and diagnostic strategy during pulmonary mucormycosis: Anational study of 114 cases. Med Mycol 2022. [PMCID: PMC9509859 DOI: 10.1093/mmy/myac072.p397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Poster session 3, September 23, 2022, 12:30 PM - 1:30 PM Objectives Pulmonary mucormycosis (PM) is a life-threatening invasive fungal infection mostly affecting immunocompromised patients. We aimed to study the influence of underlying conditions on disease presentation and diagnostic strategy during PM. Methods All PM cases from six French teaching hospitals between 2008 and 2019 were retrospectively reviewed. Cases were defined according to EORTC/MSG 2019 criteria with the addition of diabetes and traumatism as host factors and positive serum or tissue PCR as mycological evidence. Thoracic CT scans were reviewed centrally. Results Among 114 cases of PM, 52 (46%) were proven and 62 (54%) were probable, including 12 cases with a positive serum qPCR as the sole mycological criterion. Hematological malignancy was the most common risk factor (49%), followed by allogeneic hematopoietic stem-cell transplantation (21%), and solid organ transplantation (SOT, 17%). Fever was the first symptom for 66% patients and was more frequent in patients with neutropenia than in those without (97% vs 52%, P <.01). A total of 46 (40%) patients had a disseminated infection, which was more frequently reported in neutropenic patients (50% vs 25%, P <.01). Main dissemination sites were the liver (48%), spleen (48%), brain (44%), and kidneys (37%). Sinusitis was present in 13% of cases. Chest radiological presentation included consolidation (58%), pleural effusion (52%), reversed halo sign (26%), halo sign (24%), vascular abnormalities (26%), and excavation (23%). The excavation was more frequently reported in SOT patients (64%, P <.01) compared with other groups. Vascular involvement was associated with reversed halo sign and Rhizomucor infection. Neutropenic patients presented more frequently than non-neutropenic patients with ground-glass opacities (75 vs 49%, P = .01), halo sign (32% vs 10%, P = .02), and reversed halo sign (35 vs 10%, P <.01). A total of 83 (73%) patients had a positive fungal culture from any type of respiratory sample. Serum qPCR was positive for 42/53 patients (79%) and respiratory fluid qPCR for 16/21 (76%) patients. In neutropenic patients, BAL culture was less often positive (30% vs 66%, P <.01), and serum qPCR was more frequently positive (91% vs 62%, P = .02). A transthoracic lung biopsy was contributive in 8/11 (73%) patients with negative bronchoalveolar lavage (BAL). Serum qPCR was more frequently positive in patients with the main lesion of >3 cm in diameter (91% vs 62%, P = .02). Rhizomucor spp. Was identified in 31 patients (32%), Rhizopus spp. In 29 patients (30%), Lichtheimia spp. In 24 patients (25%), Mucor spp. In 10 patients (10%) and Cunninghamella spp. In 4 patients (4%). Neutropenic patients were more frequently infected with Rhizomucor (43% vs 13%, P <.01) and less frequently with Rhizopus (17% vs 50%, P <.01). Histopathological specimens were available for 48 patients (42%) and revealed Mucorales hyphae in 85% of cases. Patients with a disseminated infection and neutropenia presented more often with angioinvasion than patients with localized disease (50% vs 9%, P <.01 and 38% vs 13%, P = .10). Overall, 90-day mortality was 59%. Conclusion Underlying conditions significantly influenced clinical and radiological presentation and diagnostic tools’ contribution. Neutropenic patients present more frequently with dissemination, fever, reversed halo sign, pathological angioinvasion, the negativity of BAL culture, the positivity of serum qPCR, and Rhizomucor infection.
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Affiliation(s)
- Anne Coste
- Brest University Hospital , Brest , France
| | | | | | | | | | | | | | - Florent Morio
- Strasbourg University Hospital , Strasbourg , France
| | | | | | - Felipe Suarez
- Assistante Public - Hôpitaux de Paris , Paris , France
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12
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Gangneux JP, Dannaoui E, Fekkar A, Luyt CE, Botterel F, De Prost N, Tadié JM, Reizine F, Houzé S, Timsit JF, Iriart X, Riu-Poulenc B, Sendid B, Nseir S, Persat F, Wallet F, Le Pape P, Canet E, Novara A, Manai M, Cateau E, Thille AW, Brun S, Cohen Y, Alanio A, Mégarbane B, Cornet M, Terzi N, Lamhaut L, Sabourin E, Desoubeaux G, Ehrmann S, Hennequin C, Voiriot G, Nevez G, Aubron C, Letscher-Bru V, Meziani F, Blaize M, Mayaux J, Monsel A, Boquel F, Robert-Gangneux F, Le Tulzo Y, Seguin P, Guegan H, Autier B, Lesouhaitier M, Pelletier R, Belaz S, Bonnal C, Berry A, Leroy J, François N, Richard JC, Paulus S, Argaud L, Dupont D, Menotti J, Morio F, Soulié M, Schwebel C, Garnaud C, Guitard J, Le Gal S, Quinio D, Morcet J, Laviolle B, Zahar JR, Bougnoux ME. Fungal infections in mechanically ventilated patients with COVID-19 during the first wave: the French multicentre MYCOVID study. The Lancet Respiratory Medicine 2022; 10:180-190. [PMID: 34843666 PMCID: PMC8626095 DOI: 10.1016/s2213-2600(21)00442-2] [Citation(s) in RCA: 135] [Impact Index Per Article: 67.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 09/06/2021] [Accepted: 09/13/2021] [Indexed: 12/24/2022]
Abstract
Background Patients with severe COVID-19 have emerged as a population at high risk of invasive fungal infections (IFIs). However, to our knowledge, the prevalence of IFIs has not yet been assessed in large populations of mechanically ventilated patients. We aimed to identify the prevalence, risk factors, and mortality associated with IFIs in mechanically ventilated patients with COVID-19 under intensive care. Methods We performed a national, multicentre, observational cohort study in 18 French intensive care units (ICUs). We retrospectively and prospectively enrolled adult patients (aged ≥18 years) with RT-PCR-confirmed SARS-CoV-2 infection and requiring mechanical ventilation for acute respiratory distress syndrome, with all demographic and clinical and biological follow-up data anonymised and collected from electronic case report forms. Patients were systematically screened for respiratory fungal microorganisms once or twice a week during the period of mechanical ventilation up to ICU discharge. The primary outcome was the prevalence of IFIs in all eligible participants with a minimum of three microbiological samples screened during ICU admission, with proven or probable (pr/pb) COVID-19-associated pulmonary aspergillosis (CAPA) classified according to the recent ECMM/ISHAM definitions. Secondary outcomes were risk factors of pr/pb CAPA, ICU mortality between the pr/pb CAPA and non-pr/pb CAPA groups, and associations of pr/pb CAPA and related variables with ICU mortality, identified by regression models. The MYCOVID study is registered with ClinicalTrials.gov, NCT04368221. Findings Between Feb 29 and July 9, 2020, we enrolled 565 mechanically ventilated patients with COVID-19. 509 patients with at least three screening samples were analysed (mean age 59·4 years [SD 12·5], 400 [79%] men). 128 (25%) patients had 138 episodes of pr/pb or possible IFIs. 76 (15%) patients fulfilled the criteria for pr/pb CAPA. According to multivariate analysis, age older than 62 years (odds ratio [OR] 2·34 [95% CI 1·39–3·92], p=0·0013), treatment with dexamethasone and anti-IL-6 (OR 2·71 [1·12–6·56], p=0·027), and long duration of mechanical ventilation (>14 days; OR 2·16 [1·14–4·09], p=0·019) were independently associated with pr/pb CAPA. 38 (7%) patients had one or more other pr/pb IFIs: 32 (6%) had candidaemia, six (1%) had invasive mucormycosis, and one (<1%) had invasive fusariosis. Multivariate analysis of associations with death, adjusted for candidaemia, for the 509 patients identified three significant factors: age older than 62 years (hazard ratio [HR] 1·71 [95% CI 1·26–2·32], p=0·0005), solid organ transplantation (HR 2·46 [1·53–3·95], p=0·0002), and pr/pb CAPA (HR 1·45 [95% CI 1·03–2·03], p=0·033). At time of ICU discharge, survival curves showed that overall ICU mortality was significantly higher in patients with pr/pb CAPA than in those without, at 61·8% (95% CI 50·0–72·8) versus 32·1% (27·7–36·7; p<0·0001). Interpretation This study shows the high prevalence of invasive pulmonary aspergillosis and candidaemia and high mortality associated with pr/pb CAPA in mechanically ventilated patients with COVID-19. These findings highlight the need for active surveillance of fungal pathogens in patients with severe COVID-19. Funding Pfizer.
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13
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Hoffmann CV, Nevez G, Moal MC, Quinio D, Le Nan N, Papon N, Bouchara JP, Le Meur Y, Le Gal S. Selection of Pneumocystis jirovecii Inosine 5'-Monophosphate Dehydrogenase Mutants in Solid Organ Transplant Recipients: Implication of Mycophenolic Acid. J Fungi (Basel) 2021; 7:jof7100849. [PMID: 34682270 PMCID: PMC8537117 DOI: 10.3390/jof7100849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 10/04/2021] [Accepted: 10/06/2021] [Indexed: 11/16/2022] Open
Abstract
Mycophenolic acid (MPA) targets the inosine 5'-monophosphate dehydrogenase (IMPDH) of human lymphocytes. It is widely used as an immunosuppressant to prevent rejection in solid organ transplant (SOT) recipients who, incidentally, are at risk for Pneumocystis pneumonia (PCP). We hypothesized that MPA exerts selective pressure on P. jirovecii microorganisms considering its in vitro antifungal activity on other fungi. Thus, we analysed impdh gene in P. jirovecii isolates from SOT recipients. P. jirovecii specimens from 26 patients diagnosed with PCP from 2010 to 2020 were retrospectively examined: 10 SOT recipients treated with MPA and 16 non-SOT patients without prior exposure to MPA. The P. jirovecii impdh gene was amplified and sequenced. Nucleotide sequences were aligned with the reference sequences retrieved from available P. jirovecii whole genomes. The deduced IMPDH protein sequences were aligned with available IMPDH proteins from Pneumocystis spp. and other fungal species known to be in vitro sensitive or resistant to MPA. A total of nine SNPs was identified. One SNP (G1020A) that results in an Ala261Thr substitution was identified in all SOT recipients and in none of the non-SOT patients. Considering that IMPDHs of other fungi, resistant to MPA, harbour Thr (or Ser) at the analogous position, the Ala261Thr mutation observed in MPA-treated patients was considered to represent the signature of P. jirovecii exposure to MPA. These results suggest that MPA may be involved in the selection of specific P. jirovecii strains that circulate in the SOT recipient population.
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Affiliation(s)
- Claire V. Hoffmann
- Laboratoire de Parasitologie et Mycologie, Hôpital de La Cavale Blanche, CHU de Brest, 29609 Brest, France; (C.V.H.); (D.Q.)
- Groupe d’Etude des Interactions Hôte-Pathogène (GEIHP), Université d’Angers, Université de Brest, 29238 Brest, France;
| | - Gilles Nevez
- Laboratoire de Parasitologie et Mycologie, Hôpital de La Cavale Blanche, CHU de Brest, 29609 Brest, France; (C.V.H.); (D.Q.)
- Groupe d’Etude des Interactions Hôte-Pathogène (GEIHP), Université d’Angers, Université de Brest, 29238 Brest, France;
- Correspondence: (G.N.); (S.L.G.); Tel.: +33-(0)-2-98-14-51-02 (G.N. & S.L.G.); Fax: +33-(0)-2-98-14-51-49 (G.N. & S.L.G.)
| | - Marie-Christine Moal
- Département de Néphrologie, CHU de Brest, 29609 Brest, France; (M.-C.M.); (Y.L.M.)
| | - Dorothée Quinio
- Laboratoire de Parasitologie et Mycologie, Hôpital de La Cavale Blanche, CHU de Brest, 29609 Brest, France; (C.V.H.); (D.Q.)
- Groupe d’Etude des Interactions Hôte-Pathogène (GEIHP), Université d’Angers, Université de Brest, 29238 Brest, France;
| | - Nathan Le Nan
- Groupe d’Etude des Interactions Hôte-Pathogène (GEIHP), Université d’Angers, Université de Brest, 29238 Brest, France;
| | - Nicolas Papon
- Groupe d’Etude des Interactions Hôte-Pathogène (GEIHP), Université de Brest, Université d’Angers, 49035 Angers, France; (N.P.); (J.-P.B.)
| | - Jean-Philippe Bouchara
- Groupe d’Etude des Interactions Hôte-Pathogène (GEIHP), Université de Brest, Université d’Angers, 49035 Angers, France; (N.P.); (J.-P.B.)
| | - Yannick Le Meur
- Département de Néphrologie, CHU de Brest, 29609 Brest, France; (M.-C.M.); (Y.L.M.)
- UMR1227, Lymphocytes B et Autoimmunité, Université de Brest, Inserm, Labex IGO, 20609 Brest, France
| | - Solène Le Gal
- Laboratoire de Parasitologie et Mycologie, Hôpital de La Cavale Blanche, CHU de Brest, 29609 Brest, France; (C.V.H.); (D.Q.)
- Groupe d’Etude des Interactions Hôte-Pathogène (GEIHP), Université d’Angers, Université de Brest, 29238 Brest, France;
- Correspondence: (G.N.); (S.L.G.); Tel.: +33-(0)-2-98-14-51-02 (G.N. & S.L.G.); Fax: +33-(0)-2-98-14-51-49 (G.N. & S.L.G.)
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14
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Ochoa TJ, Bustamante B, Garcia C, Neyra E, Mendoza K, Calderón EJ, Le Gal S, Miller RF, Ponce CA, Nevez G, Vargas SL. Pneumocystis primary infection in non-immunosuppressed infants in Lima, Peru. J Mycol Med 2021; 32:101202. [PMID: 34598108 DOI: 10.1016/j.mycmed.2021.101202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 08/25/2021] [Accepted: 09/01/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To provide original data on Pneumocystis primary infection in non-immunosuppressed infants from Peru. METHODS A cross sectional study was performed. Infants less than seven months old, without any underlying medical conditions attending the "well baby" outpatient clinic at one hospital in Lima, Peru were prospectively enrolled during a 15-month period from November 2016 to February 2018. All had a nasopharyngeal aspirate (NPA) for detection of P. jirovecii DNA using a PCR assay, regardless of respiratory symptoms. P. jirovecii DNA detection was considered to represent pulmonary colonization contemporaneous with Pneumocystis primary infection. Associations between infants' clinical and demographic characteristics and results of P. jirovecii DNA detection were analyzed. RESULTS P. jirovecii DNA was detected in 45 of 146 infants (30.8%) and detection was not associated with concurrent respiratory symptoms in 40 of 45 infants. Infants with P. jirovecii had a lower mean age when compared to infants not colonized (p <0.05). The highest frequency of P. jirovecii was observed in 2-3-month-old infants (p < 0.01) and in the cooler winter and spring seasons (p <0.01). Multivariable analysis showed that infants living in a home with ≤ 1 bedroom were more likely to be colonized; Odds Ratio =3.03 (95%CI 1.31-7.00; p = 0.01). CONCLUSION Pneumocystis primary infection in this single site in Lima, Peru, was most frequently observed in 2-3-month-old infants, in winter and spring seasons, and with higher detection rates being associated with household conditions favoring close inter-individual contacts and potential transmission of P. jirovecii.
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Affiliation(s)
- Theresa J Ochoa
- Instituto de Medicina Tropical "Alexander von Humboldt", Universidad Peruana Cayetano Heredia, Lima, Perú; School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Perú.
| | - Beatriz Bustamante
- Instituto de Medicina Tropical "Alexander von Humboldt", Universidad Peruana Cayetano Heredia, Lima, Perú; Hospital Cayetano Heredia, Lima, Perú
| | - Coralith Garcia
- Instituto de Medicina Tropical "Alexander von Humboldt", Universidad Peruana Cayetano Heredia, Lima, Perú; School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Perú; Hospital Cayetano Heredia, Lima, Perú
| | - Edgar Neyra
- School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Perú; Genomic Research Unit, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Karina Mendoza
- Instituto de Medicina Tropical "Alexander von Humboldt", Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Enrique J Calderón
- Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/Consejo Superior de Investigaciones Científicas/Universidad de Sevilla, and Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, Hospital Universitario Virgen del Rocío, Seville, Spain
| | - Solene Le Gal
- Groupe d'Étude des Interactions Hôte-Pathogène (GEIHP)-Université d'Angers, Université de Brest, Brest, France; Laboratoire de Mycologie et Parasitologie, CHRU de Brest, Brest, France
| | - Robert F Miller
- Centre for Clinical Research in Infection and Sexual Health, Institute for Global Health, University College London, London, United Kingdom; Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Carolina A Ponce
- Programa de Microbiología y Micología, Instituto de Ciencias Biomédicas (ICBM), Facultad de Medicina Universidad de Chile, Santiago, Chile
| | - Gilles Nevez
- Groupe d'Étude des Interactions Hôte-Pathogène (GEIHP)-Université d'Angers, Université de Brest, Brest, France; Laboratoire de Mycologie et Parasitologie, CHRU de Brest, Brest, France.
| | - Sergio L Vargas
- Programa de Microbiología y Micología, Instituto de Ciencias Biomédicas (ICBM), Facultad de Medicina Universidad de Chile, Santiago, Chile
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15
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Nevez G, Totet A, Matos O, Calderon EJ, Miller RF, Le Gal S. It is still PCP that can stand for Pneumocystis pneumonia: Appeal for generalized use of only one acronym. Med Mycol 2021; 59:842-844. [PMID: 34003930 DOI: 10.1093/mmy/myab024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 04/08/2021] [Accepted: 04/12/2021] [Indexed: 11/14/2022] Open
Abstract
Twenty-years ago, considering the host specificity of Pneumocystis species, the human-derived Pneumocystis, Pneumocystis carinii formae specialis hominis, was renamed Pneumocystis jirovecii. Pneumocystis carinii formae specialis carinii was finally renamed Pneumocystis carinii and kept for the species derived from Rattus norvegicus. P. jirovecii is now widely used by most authors. The PCP acronym that initially referred to "Pneumocystis cariniipneumonia" was contemporaneously redefined to stand for Pneumocystispneumonia in order to avoid changing the acronym of the name of the disease that clinicians have used for several decades. Using analysis of multidata bases on PubMed, we have noted a recent acceleration in the use of PJP for Pneumocystis jiroveciipneumonia, which may be grammatically correct but not in accordance with retaining PCP, which was proposed in the early 2000s. Through this reminder, in order to standardize the literature on P. jirovecii, we plead for the use of only one acronym, PCP. LAY SUMMARY Through this reminder on Pneumocystis nomenclature, we plead for the use of only one acronym, PCP, the retention of which was proposed in the early 2000s, and which currently stands for Pneumocystispneumonia.
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Affiliation(s)
- Gilles Nevez
- Laboratoire de Parasitologie et Mycologie, Hôpital de La Cavale Blanche, CHU de Brest, Brest, France.,Groupe d'Etude des Interactions Hôte-Pathogène (GEIHP), Université d'Angers, Université de Brest, France
| | - Anne Totet
- Parasitologie et Mycologie, CHU Amiens-Picardie, Amiens, France.,Agents Infectieux, Résistance et chimiothérapie (Laboratoire AGIR, UR 4294), Université de Picardie Jules Verne, Amiens, France
| | - Olga Matos
- Medical Parasitology Unit, Group of Opportunistic Protozoa/HIV and other Protozoa, Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade NOVA de Lisboa, Lisboa, Portugal.,Instituto de Saúde Ambiental, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Enrique J Calderon
- Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/Consejo Superior de Investigaciones Científicas/Universidad de Sevilla, and Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Hospital Universitario Virgen del Rocío, Seville, Spain
| | - Robert F Miller
- Institute for Global Health, University College London, London, UK.,Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Solène Le Gal
- Laboratoire de Parasitologie et Mycologie, Hôpital de La Cavale Blanche, CHU de Brest, Brest, France.,Groupe d'Etude des Interactions Hôte-Pathogène (GEIHP), Université d'Angers, Université de Brest, France
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16
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Affiliation(s)
- Céline Nourrisson
- Laboratoire de Parasitologie-Mycologie, Centre Hospitalier Universitaire (CHU) Clermont-Ferrand, 3IHP, Clermont-Ferrand, France.,Université Clermont Auvergne, CNRS UMR 6023, Laboratoire Microorganismes: Génome et Environnement, Clermont-Ferrand, France
| | - Solène Le Gal
- Laboratoire de Parasitologie-Mycologie, Centre Hospitalier Universitaire Brest, Brest, France.,Groupe d'Etude des Interactions Hôte-Pathogène EA 3142, Université Brest, Université Angers, Brest/Angers, France
| | - Maxime Moniot
- Laboratoire de Parasitologie-Mycologie, Centre Hospitalier Universitaire (CHU) Clermont-Ferrand, 3IHP, Clermont-Ferrand, France
| | - Frédéric Delbac
- Université Clermont Auvergne, CNRS UMR 6023, Laboratoire Microorganismes: Génome et Environnement, Clermont-Ferrand, France
| | - Jean-Pierre Bail
- Service de Chirurgie Viscérale, Centre Hospitalier Universitaire Brest, Brest, France
| | - Gilles Nevez
- Laboratoire de Parasitologie-Mycologie, Centre Hospitalier Universitaire Brest, Brest, France.,Groupe d'Etude des Interactions Hôte-Pathogène EA 3142, Université Brest, Université Angers, Brest/Angers, France
| | - Philippe Poirier
- Laboratoire de Parasitologie-Mycologie, Centre Hospitalier Universitaire (CHU) Clermont-Ferrand, 3IHP, Clermont-Ferrand, France.,Université Clermont Auvergne, CNRS UMR 6023, Laboratoire Microorganismes: Génome et Environnement, Clermont-Ferrand, France
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17
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Pougnet L, Hoffmann CV, Pougnet R, Le Ny F, Gaitan L, Cros P, Artus M, Le Gal S, Nevez G. Pneumocystis exhalation by infants developing Pneumocystis primary infection: putative infectious sources in hospitals and the community. J Hosp Infect 2021; 113:10-13. [PMID: 33894307 DOI: 10.1016/j.jhin.2021.04.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 03/31/2021] [Accepted: 04/13/2021] [Indexed: 11/18/2022]
Abstract
Pneumocystis jirovecii DNA was detected using a polymerase chain reaction assay in air samples collected using an air-liquid impaction device at 1 m distance from three out of 14 infants who had developed Pneumocystis primary infection. P. jirovecii genotype identification was successful in one out of three pairs of air samples. Matching of P. jirovecii genotypes between the nasopharyngeal and air samples suggested that P. jirovecii was effectively exhaled by the infected infant. These original results represent a proof of concept of the role of infants with primary pneumocystis infection as infectious sources of P. jirovecii in hospitals and in the community.
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Affiliation(s)
- L Pougnet
- Groupe d'Étude des Interactions Hôte-Pathogène (GEIHP), Angers-Brest, Université de Bretagne Occidentale, Brest, France; Hôpital d'Instruction des Armées Clermont-Tonnerre, CC41, 29240 Brest Cedex 9, France.
| | - C V Hoffmann
- Groupe d'Étude des Interactions Hôte-Pathogène (GEIHP), Angers-Brest, Université de Bretagne Occidentale, Brest, France; Laboratoire de Mycologie et Parasitologie, CHRU de Brest, Brest, France
| | - R Pougnet
- Centre de Recherche de Pathologies Professionnelles et Environnementales, CHRU de Brest, Brest, France; Laboratoire d'études et de Recherche en Sociologie (LABERS), Université de Bretagne Occidentale, Brest
| | - F Le Ny
- Laboratoire de Mycologie et Parasitologie, CHRU de Brest, Brest, France
| | - L Gaitan
- Département de Pédiatrie, CHRU de Brest, Brest, France
| | - P Cros
- Département de Pédiatrie, CHRU de Brest, Brest, France
| | - M Artus
- Laboratoire de Mycologie et Parasitologie, CHRU de Brest, Brest, France
| | - S Le Gal
- Groupe d'Étude des Interactions Hôte-Pathogène (GEIHP), Angers-Brest, Université de Bretagne Occidentale, Brest, France; Laboratoire de Mycologie et Parasitologie, CHRU de Brest, Brest, France
| | - G Nevez
- Groupe d'Étude des Interactions Hôte-Pathogène (GEIHP), Angers-Brest, Université de Bretagne Occidentale, Brest, France; Laboratoire de Mycologie et Parasitologie, CHRU de Brest, Brest, France.
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18
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Papon N, Nevez G, Le Gal S, Vigneau C, Robert-Gangneux F, Bouchara JP, Cornely OA, Denning DW, Gangneux JP. Fungal infections in transplant recipients: pros and cons of immunosuppressive and antimicrobial treatment. The Lancet Microbe 2021; 2:e6-e8. [DOI: 10.1016/s2666-5247(20)30199-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 11/10/2020] [Indexed: 11/17/2022] Open
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19
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Le Gal S, Bonnet P, Huguenin A, Chapelle C, Boulic P, Tonnelier JM, Moal MC, Gut-Gobert C, Barnier A, Nevez G. The shift from pulmonary colonization to Pneumocystis pneumonia. Med Mycol 2020; 59:510-513. [PMID: 33369642 DOI: 10.1093/mmy/myaa107] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 11/24/2020] [Accepted: 12/04/2020] [Indexed: 11/13/2022] Open
Abstract
Pulmonary specimen pairs from five patients who presented with pulmonary colonization and later developed Pneumocystis Pneumonia (PcP) were retrospectively examined for P. jirovecii genotyping. A match of genotypes in pulmonary specimen pairs of three patients was observed, whereas a partial match and a mismatch were observed in the fourth and fifth patients, respectively. The genotyping results suggest that the colonization state can differ from PcP but can also represent the incubation period of PcP. Clinicians should not systematically rule out the treatment of putative colonized patients and should at least discuss the initiation of prophylaxis on a case-by-case basis.
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Affiliation(s)
- Solène Le Gal
- Université de Brest, Université d'Angers, GEIHP, Brest, France.,Laboratory of Parasitology and Mycology, Brest University Hospital, Brest, France
| | - Pierre Bonnet
- Université de Brest, Université d'Angers, GEIHP, Brest, France.,Laboratory of Parasitology and Mycology, Brest University Hospital, Brest, France
| | - Antoine Huguenin
- EA 7510, ESCAPE, Laboratory of Parasitology and Mycology, Université de Reims Champagne-Ardenne, 51 rue Cognacq Jay, 51092 Reims CEDEX, France
| | - Célia Chapelle
- Université de Brest, Université d'Angers, GEIHP, Brest, France
| | - Pierrick Boulic
- Université de Brest, Université d'Angers, GEIHP, Brest, France
| | | | | | | | - Aude Barnier
- Pneumology and Internal Medicine, Brest University Hospital, Brest, France
| | - Gilles Nevez
- Université de Brest, Université d'Angers, GEIHP, Brest, France.,Laboratory of Parasitology and Mycology, Brest University Hospital, Brest, France
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20
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Nevez G, Morio F, Bonnet P, Le Nan N, Blanc FX, Le Gal S. A proposal for pragmatic investigation of possible clonal clusters of pneumocystis pneumonia cases. J Hosp Infect 2020; 108:215-216. [PMID: 33271216 DOI: 10.1016/j.jhin.2020.11.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 11/25/2020] [Indexed: 11/26/2022]
Affiliation(s)
- G Nevez
- Université de Brest, Université d'Angers, GEIHP, Brest, France; Laboratory of Parasitology and Mycology, Brest University Hospital, Brest, France.
| | - F Morio
- Laboratory of Parasitology and Mycology, Nantes University Hospital, Nantes, France; IICiMed, Institut de Recherche en Santé 2, Université de Nantes, Nantes, France
| | - P Bonnet
- Université de Brest, Université d'Angers, GEIHP, Brest, France; Laboratory of Parasitology and Mycology, Brest University Hospital, Brest, France
| | - N Le Nan
- Université de Brest, Université d'Angers, GEIHP, Brest, France
| | - F-X Blanc
- Department of Respiratory Medicine, Nantes University Hospital, Nantes, France
| | - S Le Gal
- Université de Brest, Université d'Angers, GEIHP, Brest, France; Laboratory of Parasitology and Mycology, Brest University Hospital, Brest, France
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21
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22
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Bonnet P, Le Gal S, Calderon E, Delhaes L, Quinio D, Robert-Gangneux F, Ramel S, Nevez G. Pneumocystis jirovecii in Patients With Cystic Fibrosis: A Review. Front Cell Infect Microbiol 2020; 10:571253. [PMID: 33117730 PMCID: PMC7553083 DOI: 10.3389/fcimb.2020.571253] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 08/14/2020] [Indexed: 12/12/2022] Open
Abstract
Pneumocystis pneumonia (PCP) remains the most frequent AIDS-defining illness in developed countries. This infection also occurs in non-AIDS immunosuppressed patients, e.g., those who have undergone an organ transplantation. Moreover, mild Pneumocystis jirovecii infections related to low pulmonary fungal burden, frequently designated as pulmonary colonization, occurs in patients with chronic pulmonary diseases, e.g., cystic fibrosis (CF). Indeed, this autosomal recessive disorder alters mucociliary clearance leading to bacterial and fungal colonization of the airways. This mini-review compiles and discusses available information on P. jirovecii and CF. It highlights significant differences in the prevalence of P. jirovecii pulmonary colonization in European and Brazilian CF patients. It also describes the microbiota associated with P. jirovecii in CF patients colonized by P. jirovecii. Furthermore, we have described P. jirovecii genomic diversity in colonized CF patients. In addition of pulmonary colonization, it appears that PCP can occur in CF patients specifically after lung transplantation, thus requiring preventive strategies. In other respects, Pneumocystis primary infection is a worldwide phenomenon occurring in non-immunosuppressed infants within their first months. The primary infection is mostly asymptomatic but it can also present as a benign self-limiting infection. It probably occurs in the same manner in CF infants. Nonetheless, two cases of severe Pneumocystis primary infection mimicking PCP in CF infants have been reported, the genetic disease appearing in these circumstances as a risk factor of PCP while the host-pathogen interaction in older children and adults with pulmonary colonization remains to be clarified.
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Affiliation(s)
- Pierre Bonnet
- Laboratoire de Parasitologie et Mycologie, Hôpital de La Cavale Blanche, CHU de Brest, Brest, France
| | - Solène Le Gal
- Laboratoire de Parasitologie et Mycologie, Hôpital de La Cavale Blanche, CHU de Brest, Brest, France.,Groupe d'Etude des Interactions Hôte-Pathogène (ER, GEIHP), Université d'Angers, Université de Brest, Brest, France
| | - Enrique Calderon
- CIBER de Epidemiologia y Salud Publica and Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocio/CSIC/Universidad de Sevilla, Seville, Spain
| | - Laurence Delhaes
- Laboratory of Parasitology and Mycology, Bordeaux University Hospital, Bordeaux, France Inserm U1045 - University of Bordeaux, Bordeaux, France
| | - Dorothée Quinio
- Laboratoire de Parasitologie et Mycologie, Hôpital de La Cavale Blanche, CHU de Brest, Brest, France
| | - Florence Robert-Gangneux
- Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé Environnement Travail), UMR_S 1085, Rennes, France
| | - Sophie Ramel
- Centre de Ressources et de Compétences de la Mucoviscidose, Fondation Ildys, Roscoff, France
| | - Gilles Nevez
- Laboratoire de Parasitologie et Mycologie, Hôpital de La Cavale Blanche, CHU de Brest, Brest, France.,Groupe d'Etude des Interactions Hôte-Pathogène (ER, GEIHP), Université d'Angers, Université de Brest, Brest, France
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23
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Nevez G, Guillaud-Saumur T, Cros P, Papon N, Vallet S, Quinio D, Minoui-Tran A, Pilorgé L, de Parscau L, Sizun J, Ochoa TJ, Bustamante B, Ponce C, Vargas SL, Le Gal S. Pneumocystis primary infection in infancy: Additional French data and review of the literature. Med Mycol 2020; 58:163-171. [PMID: 31127850 PMCID: PMC7107579 DOI: 10.1093/mmy/myz040] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 04/03/2019] [Accepted: 04/05/2019] [Indexed: 11/12/2022] Open
Abstract
Data on features of Pneumocystis primary infection in infancy are still fragmented. To study Pneumocystis primary infection, 192 infants who were monitored for acute pulmonary disease or fever over a 40-month period were retrospectively investigated. P. jirovecii detection on archival nasopharyngeal aspirates was performed using a qPCR assay. Factors associated with P. jirovecii were assessed using univariate and multivariate analyses. P. jirovecii genotypes in infants and a control group of adults contemporaneously diagnosed with Pneumocystis pneumonia were identified using unilocus, bilocus, and multilocus sequence typing (MLST). P. jirovecii was detected in 35 infants (18.2%). The univariate analysis pointed out four factors: viral infection (P = .035, OR [IC 95], 2.2 [1.1–4.7]), lower respiratory tract infection (P = .032, OR [IC 95], 2.5 [1.1–5.9]), absence of hospital discharge after birth (P = .003, OR (IC 95), 0.1 (0.02–0.5]), and the 63–189-day group (P < .001, OR [IC 95], 42.2 [5.4–332]). The multivariate analysis confirmed these two latter factors (P = .02, OR [IC 95], 0.1 [0.02–0.72]; P = .005, OR [IC 95], 11.5 [2.1–63.5]). Thus, P. jirovecii acquisition mostly takes place in the community. A comparison of these data with those of previously published studies showed that median and interquartile range of positive-infant ages were close to those observed in Chile, Denmark, and Peru, highlighting similar characteristics. Common unilocus or bilocus genotypes were identified in infants and adults, whereas no MLST genotypes were shared. Therefore, a common reservoir made up of infected infants and adults is still hypothetical. Finally, primary infection is a worldwide phenomenon occurring at the same time in childhood regardless of geographical location, rather than an incidental event.
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Affiliation(s)
- Gilles Nevez
- Groupe d'Étude des Interactions Hôte-Pathogène (GEIHP) EA 3142, Angers-Brest, Université de Bretagne-Loire, France.,Laboratoire de Mycologie et Parasitologie, CHRU de Brest, Brest, France
| | - Thibaud Guillaud-Saumur
- Groupe d'Étude des Interactions Hôte-Pathogène (GEIHP) EA 3142, Angers-Brest, Université de Bretagne-Loire, France.,Laboratoire de Mycologie et Parasitologie, CHRU de Brest, Brest, France
| | - Pierrick Cros
- Département de Pédiatrie, CHRU de Brest, Brest, France
| | - Nicolas Papon
- Groupe d'Étude des Interactions Hôte-Pathogène (GEIHP) EA 3142, Angers-Brest, Université de Bretagne-Loire, France
| | - Sophie Vallet
- Laboratoire de Virologie, CHRU de Brest, Brest, France.,UMR INSERM U 1078, Université de Bretagne-Loire, Brest, France
| | - Dorothée Quinio
- Groupe d'Étude des Interactions Hôte-Pathogène (GEIHP) EA 3142, Angers-Brest, Université de Bretagne-Loire, France.,Laboratoire de Mycologie et Parasitologie, CHRU de Brest, Brest, France
| | | | - Léa Pilorgé
- Laboratoire de Virologie, CHRU de Brest, Brest, France
| | | | - Jacques Sizun
- Département de Pédiatrie, CHRU de Brest, Brest, France
| | - Theresa J Ochoa
- Instituto de Medicina Tropical "Alexander von Humboldt", Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Beatriz Bustamante
- Instituto de Medicina Tropical "Alexander von Humboldt", Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Carolina Ponce
- Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Santiago
| | - Sergio L Vargas
- Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Santiago
| | - Solène Le Gal
- Groupe d'Étude des Interactions Hôte-Pathogène (GEIHP) EA 3142, Angers-Brest, Université de Bretagne-Loire, France.,Laboratoire de Mycologie et Parasitologie, CHRU de Brest, Brest, France
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Garcia-Hermoso D, Hamane S, Fekkar A, Jabet A, Denis B, Siguier M, Galeazzi G, Haddad E, Brun S, Vidal V, Nevez G, Le Berre R, Gits-Muselli M, Lanternier F, Bretagne S. Invasive Infections with Nannizziopsis obscura Species Complex in 9 Patients from West Africa, France, 2004-2020 1. Emerg Infect Dis 2020; 26. [PMID: 32819454 PMCID: PMC7454062 DOI: 10.3201/eid2609.200276] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Nine new human invasive infections caused by the keratinophilic fungi Nannizziopsis obscura have been reported in France since 2004. The patients had variable clinical manifestations, had frequent dissemination, were mainly T-cell immunocompromised, and all originated from sub-Saharan West Africa. Before collection of the isolates, the etiologies of these infections were often misidentified, underscoring the extent of microscopic and cultural polymorphisms. All isolates but 1 had low MICs for the 8 antifungal drugs tested. When treated, patients received mainly azole therapy. Two of 7 patients with a known outcome died. We performed multilocus sequence analysis of N. obscura clinical strains and several strains of Nannizziopsis spp. isolated from reptiles. The human strains were clearly differentiated from the animal strains. N. obscura might be endemic to West Africa and responsible for undetected infections, which might become reactivated when immunosuppression occurs. N. obscura infection is probably underestimated because only sequencing enables proper identification.
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Hoffmann C, Guillerm G, Le Pape P, Carausu L, Lavergne RA, Nevez G, Le Gal S. Mucorales DNA detection in serum specimens for early diagnosis of mucormycosis. Diagn Microbiol Infect Dis 2020; 97:115004. [PMID: 32156450 DOI: 10.1016/j.diagmicrobio.2020.115004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 01/13/2020] [Accepted: 01/26/2020] [Indexed: 10/25/2022]
Abstract
We report a case of pulmonary mucormycosis in a patient with T-cell acute lymphoblastic leukemia. The diagnosis of mucormycosis was initially based on mycological examination of a pulmonary specimen. However, we describe how it could have been made 2 months earlier using polymerase chain reaction assays targeting Mucorales species on serum specimens.
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Affiliation(s)
- Claire Hoffmann
- Laboratoire de Parasitologie et Mycologie, Hôpital de La Cavale Blanche, CHU de Brest, Brest, France; Groupe d'Etude des Interactions Hôte-Pathogène (GEIHP; EA 3142), Université de Bretagne Occidentale-Université d'Angers, Brest, France
| | - Gaëlle Guillerm
- Service d'Hématologie Clinique, Hôpital Morvan, CHU de Brest, Brest, France
| | - Patrice Le Pape
- Laboratoire de Parasitologie-Mycologie, Institut de Biologie, CHU de Nantes, France; Département de Parasitologie et Mycologie Médicale, Université de Nantes, Nantes Atlantique Universités, EA1155-IICiMed, Faculté de Pharmacie, Nantes, France
| | - Liana Carausu
- Service d'Hématologie Clinique, Hôpital Morvan, CHU de Brest, Brest, France
| | - Rose-Anne Lavergne
- Laboratoire de Parasitologie-Mycologie, Institut de Biologie, CHU de Nantes, France; Département de Parasitologie et Mycologie Médicale, Université de Nantes, Nantes Atlantique Universités, EA1155-IICiMed, Faculté de Pharmacie, Nantes, France
| | - Gilles Nevez
- Laboratoire de Parasitologie et Mycologie, Hôpital de La Cavale Blanche, CHU de Brest, Brest, France; Groupe d'Etude des Interactions Hôte-Pathogène (GEIHP; EA 3142), Université de Bretagne Occidentale-Université d'Angers, Brest, France
| | - Solène Le Gal
- Laboratoire de Parasitologie et Mycologie, Hôpital de La Cavale Blanche, CHU de Brest, Brest, France; Groupe d'Etude des Interactions Hôte-Pathogène (GEIHP; EA 3142), Université de Bretagne Occidentale-Université d'Angers, Brest, France.
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26
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Le Gal S, Hoarau G, Bertolotti A, Negri S, Le Nan N, Bouchara JP, Papon N, Blanchet D, Demar M, Nevez G. Pneumocystis jirovecii Diversity in Réunion, an Overseas French Island in Indian Ocean. Front Microbiol 2020; 11:127. [PMID: 32117149 PMCID: PMC7019000 DOI: 10.3389/fmicb.2020.00127] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 01/20/2020] [Indexed: 12/17/2022] Open
Abstract
Data on Pneumocystis jirovecii characteristics from the overseas French territories are still scarce whereas numerous data on P. jirovecii genotypes are available for metropolitan France. The main objective of the present study was to identify P. jirovecii multilocus genotypes in patients living in Réunion and to compare them with those identified using the same method in metropolitan France and in French Guiana. Archival P. jirovecii specimens from immunosuppressed patients, 16 living in Réunion (a French island of the Indian ocean), six living in French Guiana (a South-American French territory), and 24 living in Brest (Brittany, metropolitan France) were examined at the large subunit rRNA (mtLSUrRNA) genes, cytochrome b (CYB), and superoxide dismutase (SOD) genes using PCR assays and direct sequencing. A total of 23 multi-locus genotypes (MLG) were identified combining mtLSUrRNA, CYB, and SOD alleles, i.e., six in Reunionese patients, three in Guianese patients, and 15 in Brest patients. Only one MLG (mtLSU1-CYB1-SOD2) was shared by Reunionese and Guianese patients (one patient from each region) whereas none of the 22 remaining MLG were shared by the 3 patient groups. A total of eight MLG were newly identified, three in Réunion and five in Brest. These results that were obtained through a retrospective investigation of a relatively low number of P. jirovecii specimens, provides original and first data on genetic diversity of P. jirovecii in Réunion island. The results suggest that P. jirovecii organisms from Réunion present specific characteristics compared to other P. jirovecii organisms from metropolitan France and French Guiana.
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Affiliation(s)
- Solène Le Gal
- Groupe d'Étude des Interactions Hôte-Pathogène (GEIHP) EA 3142, Université d'Angers-Université de Brest, Angers, France.,Laboratory of Mycology and Parasitology, CHRU de Brest, Brest, France
| | - Gautier Hoarau
- Department of Microbiology, CHU La Réunion, Saint Pierre, France
| | | | - Steven Negri
- Groupe d'Étude des Interactions Hôte-Pathogène (GEIHP) EA 3142, Université d'Angers-Université de Brest, Angers, France
| | - Nathan Le Nan
- Groupe d'Étude des Interactions Hôte-Pathogène (GEIHP) EA 3142, Université d'Angers-Université de Brest, Angers, France
| | - Jean-Philippe Bouchara
- Groupe d'Étude des Interactions Hôte-Pathogène (GEIHP) EA 3142, Université d'Angers-Université de Brest, Angers, France
| | - Nicolas Papon
- Groupe d'Étude des Interactions Hôte-Pathogène (GEIHP) EA 3142, Université d'Angers-Université de Brest, Angers, France
| | - Denis Blanchet
- Laboratory of Mycology and Parasitology, Andrée Rosemon Hospital, Cayenne, French Guiana.,Equipe EA3593 - Ecosystèmes Amazoniens et Pathologie Tropicale, Université de Guyane, Cayenne, French Guiana
| | - Magalie Demar
- Laboratory of Mycology and Parasitology, Andrée Rosemon Hospital, Cayenne, French Guiana.,Equipe EA3593 - Ecosystèmes Amazoniens et Pathologie Tropicale, Université de Guyane, Cayenne, French Guiana
| | - Gilles Nevez
- Groupe d'Étude des Interactions Hôte-Pathogène (GEIHP) EA 3142, Université d'Angers-Université de Brest, Angers, France.,Laboratory of Mycology and Parasitology, CHRU de Brest, Brest, France
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Bouchara JP, Le Govic Y, Kabbara S, Cimon B, Zouhair R, Hamze M, Papon N, Nevez G. Advances in understanding and managing Scedosporium respiratory infections in patients with cystic fibrosis. Expert Rev Respir Med 2019; 14:259-273. [PMID: 31868041 DOI: 10.1080/17476348.2020.1705787] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Introduction: Considered for a long time to be exclusively responsible for chronic localized infections, fungi of the genus Scedosporium have recently received a renewed interest because of their recognition as common colonizing agents of the respiratory tract of patients with cystic fibrosis, and of the description of severe disseminated infections in patients undergoing lung transplantation. Recently, several studies have been carried out on these opportunistic pathogens, which led to some advances in the understanding of their pathogenic mechanisms and in the biological diagnosis of the airway colonization/respiratory infections caused by these fungi.Areas covered: From a bibliographic search on the Pubmed database, we summarize the current knowledge about the taxonomy of Scedosporium species, the epidemiology of these fungi and their pathogenic mechanisms, and present the improvements in the detection of the airway colonization and diagnosis of Scedosporium respiratory infections, the difficulties in their therapeutic management, and the antifungal drugs in development.Expert opinion: As described in this review, many advances have been made regarding the taxonomy and ecology of Scedosporium species or the molecular determinants of their pathogenicity, but also in the management of Scedosporium infections, particularly by improving the biological diagnostic and publishing evidence for the efficacy of combined therapy.
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Affiliation(s)
- Jean-Philippe Bouchara
- Groupe d'Etude des Interactions Hôte-Pathogène (GEIHP, EA 3142), UNIV Angers, UNIV Brest, SFR 4208 ICAT, Angers, France
| | - Yohann Le Govic
- Groupe d'Etude des Interactions Hôte-Pathogène (GEIHP, EA 3142), UNIV Angers, UNIV Brest, SFR 4208 ICAT, Angers, France
| | - Samar Kabbara
- Groupe d'Etude des Interactions Hôte-Pathogène (GEIHP, EA 3142), UNIV Angers, UNIV Brest, SFR 4208 ICAT, Angers, France
| | - Bernard Cimon
- Groupe d'Etude des Interactions Hôte-Pathogène (GEIHP, EA 3142), UNIV Angers, UNIV Brest, SFR 4208 ICAT, Angers, France
| | - Rachid Zouhair
- Groupe d'Etude des Interactions Hôte-Pathogène (GEIHP, EA 3142), UNIV Angers, UNIV Brest, SFR 4208 ICAT, Angers, France
| | - Monzer Hamze
- Laboratoire Microbiologie Santé et Environnement (LMSE), Ecole Doctorale des Sciences et de Technologie, Faculté de Santé Publique, Université Libanaise, Tripoli, Liban
| | - Nicolas Papon
- Groupe d'Etude des Interactions Hôte-Pathogène (GEIHP, EA 3142), UNIV Angers, UNIV Brest, SFR 4208 ICAT, Angers, France
| | - Gilles Nevez
- Groupe d'Etude des Interactions Hôte-Pathogène (GEIHP, EA 3142), UNIV Angers, UNIV Brest, Brest, France
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Le Clech L, Uguen M, Quinio D, Nevez G, Couturier MA, Ianotto JC, Berthou C, Guillerm G, Le Bars H, Payan C, Narbonne V, Baron R, Saliou P. Evaluation of posaconazole antifungal prophylaxis in reducing the incidence of invasive aspergillosis in patients with acute myeloid leukemia. Curr Res Transl Med 2019; 68:23-28. [PMID: 31787568 DOI: 10.1016/j.retram.2019.11.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 10/28/2019] [Accepted: 11/11/2019] [Indexed: 11/16/2022]
Abstract
PURPOSE OF THE STUDY Invasive aspergillosis (IA) is the most prevalent invasive fungal disease (IFD) in neutropenic patients. Environment is the main source of Aspergillus spores aerosolization especially during building construction. International guidelines recommend mechanical protection during hospital building works; otherwise the use of antifungal prophylaxis is not clearly indicated. Our objective was to determine the efficacy of antifungal prophylaxis by posaconazole on IA incidence in acute myeloid leukemia population and to analyse the benefit of this prophylaxis and HEPA-filters during hospital buildings works. PATIENTS AND METHODS We included patients treated for acute myeloid leukemia at Brest teaching hospital from January 2009 to December 2015. We compared incidence of IA in the group treated by posaconazole from 2012 to 2015 to the incidence of IA in the first group who did not receive antifungal prophylaxis (from 2009 to 2011). The one-year overall survival was also analyzed using the Kaplan-Meier method. RESULTS 245 patients were enrolled including 151 treated with posaconazole. 23 IA were diagnosed between 2009 and 2011 (without antifungal prophylaxis), then 31 between 2012 and 2015 (with posaconazole) without statistical difference between the incidence densities (0.34 per 100 hospitalization-days vs. 0.30 per 100 hospitalization-days, p = 0.71). Incidence density of IA increased during building works (2.40 per 100 hospitalization-days vs. 0.28 per 100 hospitalization-days, p < 0.0001). The incidence density of IA significantly decreased during construction periods when posaconazole prophylaxis was used (1.59 per 100 hospitalization-days vs. 4.87 per 100 hospitalization-days p < 0.0001). CONCLUSION Our study suggests, for the first time, the interest of antifungal prophylaxis in addition to HEPA filtration in prevention of IA during hospital building works.
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Affiliation(s)
- Lenaïg Le Clech
- Department of Haematology, Brest Teaching Hospital, Brest, France; Department of Internal Medicine, Infectious Diseases and Haematology, Cornouaille Hospital Quimper, Quimper, France
| | - Marie Uguen
- Infection Control Unit, Brest Teaching Hospital, Brest, France
| | - Dorothée Quinio
- Laboratory of Mycology, Brest Teaching Hospital, GEIHP EA 3142, Brest, France
| | - Gilles Nevez
- Laboratory of Mycology, Brest Teaching Hospital, GEIHP EA 3142, Brest, France; Université de Bretagne Occidentale, Brest, France
| | | | | | - Christian Berthou
- Department of Haematology, Brest Teaching Hospital, Brest, France; Université de Bretagne Occidentale, Brest, France
| | - Gaëlle Guillerm
- Department of Haematology, Brest Teaching Hospital, Brest, France
| | - Hervé Le Bars
- Department of Microbiology, Brest Teaching Hospital, Brest, France
| | - Christopher Payan
- Université de Bretagne Occidentale, Brest, France; Department of Microbiology, Brest Teaching Hospital, Brest, France; Inserm U1078, Génétique, Génomique et Biotechnologies, Brest, France
| | - Valérie Narbonne
- Department of Microbiology, Brest Teaching Hospital, Brest, France
| | - Raoul Baron
- Infection Control Unit, Brest Teaching Hospital, Brest, France
| | - Philippe Saliou
- Infection Control Unit, Brest Teaching Hospital, Brest, France; Université de Bretagne Occidentale, Brest, France; Inserm U1078, Génétique, Génomique et Biotechnologies, Brest, France.
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Le Gal S, Toubas D, Totet A, Dalle F, Abou Bacar A, Le Meur Y, Nevez G, Accoceberry I, Bailly E, Bellanger AP, Bonhomme J, Cateau E, Candolfi E, Damiani C, Dannaoui E, Dardé ML, Debourgogne A, Delhaes L, Desoubeaux G, Favennec L, Flori P, Gabriel F, Iriart X, Lachaud L, Leterrier M, Le Pape P, Machouard M, Marty P, Maubon D, Millon L, Pomares C, Pons D, Rodier MH. Pneumocystis Infection Outbreaks in Organ Transplantation Units in France: A Nation-Wide Survey. Clin Infect Dis 2019; 70:2216-2220. [DOI: 10.1093/cid/ciz901] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 09/09/2019] [Indexed: 11/14/2022] Open
Abstract
Abstract
The burden of nosocomial Pneumocystis infections in transplantation units in France was evaluated through a retrospective survey. Over 12 years, 16 outbreaks occurred, including 13 among renal transplant recipients (RTRs). We performed Pneumocystis jirovecii genotyping in 5 outbreaks, which suggested that specific strains may have been selected by RTRs.
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Affiliation(s)
- Solène Le Gal
- Groupe d’études des Interactions Hôte-Pathogène (EA 3142), Université de Brest, Université d’Angers, France
- Laboratory of Parasitology and Mycology, Brest University Hospital Brest, France Brest, France
| | - Dominique Toubas
- Laboratory of Parasitology and Mycology, Reims University Hospital Brest, France Reims, France
| | - Anne Totet
- Laboratory of Parasitology and Mycology, Amiens University Hospital Brest, France Amiens, France
| | - Frederic Dalle
- Laboratory of Parasitology and Mycology, Dijon University Hospital Brest, France Dijon, France
| | - Ahmed Abou Bacar
- Institut de Parasitologie et de Pathologie Tropicale de Strasbourg, Université de Strasbourg, Hôpitaux Universitaires de Strasbourg Strasbourg, France
| | - Yann Le Meur
- Department of Nephrology and Renal Transplantation Unit, Brest University Hospital, Brest, France
| | - Gilles Nevez
- Groupe d’études des Interactions Hôte-Pathogène (EA 3142), Université de Brest, Université d’Angers, France
- Laboratory of Parasitology and Mycology, Brest University Hospital Brest, France Brest, France
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Nevez G, Le Gal S. Pulmonary co-infection with Pneumocystis jirovecii and Histoplasma capsulatum in AIDS patients is not a rare event. Int J Infect Dis 2019; 87:126-127. [DOI: 10.1016/j.ijid.2019.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 08/14/2019] [Indexed: 10/26/2022] Open
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Nevez G, Guillaud-Saumur T, Cros P, Roué JM, Le Ny F, Tierrie T, Sizun J, de Parscau L, Le Gal S. Pneumocystis Is Still Involved in Nonimmunosuppressed Preterm Infants in Europe. Clin Infect Dis 2019; 67:645-646. [PMID: 29462273 DOI: 10.1093/cid/ciy132] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Gilles Nevez
- Groupe d'Étude des Interactions Hôtes-Pathogènes-EA, Angers-Brest, Université de Bretagne-Loire, France.,Laboratoire de Mycologie et Parasitologie, CHRU de Brest, France
| | - Thibaud Guillaud-Saumur
- Groupe d'Étude des Interactions Hôtes-Pathogènes-EA, Angers-Brest, Université de Bretagne-Loire, France.,Laboratoire de Mycologie et Parasitologie, CHRU de Brest, France
| | - Pierrick Cros
- Département de Pédiatrie, CHRU de Brest, Brest, France
| | | | - Fabien Le Ny
- Laboratoire de Mycologie et Parasitologie, CHRU de Brest, France
| | - Tess Tierrie
- Département de Pédiatrie, CHRU de Brest, Brest, France
| | - Jacques Sizun
- Département de Pédiatrie, CHRU de Brest, Brest, France
| | | | - Solène Le Gal
- Groupe d'Étude des Interactions Hôtes-Pathogènes-EA, Angers-Brest, Université de Bretagne-Loire, France
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Pougnet R, Pougnet L, Le Gal S, Loddé B, Nevez G. "Champimer" project: investigation of fungal diversity at the air-water interface of maritime environment. Int Marit Health 2019; 70:140-141. [PMID: 31237675 DOI: 10.5603/imh.2019.0022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 05/27/2019] [Indexed: 11/25/2022] Open
Affiliation(s)
- Richard Pougnet
- French Society of Maritime Medicine (Société Française de Médecine Maritime [SFMM]), Brest, France. .,Environmental Diseases Unit, University Hospital, CHRU, Brest, France. .,Universitive Preventive Medicine Unit (Service Universitaire de Médecine Préventive et de Promotion de la Santé [SUMPPS]), Université de Bretagne Occidentale, Brest, France.
| | - Laurence Pougnet
- French Society of Maritime Medicine (Société Française de Médecine Maritime [SFMM]), Brest, France.,Military Hospital, Clermont-Tonnerre, Brest, France.,Groupe d'Etudes des Interactions Hôte-Pathogène (GEIHP), Université de Bretagne Occidentale, Brest, France
| | - Solène Le Gal
- Groupe d'Etudes des Interactions Hôte-Pathogène (GEIHP), Université de Bretagne Occidentale, Brest, France.,Laboratoire de parasitologie et mycologie médicales (UF 8872), CHRU, Brest, France
| | - Brice Loddé
- French Society of Maritime Medicine (Société Française de Médecine Maritime [SFMM]), Brest, France.,Environmental Diseases Unit, University Hospital, CHRU, Brest, France.,Optimisation des Régulations Physiologiques (ORPHY), Université de Bretagne Occidentale, Brest, France
| | - Gilles Nevez
- Groupe d'Etudes des Interactions Hôte-Pathogène (GEIHP), Université de Bretagne Occidentale, Brest, France.,Laboratoire de parasitologie et mycologie médicales (UF 8872), CHRU, Brest, France
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Schwarz C, Vandeputte P, Rougeron A, Giraud S, Dugé de Bernonville T, Duvaux L, Gastebois A, Alastruey-Izquierdo A, Martín-Gomez MT, Mazuelos EM, Sole A, Cano J, Pemán J, Quindos G, Botterel F, Bougnoux ME, Chen S, Delhaès L, Favennec L, Ranque S, Sedlacek L, Steinmann J, Vazquez J, Williams C, Meyer W, Le Gal S, Nevez G, Fleury M, Papon N, Symoens F, Bouchara JP. Developing collaborative works for faster progress on fungal respiratory infections in cystic fibrosis. Med Mycol 2018. [PMID: 29538733 DOI: 10.1093/mmy/myx106] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Cystic fibrosis (CF) is the major genetic inherited disease in Caucasian populations. The respiratory tract of CF patients displays a sticky viscous mucus, which allows for the entrapment of airborne bacteria and fungal spores and provides a suitable environment for growth of microorganisms, including numerous yeast and filamentous fungal species. As a consequence, respiratory infections are the major cause of morbidity and mortality in this clinical context. Although bacteria remain the most common agents of these infections, fungal respiratory infections have emerged as an important cause of disease. Therefore, the International Society for Human and Animal Mycology (ISHAM) has launched a working group on Fungal respiratory infections in Cystic Fibrosis (Fri-CF) in October 2006, which was subsequently approved by the European Confederation of Medical Mycology (ECMM). Meetings of this working group, comprising both clinicians and mycologists involved in the follow-up of CF patients, as well as basic scientists interested in the fungal species involved, provided the opportunity to initiate collaborative works aimed to improve our knowledge on these infections to assist clinicians in patient management. The current review highlights the outcomes of some of these collaborative works in clinical surveillance, pathogenesis and treatment, giving special emphasis to standardization of culture procedures, improvement of species identification methods including the development of nonculture-based diagnostic methods, microbiome studies and identification of new biological markers, and the description of genotyping studies aiming to differentiate transient carriage and chronic colonization of the airways. The review also reports on the breakthrough in sequencing the genomes of the main Scedosporium species as basis for a better understanding of the pathogenic mechanisms of these fungi, and discusses treatment options of infections caused by multidrug resistant microorganisms, such as Scedosporium and Lomentospora species and members of the Rasamsonia argillacea species complex.
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Affiliation(s)
- Carsten Schwarz
- Department of Pediatric Pneumology and Immunology, Cystic Fibrosis Center Berlin/Charité -Universitätsmedizin Berlin, Berlin, Germany
| | - Patrick Vandeputte
- Host-Pathogen Interaction Study Group (EA 3142), UNIV Angers, UNIV Brest, Université Bretagne-Loire, Angers, France.,Laboratoire de Parasitologie-Mycologie, CHU, Angers, France
| | - Amandine Rougeron
- Université de Bordeaux, Microbiologie Fondamentale et Pathogénicité UMR 5234, Bordeaux, France; CNRS, Microbiologie Fondamentale et Pathogénicité, UMR 5234, Bordeaux, France; Laboratoire de Parasitologie-Mycologie, CHU, Bordeaux, France
| | - Sandrine Giraud
- Host-Pathogen Interaction Study Group (EA 3142), UNIV Angers, UNIV Brest, Université Bretagne-Loire, Angers, France
| | - Thomas Dugé de Bernonville
- Biomolécules et Biotechnologies Végétales (EA 2106), Département de Biologie et Physiologie Végétales, UFR Sciences et Techniques, Université François Rabelais, Tours
| | - Ludovic Duvaux
- Host-Pathogen Interaction Study Group (EA 3142), UNIV Angers, UNIV Brest, Université Bretagne-Loire, Angers, France.,Institut de Recherche en Horticulture et Semences (IRHS), UMR INRA 1345, Beaucouzé, France
| | - Amandine Gastebois
- Host-Pathogen Interaction Study Group (EA 3142), UNIV Angers, UNIV Brest, Université Bretagne-Loire, Angers, France
| | - Ana Alastruey-Izquierdo
- Mycology Reference Laboratory, National Centre for Microbiology, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - Maria Teresa Martín-Gomez
- Respiratory Bacteriology Unit & Clinical Mycology Unit, Department of Microbiology, Vall D'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Amparo Sole
- Unidad de Trasplante Pulmonar y Fibrosis Quística, Hospital Universitari la Fe, Valencia, Spain
| | - Josep Cano
- Mycology Unit, Medical School/Oenology School, Universitat Rovira i Virgili, Reus, Spain
| | - Javier Pemán
- Unidad de Micología, Servicio de Microbiología, Universitari la Fe, Valencia, Spain
| | - Guillermo Quindos
- Laboratorio de Micología Médica, Departamento de Inmunología, Microbiología y Parasitología, Facultad de Medicina y Enfermería, Universidad del País Vasco, Bilbao, Spain
| | - Françoise Botterel
- Laboratoire de Parasitologie-Mycologie, CHU Henri Mondor, Créteil, France
| | | | - Sharon Chen
- Centre for Infectious Diseases and Microbiology Laboratory Services, ICPMR - Pathology West, Westmead Hospital, Westmead, New South Wales, Australia
| | - Laurence Delhaès
- Center for Cardiothoracic Research of Bordeaux, Inserm U1045, Bordeaux, France
| | - Loïc Favennec
- Laboratoire de Parasitologie-Mycologie, EA 3800, CHU Charles Nicolle and Université de Rouen, Rouen, France
| | - Stéphane Ranque
- Laboratoire de Parasitologie-Mycologie, AP-HM Timone, Marseille, France
| | - Ludwig Sedlacek
- Institute of Medical Microbiology and Hospital Epidemiology, Medical School Hannover, Hannover, Germany
| | - Joerg Steinmann
- Institute of Medical Microbiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Jose Vazquez
- Division of Infectious Diseases, Department of Medicine, Georgia Regents University, Augusta, GA, USA
| | - Craig Williams
- University of the West of Scotland, Institute of Healthcare Associated Infection, University Hospital Crosshouse, Kilmarnock, United Kingdom
| | - Wieland Meyer
- Molecular Mycology Research Laboratory, Centre for Infectious Diseases and Microbiology, Sydney Medical School, Westmead Clinical School, Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Westmead Hospital, Westmead Institute for Medical Research, Westmead, NSW, Australia
| | - Solène Le Gal
- Host-Pathogen Interaction Study Group (EA 3142), UNIV Angers, UNIV Brest, Université Bretagne-Loire, Brest, France.,Laboratoire de Parasitologie-Mycologie, CHU, Brest, France
| | - Gilles Nevez
- Host-Pathogen Interaction Study Group (EA 3142), UNIV Angers, UNIV Brest, Université Bretagne-Loire, Brest, France.,Laboratoire de Parasitologie-Mycologie, CHU, Brest, France
| | - Maxime Fleury
- Host-Pathogen Interaction Study Group (EA 3142), UNIV Angers, UNIV Brest, Université Bretagne-Loire, Angers, France
| | - Nicolas Papon
- Host-Pathogen Interaction Study Group (EA 3142), UNIV Angers, UNIV Brest, Université Bretagne-Loire, Angers, France
| | - Françoise Symoens
- Host-Pathogen Interaction Study Group (EA 3142), UNIV Angers, UNIV Brest, Université Bretagne-Loire, Angers, France
| | - Jean-Philippe Bouchara
- Host-Pathogen Interaction Study Group (EA 3142), UNIV Angers, UNIV Brest, Université Bretagne-Loire, Angers, France.,Laboratoire de Parasitologie-Mycologie, CHU, Angers, France
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Delhaes L, Touati K, Faure-Cognet O, Cornet M, Botterel F, Dannaoui E, Morio F, Le Pape P, Grenouillet F, Favennec L, Le Gal S, Nevez G, Duhamel A, Borman A, Saegeman V, Lagrou K, Gomez E, Carro ML, Canton R, Campana S, Buzina W, Chen S, Meyer W, Roilides E, Simitsopoulou M, Manso E, Cariani L, Biffi A, Fiscarelli E, Ricciotti G, Pihet M, Bouchara JP. Prevalence, geographic risk factor, and development of a standardized protocol for fungal isolation in cystic fibrosis: Results from the international prospective study "MFIP". J Cyst Fibros 2018; 18:212-220. [PMID: 30348610 DOI: 10.1016/j.jcf.2018.10.001] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 08/07/2018] [Accepted: 10/01/2018] [Indexed: 01/18/2023]
Affiliation(s)
| | - Kada Touati
- University & CHU of Lille, F-59000 Lille, France
| | - Odile Faure-Cognet
- Univ. Grenoble Alpes, CNRS, Grenoble INP, CHU Grenoble Alpes, TIMC-IMAG, Grenoble, France
| | - Muriel Cornet
- Univ. Grenoble Alpes, CNRS, Grenoble INP, CHU Grenoble Alpes, TIMC-IMAG, Grenoble, France
| | | | | | | | | | | | | | | | | | | | | | - Veroniek Saegeman
- University of Leuven, National Reference center for Mycosis, Belgium
| | - Katrien Lagrou
- University of Leuven, National Reference center for Mycosis, Belgium
| | - Elia Gomez
- Hosital Universitario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), University of Madrid, Spain
| | - Maiz-Luis Carro
- Hosital Universitario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), University of Madrid, Spain
| | - Rafael Canton
- Hosital Universitario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), University of Madrid, Spain
| | | | | | - Sharon Chen
- Molecular Mycology Research Laboratory, Marie Bashir Institute for Biosecurity and Emerging Infections, University of Sydney, Australia
| | - Wieland Meyer
- Molecular Mycology Research Laboratory, Marie Bashir Institute for Biosecurity and Emerging Infections, University of Sydney, Australia
| | | | | | | | - Lisa Cariani
- Microbiology and Cystic Fibrosis Microbiology Laboratory, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milano, Italy
| | - Arianna Biffi
- Microbiology and Cystic Fibrosis Microbiology Laboratory, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milano, Italy
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Fréalle E, Valade S, Guigue N, Hamane S, Chabé M, Le Gal S, Damiani C, Totet A, Aliouat EM, Nevez G, Menotti J. Diffusion of Pneumocystis jirovecii in the surrounding air of patients with Pneumocystis colonization: frequency and putative risk factors. Med Mycol 2018; 55:568-572. [PMID: 27811179 DOI: 10.1093/mmy/myw113] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 10/19/2016] [Indexed: 11/14/2022] Open
Abstract
In a prospective bicentric study, Pneumocystis jirovecii excretion and diffusion was explored in air samples collected in the rooms occupied by 17 Pneumocystis-colonized patients. P. jirovecii DNA was detected by real-time PCR in the air collected from 3 patients' rooms (17.6%), with identical genotypes in corresponding clinical and air samples. Pneumocystis DNA was detected for 2/3 patients with autoimmune disease treated with corticosteroids versus 1/6 patients with hematologic disease and 0/5 kidney transplant recipients. These data confirm the possible excretion of the fungus by Pneumocystis-colonized patients and thus bring additional arguments for the prevention of airborne transmission in hospital wards.
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Affiliation(s)
- Emilie Fréalle
- CHU Lille, Laboratory of Parasitology-Mycology, F-59000, Lille.,Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, U1019-UMR 8204 - CIIL - Center for Infection and Immunity of Lille, Lille
| | - Sandrine Valade
- Intensive Care Unit, Saint-Louis University Hospital, AP-HP and Paris-Diderot University, Sorbonne Paris Cité, Paris
| | - Nicolas Guigue
- Laboratory of Parasitology-Mycology, Saint-Louis University Hospital, AP-HP and Paris-Diderot University, Sorbonne Paris Cité, Paris
| | - Samia Hamane
- Laboratory of Parasitology-Mycology, Saint-Louis University Hospital, AP-HP and Paris-Diderot University, Sorbonne Paris Cité, Paris
| | - Magali Chabé
- Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, U1019-UMR 8204 - CIIL - Center for Infection and Immunity of Lille, Lille
| | - Solène Le Gal
- Laboratory of Parasitology-Mycology, GEIHP EA 3142, Brest University Hospital, Brest
| | - Céline Damiani
- Laboratory of Parasitology-Mycology, Amiens University Hospital and University of Picardie-Jules Verne, Amiens
| | - Anne Totet
- Laboratory of Parasitology-Mycology, Amiens University Hospital and University of Picardie-Jules Verne, Amiens
| | - El Moukhtar Aliouat
- Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, U1019-UMR 8204 - CIIL - Center for Infection and Immunity of Lille, Lille
| | - Gilles Nevez
- Laboratory of Parasitology-Mycology, GEIHP EA 3142, Brest University Hospital, Brest
| | - Jean Menotti
- Laboratory of Parasitology-Mycology, Saint-Louis University Hospital, AP-HP and Paris-Diderot University, Sorbonne Paris Cité, Paris.,Environmental epidemiology unit, EA 4064, Paris-Descartes University, Sorbonne Paris Cité, Paris, France
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Argy N, Le Gal S, Coppée R, Song Z, Vindrios W, Massias L, Kao WC, Hunte C, Yazdanpanah Y, Lucet JC, Houzé S, Clain J, Nevez G. Pneumocystis Cytochrome b Mutants Associated With Atovaquone Prophylaxis Failure as the Cause of Pneumocystis Infection Outbreak Among Heart Transplant Recipients. Clin Infect Dis 2018. [DOI: 10.1093/cid/ciy154] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Nicolas Argy
- Laboratoire de Parasitologie, Hôpital Bichat–Claude Bernard, APHP, France
- Faculté de Pharmacie de Paris, Université Paris Descartes, Sorbonne Paris Cité, France
- MERIT UMR 216 Institut de Recherche pour le Développement, France
| | - Solène Le Gal
- Laboratoire de Parasitologie, Centre Hospitalo-Universitaire de Brest, France
- GEIHP EA 3142, Université de Bretagne Occidentale, Brest, France
| | - Romain Coppée
- Faculté de Pharmacie de Paris, Université Paris Descartes, Sorbonne Paris Cité, France
- MERIT UMR 216 Institut de Recherche pour le Développement, France
| | - Zehua Song
- Institute for Integrative Biology of the Cell, CEA, CNRS, Université Paris-Sud, Gif-sur-Yvette, France
- Translational Research Institute, Henan Provincial People’s Hospital, School of Medicine, Henan University, Zhengzhou, China
| | | | - Laurent Massias
- Laboratoire de Pharmacologie-Toxicologie, Hôpital Bichat–Claude Bernard, APHP, France
- IAME, UMR 1137, INSERM, Université Paris Diderot, COMUE Sorbonne Paris Cité, France
| | - Wei-Chun Kao
- Institute for Biochemistry and Molecular Biology, ZBMZ, Faculty of Medicine, BIOSS Centre for Biological Signalling Studies, University of Freiburg, Germany
| | - Carola Hunte
- Institute for Biochemistry and Molecular Biology, ZBMZ, Faculty of Medicine, BIOSS Centre for Biological Signalling Studies, University of Freiburg, Germany
| | - Yazdan Yazdanpanah
- Service des Maladies Infectieuses et Tropicales, France
- IAME, UMR 1137, INSERM, Université Paris Diderot, COMUE Sorbonne Paris Cité, France
| | - Jean-Christophe Lucet
- IAME, UMR 1137, INSERM, Université Paris Diderot, COMUE Sorbonne Paris Cité, France
- Unité d’Hygiène et de Lutte Contre l’Infection Nosocomiale, Hôpital Bichat–Claude Bernard, APHP, Paris, France
| | - Sandrine Houzé
- Laboratoire de Parasitologie, Hôpital Bichat–Claude Bernard, APHP, France
- Faculté de Pharmacie de Paris, Université Paris Descartes, Sorbonne Paris Cité, France
- MERIT UMR 216 Institut de Recherche pour le Développement, France
| | - Jérôme Clain
- Faculté de Pharmacie de Paris, Université Paris Descartes, Sorbonne Paris Cité, France
- MERIT UMR 216 Institut de Recherche pour le Développement, France
| | - Gilles Nevez
- Laboratoire de Parasitologie, Centre Hospitalo-Universitaire de Brest, France
- GEIHP EA 3142, Université de Bretagne Occidentale, Brest, France
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Nevez G, Le Gal S, Noel N, Wynckel A, Huguenin A, Le Govic Y, Pougnet L, Virmaux M, Toubas D, Bajolet O. Investigation of nosocomial pneumocystis infections: usefulness of longitudinal screening of epidemic and post-epidemic pneumocystis genotypes. J Hosp Infect 2017; 99:332-345. [PMID: 28943270 DOI: 10.1016/j.jhin.2017.09.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 09/18/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Twenty-five patients, of whom 22 were renal transplant recipients, developed Pneumocystis jirovecii infections at the nephrology department of Reims University Hospital (France) from September 2008 to October 2009, whereas only four sporadic cases had been diagnosed in this department over the 14 previous years. AIM This outbreak was investigated by analysing patient encounters and P. jirovecii types. METHODS A transmission map was drawn up. P. jirovecii typing at DHPS, ITS and mtLSU rRNA sequences was performed in the patients of the cluster (18 patients with Pneumocystis pneumonia (PCP) and seven colonized patients), 10 unlinked control patients (six PCP patients and four colonized patients), as well as 23 other patients diagnosed with P. jirovecii (nine PCP patients and 14 colonized patients) in the same department over a three-year post-epidemic period. FINDINGS Eleven encounters between patients harbouring the same types were observed. Three PCP patients and one colonized patient were considered as possible index cases. The most frequent types in the cluster group and the control group were identical. However, their frequency was significantly higher in the first than in the second group (P < 0.01). Identical types were also identified in the post-epidemic group, suggesting a second outbreak due to the same strain, contemporary to a disruption in prevention measures. CONCLUSIONS These results provide additional data on the role of both PCP and colonized patients as infectious sources. Longitudinal screening of P. jirovecii types in infected patients, including colonized patients, is required in the investigation of the fungus's circulation within hospitals.
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Affiliation(s)
- G Nevez
- Université de Bretagne Loire, GEIHP EA 3142, Brest, France; Laboratory of Parasitology and Mycology, Brest University Hospital, Brest, France.
| | - S Le Gal
- Université de Bretagne Loire, GEIHP EA 3142, Brest, France; Laboratory of Parasitology and Mycology, Brest University Hospital, Brest, France
| | - N Noel
- Department of Nephrology, Reims University Hospital, Reims, France
| | - A Wynckel
- Department of Nephrology, Reims University Hospital, Reims, France
| | - A Huguenin
- Laboratory of Parasitology and Mycology, Reims University Hospital, Reims, France
| | - Y Le Govic
- Université de Bretagne Loire, GEIHP EA 3142, Angers, France
| | - L Pougnet
- Université de Bretagne Loire, GEIHP EA 3142, Brest, France
| | - M Virmaux
- Université de Bretagne Loire, GEIHP EA 3142, Brest, France
| | - D Toubas
- Laboratory of Parasitology and Mycology, Reims University Hospital, Reims, France; Université de Reims Champagne-Ardenne, Equipe MéDIAN, Biophotonique et Technologies pour la Santé, Reims, France
| | - O Bajolet
- Université de Reims Champagne-Ardenne, EA 7887, Reims, France; Equipe Opérationnelle d'Hygiène, Reims University Hospital, Reims, France
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Guillaud-Saumur T, Le Gal S, Cros P, Virmaux M, Vallet S, Pougnet L, Totet A, De Parscau L, Nevez G. Primo-infection à Pneumocystis jirovecii et diversité génotypique. J Mycol Med 2017. [DOI: 10.1016/j.mycmed.2017.04.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Navarro-Arias MJ, Dementhon K, Defosse TA, Foureau E, Courdavault V, Clastre M, Le Gal S, Nevez G, Le Govic Y, Bouchara JP, Giglioli-Guivarc'h N, Noël T, Mora-Montes HM, Papon N. Group X hybrid histidine kinase Chk1 is dispensable for stress adaptation, host–pathogen interactions and virulence in the opportunistic yeast Candida guilliermondii. Res Microbiol 2017; 168:644-654. [DOI: 10.1016/j.resmic.2017.04.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2017] [Revised: 03/03/2017] [Accepted: 04/26/2017] [Indexed: 10/19/2022]
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Le Gal S, Hoarau G, Virmaux M, Pougnet L, Poubeau P, Picot S, Nevez G. Diversité génotypique de Pneumocystis jirovecii à la Réunion. J Mycol Med 2017. [DOI: 10.1016/j.mycmed.2017.04.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Hoarau G, Le Gal S, Zunic P, Poubeau P, Antok E, Jaubert J, Nevez G, Picot S. Evaluation of quantitative FTD-Pneumocystis jirovecii kit for Pneumocystis infection diagnosis. Diagn Microbiol Infect Dis 2017; 89:212-217. [PMID: 28851493 DOI: 10.1016/j.diagmicrobio.2017.08.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 08/02/2017] [Accepted: 08/04/2017] [Indexed: 11/28/2022]
Abstract
We evaluated the Fast track Diagnostics (FTD) Pneumocystis PCR kit, targeting the mitochondrial large subunit ribosomal RNA gene (mtLSU rRNA) of Pneumocystis jirovecii (P. jirovecii). A hundred and thirty-three patients were prospectively enrolled. Respiratory specimens were examined using both microscopy and the PCR assay. Twenty-six patients led to P. jirovecii detection. Fourteen patients presented with Pneumocystis pneumonia (PCP) whereas 12 patients were considered to be colonized. The median copy numbers in bronchoalveolar lavage fluid were significantly different in the PCP and colonization groups (1.35×108/ml vs. 1.45×105/ml, P < 0.0001). Lower and upper cut-off values of 3.9×105 copies/ml and 3.2×106 copies/ml allowed differentiating PCP and colonization. The FTD P. jirovecii assay was secondarily compared to an in-house reference PCR assay targeting the mtLSUrRNA gene. A concordance rate of 97.5% was observed (Cohen's kappa coefficient κ=0.935). The FTD Pneumocystis PCR kit showed good performance and represents an alternative method to diagnose P. jirovecii infections.
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Affiliation(s)
- Gautier Hoarau
- Department of Microbiology, CHU La Reunion, St Pierre, France; UMR PIMIT « processus infectieux en milieu insulaire tropical », Inserm 1187, CNRS 9192, IRD 249, université de La Réunion, CYROI, 97490 Sainte-Clotilde, Reunion.
| | | | - Patricia Zunic
- Department of Hematology and Medical Oncology, CHU La Reunion, St Pierre, France
| | - Patrice Poubeau
- Department of Infectious Diseases, CHU La Reunion, St Pierre, France
| | | | - Julien Jaubert
- Department of Microbiology, CHU La Reunion, St Pierre, France
| | - Gilles Nevez
- University of Brest, GEIHP EA, 3142, Brest, France
| | - Sandrine Picot
- Department of Microbiology, CHU La Reunion, St Pierre, France
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Nevez G, Robert-Gangneux F, Pougnet L, Virmaux M, Belleguic C, Deneuville E, Rault G, Chevrier S, Ramel S, Le Bihan J, Guillaud-Saumur T, Calderon E, Le Govic Y, Gangneux JP, Le Gal S. Pneumocystis jirovecii and Cystic Fibrosis in Brittany, France. Mycopathologia 2017; 183:81-87. [DOI: 10.1007/s11046-017-0172-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 06/27/2017] [Indexed: 11/30/2022]
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Vargas SL, Ponce C, Bustamante R, Calderón E, Nevez G, De Armas Y, Matos O, Miller RF, Gallo MJ. Importance of tissue sampling, laboratory methods, and patient characteristics for detection of Pneumocystis in autopsied lungs of non-immunosuppressed individuals. Eur J Clin Microbiol Infect Dis 2017; 36:1711-1716. [PMID: 28584896 PMCID: PMC5602097 DOI: 10.1007/s10096-017-3006-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Accepted: 05/03/2017] [Indexed: 11/29/2022]
Abstract
To understand the epidemiological significance of Pneumocystis detection in a lung tissue sample of non-immunosuppressed individuals, we examined sampling procedures, laboratory methodology, and patient characteristics of autopsy series reported in the literature. Number of tissue specimens, DNA-extraction procedures, age and underlying diagnosis highly influence yield and are critical to understand yield differences of Pneumocystis among reports of pulmonary colonization in immunocompetent individuals.
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Affiliation(s)
- S L Vargas
- Programa de Microbiología y Micología, Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Independencia 1027, 8380453, Santiago, Chile.
| | - C Ponce
- Programa de Microbiología y Micología, Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Independencia 1027, 8380453, Santiago, Chile
| | - R Bustamante
- Programa de Microbiología y Micología, Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Independencia 1027, 8380453, Santiago, Chile
| | - E Calderón
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP) and Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain
| | - G Nevez
- Laboratory of Parasitology and Mycology, Brest University Hospital, & University of Brest, GEIHP, EA 3142, Brest, France
| | - Y De Armas
- Hospital Microbiology Department, Institute of Tropical Medicine "Pedro Kourí" Pathology Department, Institute of Tropical Medicine "Pedro Kourí" Hospital, Havana, Cuba
| | - O Matos
- Unidade de Parasitología Médica, Grupo de Protozoários Oportunistas/VIH e Outros Protozoarios, Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade NOVA de Lisboa, 1349-008, Lisbon, Portugal
| | - R F Miller
- Research Department of Infection and Population Health, Institute of Global Health, University College London, Mortimer Market Street, London, WC1E 6BT, UK
- Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK
| | - M J Gallo
- Servicio Médico Legal, Av. La Paz 1012, 8380454, Santiago, Chile
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Le Gal S, Robert-Gangneux F, Damiani C, Virmaux M, Belleguic C, Deneuville E, Rault G, Ramel S, Bihan J, Guillaud-Saumur T, Pougnet L, Totet A, Gangneux JP, Bouchara JP, Nevez G. 159 Pneumocystis jirovecii and cystic fibrosis in Britanny, France. J Cyst Fibros 2017. [DOI: 10.1016/s1569-1993(17)30523-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Vandeputte P, Dugé de Bernonville T, Le Gal S, Le Govic Y, Giraud S, Fleury M, Nevez G, Bouchara JP, Papon N. 146 Deciphering the adaptive mechanisms implemented by Scedosporium apiospermum to cope with environmental conditions in cystic fibrosis-modified lung mucus: a transcriptomic analysis. J Cyst Fibros 2017. [DOI: 10.1016/s1569-1993(17)30510-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Vindrios W, Argy N, Le Gal S, Lescure FX, Massias L, Le MP, Wolff M, Yazdanpanah Y, Nevez G, Houze S, Dorent R, Lucet JC. Outbreak of Pneumocystis jirovecii Infection Among Heart Transplant Recipients: Molecular Investigation and Management of an Interhuman Transmission. Clin Infect Dis 2017; 65:1120-1126. [DOI: 10.1093/cid/cix495] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 05/24/2017] [Indexed: 11/14/2022] Open
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Argy N, Bertin G, Milet J, Hubert V, Clain J, Cojean S, Houzé P, Tuikue-Ndam N, Kendjo E, Deloron P, Houzé S, Matheron S, Casalino E, Wolff M, Delaval A, Agnamey P, Durand R, Pilo J, Rapp C, Faucher J, Cuisenier B, Poilane I, Bemba D, Roide A, Debourgogne A, Thibault M, Toubas D, Patoz P, De Gentile L, Pons D, Hurst J, Lohmann C, Bigel M, Godineau N, Thouvenin M, Dunand J, Ait-Ammar N, Angoulvant A, Dahane N, Lefevre M, Murat J, Garnaud C, Dannaoui E, Botterel F, Dutoit E, Dardé M, Ichou H, Branger C, Penn P, Angebault C, Morio F, Bret L, Thellier M, Mouri O, Cateau E, Siriez J, Fenneteau O, Revest M, Belaz S, Belkadi G, Hamane S, Bretagne S, Aboubacar A, Leloup G, Develoux M, Lapillonne H, Eloy O, Nevez G, Raffenot D, Buret B, Desoubeaux G, Goepp A. Preferential expression of domain cassettes 4, 8 and 13 of Plasmodium falciparum erythrocyte membrane protein 1 in severe malaria imported in France. Clin Microbiol Infect 2017; 23:211.e1-211.e4. [DOI: 10.1016/j.cmi.2016.10.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Revised: 10/06/2016] [Accepted: 10/12/2016] [Indexed: 11/25/2022]
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Le Gal S, Robert-Gangneux F, Pépino Y, Belaz S, Damiani C, Guéguen P, Pitous M, Virmaux M, Lissillour E, Pougnet L, Guillaud-Saumur T, Toubas D, Valot S, Hennequin C, Morio F, Hasseine L, Bouchara JP, Totet A, Nevez G. A misleading false-negative result of Pneumocystis real-time PCR assay due to a rare punctual mutation: A French multicenter study. Med Mycol 2016; 55:180-184. [PMID: 27489302 DOI: 10.1093/mmy/myw051] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 02/05/2016] [Accepted: 06/18/2016] [Indexed: 11/13/2022] Open
Abstract
This article describes a previously unreported mutation at position 210 (C210T) of the mitochondrial large subunit ribosomal RNA (mtLSUrRNA) gene of Pneumocystis jirovecii, which led to a false-negative result of a real-time polymerase chain reaction (PCR) assay. Since the aforementioned real-time PCR assay is widely used in France, a French multicenter study was conducted to estimate the mutation frequency and its potential impact on the routine diagnosis of Pneumocystis pneumonia (PCP). Through analysis of data obtained from eight centers, the mutation frequency was estimated at 0.28%. This low frequency should not call into question the routine use of this PCR assay. Nonetheless, the occurrence of the false-negative PCR result provides arguments for maintaining microscopic techniques combined to PCR assays to achieve PCP diagnosis.
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Affiliation(s)
- Solène Le Gal
- University of Brest, GEIHP EA 3142, Brest, France .,Laboratory of Parasitology and Mycology, Brest University Hospital, Brest, France
| | - Florence Robert-Gangneux
- University of Rennes 1, INSERM U1085, Rennes, France.,Laboratory of Parasitology and Mycology, Rennes University Hospital, Rennes, France
| | - Yann Pépino
- University of Brest, GEIHP EA 3142, Brest, France
| | - Sorya Belaz
- University of Rennes 1, INSERM U1085, Rennes, France.,Laboratory of Parasitology and Mycology, Rennes University Hospital, Rennes, France
| | - Céline Damiani
- University of Picardy-Jules Verne, EA 4285 UMR-I 01 INERIS, Amiens, France.,Department of Parasitology and Mycology, Amiens University Hospital, Amiens, France
| | - Paul Guéguen
- Laboratory of Molecular Genetics and Histocompatibility, Brest University Hospital, Brest, France.,University of Brest, INSERM 1078, Molecular Genetics and Epidemiological Genetics, SFR 148, Brest, France
| | | | | | | | | | | | - Dominique Toubas
- Parasitology and Mycology laboratory, Reims University Hospital, Reims, France
| | - Stéphane Valot
- Parasitology and Mycology laboratory, Dijon University Hospital, Dijon, France
| | - Christophe Hennequin
- Parasitology and Mycology laboratory, Saint Antoine Hospital, Assistance Publique-Hôpitaux de Paris, France
| | - Florent Morio
- Parasitology and Mycology laboratory, Nantes University Hospital, Nantes, France
| | - Lilia Hasseine
- Parasitology and Mycology laboratory, Nice University Hospital, Nice, France
| | | | - Anne Totet
- University of Picardy-Jules Verne, EA 4285 UMR-I 01 INERIS, Amiens, France.,Department of Parasitology and Mycology, Amiens University Hospital, Amiens, France
| | - Gilles Nevez
- University of Brest, GEIHP EA 3142, Brest, France .,Laboratory of Parasitology and Mycology, Brest University Hospital, Brest, France
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Guillaud-Saumur T, Le Gal S, Nevez G. Comparison of a new commercial real-time PCR assay (RealCycler PJIR kit, Progenie Molecular) to an in-house real-time PCR assay for the diagnosis of Pneumocystis jirovecii infections. J Mycol Med 2016. [DOI: 10.1016/j.mycmed.2016.04.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Nevez G, Le Gal S, Quinio D, Ianotto JC, Berthou C, Hamane S, Sarfati C, Menotti J. Encephalitozoon hellem in a patient with CD4+ T-cell prolymphocytic leukemia: case report and genomic identification. Diagn Microbiol Infect Dis 2015; 83:245-7. [DOI: 10.1016/j.diagmicrobio.2015.07.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Accepted: 07/20/2015] [Indexed: 11/26/2022]
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