Interhuman transmission of pneumocystis jiroveci

A cluster of cases of pneumocystis pneumonia has been reported from the Westmead hospital transplant unit in Sydney. All patients had had conventional prophylaxis, namely treatment with trimethoprin/sulfamethoxazole for 6 months after transplantation. These cases have all been documented very carefully and the pneumocystis jiroveci have been genotyped and the authors produce convincing evidence that this epidemic outbreak has been due to interhuman transmission. There were 14 cases of whom two died and 6 transplants failed. The unit is now continuing prophylaxis for one year and I understand now are putting all patients on lifetime prophylaxis. This is a fascinating report but also quite alarming, just at a stage when we thought that pnemocystis with prophylaxis in the early months after transplantation was no longer a problem in our transplant populations. I believe there may be other cases of pneumocystis occurring late in the UK; we would like some feed back if so.