646 • CID 2018:67 (15 August) • CORRESPONDENCE results combined with ours, obtained from Spanish and French populations, respec- tively, show that P. jirovecii is still involved in nonimmunosuppressed preterm infants in Europe and should arouse the interest of pediatricians. Notes Funding. Tis study was supported in part by the European Union (grant number ERANet- LAC CAPRI-PC HID-0254) Potential confict of interest. All authors: No reported conficts of interest. Te author has submitted the ICMJE Form for Disclosure of Potential Conficts of Interest. Conficts that the editors consider relevant to the content of the manuscript have been disclosed. Gilles Nevez, 1,2 Thibaud Guillaud-Saumur, 1,2 Pierrick Cros, 3 Jean-Michel Roué, 3 Fabien Le Ny, 2 Tess Tierrie, 3 Jacques Sizun, 3 Loic de Parscau, 3 and Solène Le Gal 1 1 Groupe d’Étude des Interactions Hôtes-Pathogènes-EA 3142, Angers-Brest, Université de Bretagne-Loire, 2 Laboratoire de Mycologie et Parasitologie, CHRU de Brest, and 3 Département de Pédiatrie, CHRU de Brest, Brest, France References 1. Gajdusek DC. Pneumocystis carinii: etiologic agent of interstitial plasma cell pneumonia of premature and young infants. Pediatrics 1957; 19:543–65. 2. Nevez G, Totet A, Pautard JC, Raccurt C. Pneumocystis carinii detection using nested-PCR in nasopharyngeal aspirates of immunocompetent infants with bronchiolitis. J Eukaryot Microbiol 2001; 48(suppl):S122S–3. 3. Rojas P, Friaza V, García E, et al. Early acquisition of Pneumocystis jirovecii colonization and potential association with respiratory distress syndrome in preterm newborn infants. Clin Infect Dis 2017; 65:976–81. 4. Gal SL, Héry-Arnaud G, Ramel S, et al. Pneumocystis jirovecii and cystic fibrosis in France. Scand J Infect Dis 2010; 42:225–7. 5. Vargas SL, Hughes WT, Santolaya ME, et al. Search for primary infection by Pneumocystis carinii in a cohort of normal, healthy infants. Clin Infect Dis 2001; 32:855–61. 6. Vargas SL, Ponce CA, Luchsinger V, et al. Detection of Pneumocystis carinii f. sp. hominis and viruses in presumably immunocompetent infants who died in the hospital or in the community. J Infect Dis 2005; 191:122–6. 7. Larsen HH, von Linstow ML, Lundgren B, Høgh B, Westh H, Lundgren JD. Primary pneumocystis infection in infants hospitalized with acute res- piratory tract infection. Emerg Infect Dis 2007; 13:66–72. © The Author(s) 2018. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com. DOI: 10.1093/cid/ciy132 Correspondence: G. Nevez, Laboratoire de Mycologie- Parasitologie, CHRU de Brest, 29609 Brest, France (gilles. nevez@univ-brest.fr). Clinical Infectious Diseases ® 2018;67(4):645–6 Reply to Nevez et al To the Editor—We appreciate the comments by Dr Nevez and cowork- ers regarding our article reporting the prevalence of Pneumocystis jirovecii colonization in preterm births and its potential relationship with respiratory distress syndrome [1]. Tey detected by mean of a quantitative polymerase chain reaction (qPCR) assay at mtLSUrRNA gene a 12.3% of P. jirovecii colonization in infants that is lower than the 25.5% of prevalence observed in our study [1, 2]. Te authors think that these difer- ences could be due to 4 causes: (i) study design (prospective vs. retrospective), (ii) the sizes of populations studied (128 vs. 81 babies), (iii) diferences in PCR techniques used for DNA Pneumocystis identifcation, and (iv) geographical dif- ferences in P. jirovecii epidemiology. We agree with Dr Nevez and coworkers but think that mainly the lower level of colon- ization found in their study is explained by varying geographic exposure. In this sense, the prevalence of P. jirovecii col- onization among cystic fbrosis patients from Brittany, the French region where is localized Brest, is 2.5% lower than 21.5% (P < .001) reported in cys- tic fbrosis patients from Seville [3, 4]. Tese data suggested that circulation and transmission of this fungus is more reduced in Brest than in Seville, prob- ably due to climatic factors. Brest has a cool temperate maritime climate, whereas Seville has a hot Continental Mediterranean climate [3–5]. On the other hand, the absence of association between Pneumocystis colon- ization and respiratory distress syndrome in the Nevez’s work could be explained by the few cases of P. jirovecii coloniza- tion identifed in the infants included in the study. Nevertheless, it would be interesting to know the gestational age of the babies included in this study and the prevalence of respiratory distress syn- drome in these population. In any case, data from both studies put together show that P. jirovecii is a fre- quent infectious agent faced by preterm infants, and we agree with Dr Nevez and coworkers that primary Pneumocystis infection should arouse the interest of pediatricians. Future research works in other geographical areas are needed to assess the importance of Pneumocystis colonization in newborns. Notes Financial support. Our work was sup- ported by the European Commission (ERANet- LAC) within the framework of the project ELAC2014/HID0254 and the Institute of Health Carlos III (Spanish Ministry of Economy, Industry and Competitiveness) [AC15/00042, FIS- PI11/02468]. Potential conficts of interest. All authors: No reported conficts of interest. All authors have submitted the ICMJE Form for Disclosure of Potential Conficts of Interest. Pilar Rojas, 1 Vicente Friaza, 2,3 Elisa García, 1 Carmen de la Horra, 2,3 Sergio L. Vargas, 4 Enrique J. Calderón, 2,3 and Antonio Pavón 1 1 Neonatology Unit, Virgen del Rocío University Children’s Hospital, and 2 Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/Consejo Superior de Investigaciones Científcas/Universidad de Sevilla, and 3 Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Hospital Universitario Virgen del Rocío, Seville, Spain; and 4 Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Santiago References 1. Rojas P, Friaza V, García E, et al. Early acquisition of Pneumocystis jirovecii colonization and potential association with respiratory distress syndrome in preterm newborn infants. Clin Infect Dis 2017; 65:976–81. 2. Nevez G, Guillaud-Saumue T, Cros P, et al. Pneumocystis is still involved in non-immunosup- pressed preterm infants in Europe. Clin Infect Dis 2018. doi: 10.12688/f1000research.10619.1. 3. Nevez G, Robert-Gangneux F, Pougnet L, et al. Pneumocystis jirovecii and cystic fibrosis in Brittany, France. Mycopathologia 2018; 183:81–7. 4. Respaldiza N, Montes-Cano MA, Dapena FJ, et al. Prevalence of colonisation and genotypic charac- terisation of Pneumocystis jirovecii among cystic fibrosis patients in Spain. Clin Microbiol Infect 2005; 11:1012–5. 5. Varela JM, Regordán C, Medrano FJ, et al. Climatic factors and Pneumocystis jiroveci infection in south- ern Spain. Clin Microbiol Infect 2004; 10:770–2. © The Author(s) 2018. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com. Correspondence: E. J. Calderón, Department of Internal Medicine, Virgen del Rocío University Hospital, Avda Manuel Siurot s/n, 41013 Seville, Spain (sandube@cica.es). Clinical Infectious Diseases ® 2018;67(4):646 DOI: 10.1093/cid/ciy134 Downloaded from https://academic.oup.com/cid/article-abstract/67/4/646/4859679 by guest on 25 May 2020