Possible patient to patient transmission of progressive multifocal leukoencephalopathy among kidney-transplant patients

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Possible patient to patient transmission of progressive

multifocal leukoencephalopathy among

kidney-transplant patients

Rebecca Lajaunie, Catherine Mengelle, Nassim Kamar, Arnaud del Bello

To cite this version:

Rebecca Lajaunie, Catherine Mengelle, Nassim Kamar, Arnaud del Bello. Possible patient to patient

transmission of progressive multifocal leukoencephalopathy among kidney-transplant patients.

Brazil-ian Journal of Infectious Diseases, Elsevier, 2020, 24 (5), pp.473-474. �10.1016/j.bjid.2020.07.004�.

�hal-03180615�

brazjinfectdis2020;24(5):473–474

w w w . e l s e v i e r . c o m / l o c a t e / b j i d

The

Brazilian

Journal

of

INFECTIOUS

DISEASES

Letter

to

the

editor

Possible

patient

to

patient

transmission

of

progressive

multifocal

leukoencephalopathy

among

kidney-transplant

patients

Rebecca

Lajaunie

_,

_Catherine

_Mengelle

_,

_Nassim

_Kamar

_,

Arnaud

Del

Bello

a_{NephrologyandOrganTransplantDepartment,CHUdeToulouse,Toulouse,France} b_{DepartmentofVirology,CHUdeToulouse,Toulouse,France}

c_{UniversitéPaulSabatier,Toulouse,France}

d_{CentredePhysiopathologieToulouse-Purpan,Toulouse,France}

DearEditor,

Progressive multifocal leukoencephalopathy (PML) is a brain devastating demyelinating disease caused by the John Cunningham polyomavirus (JCV), that occurs almost

Patient 1 Patient 2 Patient 3 08/12/2016 07/6/2017

PML diagnosis

PML diagnosis

PML diagnosis

Fig.1–EvidenceofhospitalcontactspreviousPMLdiagnosis;redarrowsrepresentpatientscontactsonewithanother; bluearrowsrepresentdatesofPMLdiagnosis.

∗ _{Correspondingauthor.}

E-mailaddress:rebecca.lajaunie@hotmail.fr(R.Lajaunie).

exclusively in immunocompromisedpatients. Nonetheless, PML is a rare complication after solid organ transplanta-tion, with an incidence of 1.24 per 1000 person years,1

and is mostly considered to be a consequence of viral reactivation.

https://doi.org/10.1016/j.bjid.2020.07.004

1413-8670/©2020SociedadeBrasileiradeInfectologia.PublishedbyElsevierEspa ˜na,S.L.U.ThisisanopenaccessarticleundertheCC BY-NC-NDlicense(http://creativecommons.org/licenses/by-nc-nd/4.0/).

474

Patient-to-patienttransmissionofJCV-associatedPMLwas suspectedinnatalizumabtreatedpatients.2,3 _However,this

was not reported after solid organ transplantation so far. Between July 2017 and April 2018, three kidney-transplant recipients followed in our center (81, 77, and 67 years-old, respectively) presented a definite PML (as defined by the American AcademyofNeurology) at5, 2and 11 years post-transplantation,respectively.Twopatientswere receiv-ing tacrolimus, mycophenolic acid and steroids, and the thirdpatientwastreatedwithbelatacept,mycophenolicacid and steroids. Aspreviously reported,4 _despite

discontinua-tionofimmunosuppressantsanduseofimmunecheckpoint inhibitortherapy,allthreepatientsdied.

ThediagnosisofthreecasesofPMLwithinashortperiod, ledustoanalyzetheincidenceofPMLinsolidorgan trans-plantrecipientsinourcenter.BetweenJanuary2007andJune 2017,aswellasbetweenMay2018andMay2020(i.e.atotalof 150months)nocaseofPMLoccurredinourcenter,whilethree caseswerediagnosedinlessthanninemonths,betweenJuly 2017toApril2018.Thispromptedustoinvestigateapotential closecontactbetweenthesepatientsandapossible nosoco-mialtransmission. Indeed,aspresentedinFig. 1wefound thatthethreepatientsattendedtheclinicatthesametime atleastoncewithinthefewmonthsbeforediagnosis,i.e.two timesforpatients1and2,onceforpatients1and3,andonce forpatients2and3.

JCV could be detected in several biological fluids, such assaliva,oropharyngealfluids,bloodorurine.Althoughthe modeoftransmissionisnotwellknown,initialinfectionby JCVisconsideredtobecausedbyingestionorinhalationof virionparticlesleadingtosubacuteinfections,mainlyduring thechildhood.5_{Unfortunately,wewerenotabletoperformthe}

sequencingofJCVthatcausedPMLinourpatientstoconfirm viraltransmission.Nevertheless,thediagnosisofthreecases withinashortperiodoftimeamongpatientswhoattendedthe

clinicatthesametime,issuggestiveofapatient-to-patient transmission.

Hence, our data suggest that patient to patient trans-mission couldoccurinatransplant-unit, evenifwecannot excludeanothersourceoftransmission.Wesuggestisolation andbarriermeasuresforpatientswithsuspectedorconfirmed PML.

Conflicts

of

interest

Theauthorsdeclarenoconflictsofinterest.

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1.MateenFJ,MuralidharanR,CaroneM,vandeBeekD,Harrison DM,AksamitAJ,etal.Progressivemultifocal

leukoencephalopathyintransplantrecipients.AnnNeurol. 2011;70:305–22,http://dx.doi.org/10.1002/ana.22408.

2.BacchettaF,MathiasA,SchluepM,DuPasquierR.Progressive multifocalleukoencephalopathyintwonatalizumab-treated stepsisters:anintriguingcoincidence.MultScler.

2017;23:300–3,http://dx.doi.org/10.1177/1352458516670734. 3.HohlfeldR,HavlaJ,KümpfelT.Patient-to-patienttransmission

ofnatalizumab-associatedPML?MultScler.2017;23:1564–5,

http://dx.doi.org/10.1177/1352458517701316.

4.MedranoC,VergezF,MengelleC,FaguerS,KamarN,DelBello A.Effectivenessofimmunecheckpointinhibitorsintransplant recipientswithprogressivemultifocalleukoencephalopathy. EmergInfectDis.2019;25:2145–7,

http://dx.doi.org/10.3201/eid2511.190705.

5.MajorEO,YousryTA,CliffordDB.Pathogenesisofprogressive multifocalleukoencephalopathyandrisksassociatedwith treatmentsformultiplesclerosis:adecadeoflessonslearned. LancetNeurol.2018;17:467–80,