Introduction:
Pneumocystis Jiroveci is a fungal pathogen causing opportunistic respiratory infection in immunocompromised patients. The present study is a retrospective analysis to assess the clinical profile, time between transplantation and infection, risk factors and prognosis of Pneumocystis infection in post kidney transplant setting.
Methods:
The study includes 14 out of 300 post kidney transplant patients diagnosed with Pneumocystis infection. We collected computer-based data of these patients.
Results:
The most common clinical presentation was shortness of breath (72%) followed by fever (36%) and nonproductive cough (36%). Mean time to infection post kidney transplant was 3.3 years and 55% were diagnosed post 1 year of transplant. 5 out of 300 patients did not receive Trimethoprim-Sulfamethoxazole prophylaxis in view of their G6PD deficient status or Sulfa allergy. 80% (4out of 5) patients who did not receive TMP-SMX prophylaxis ended up having PCP, while only 3.7%(10 out of 296) of those who received prophylaxis were infected. All patients were treated with TMP-SMX, Dalacin except those who were G6PD deficient who received IV Pentamidine and Dalacin or had Sulfa allergy who received Primaquine and Dalacin. Mean hospital stay was 13 days. 28%(4out of 14) patients had co existing CMV infection. CMV coinfection was associated with a longer hospital stay with a mean of 21days, and mortality of 2 patients. The remaining 12 patients recovered. All patients were diagnosed by PCP PCR from upper respiratory tract swab .Most common HRCT chest finding was bilateral diffuse perihilar ground glass opacities (54%).28%(4 out of 14) patients had co existing Rhino virus infection while 14%(2 out of 14) patients had covid 19.
Conclusions:
Pneumocystis pneumonia remains a serious cause of opportunistic respiratory infection occurring post kidney transplant with an incidence of 4.6% in our setting, with the most common presentation being shortness of breath. This study signifies the importance of universal TMP-SMX prophylaxis in all post kidney transplant patients as 80% of patients in this study who didn’t receive prophylaxis ended up having PCP, and the need for administering an alternative prophylactic drug like Atovaquone or aerosolized Pentamidine or Dapsone in patients who cannot receive TMP-SMX, the only drawback being its difficult availability in India. CMV screening and prompt treatment is integral as it is found to be a risk factor in increasing morbidity and mortality in these patients.
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.