Ability of quantitative PCR to discriminate Pneumocystis jirovecii pneumonia from colonization.

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Version: Final published version
License: CC BY 4.0
Serval ID
serval:BIB_BFDF364602B9
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Ability of quantitative PCR to discriminate Pneumocystis jirovecii pneumonia from colonization.
Journal
Journal of medical microbiology
Author(s)
Perret T., Kritikos A., Hauser P.M., Guiver M., Coste A.T., Jaton K., Lamoth F.
ISSN
1473-5644 (Electronic)
ISSN-L
0022-2615
Publication state
Published
Issued date
05/2020
Peer-reviewed
Oui
Volume
69
Number
5
Pages
705-711
Language
english
Notes
Publication types: Journal Article
Publication Status: ppublish
Abstract
Introduction.Pneumocystis jirovecii pneumonia (PCP) is a severe disease affecting immunocompromised patients. Diagnosis is difficult due to the low sensitivity of direct examination and inability to grow the pathogen in culture. Quantitative PCR in bronchoalveolar lavage fluid (BAL) has high sensitivity, but limited specificity for distinguishing PCP from colonization.Aim. To assess the performance of an in-house quantitative PCR to discriminate between PCP and colonization.Methodology. This was a single-centre retrospective study including all patients with a positive PCR result for P. jirovecii in BAL between 2009 and 2017. Irrespective of PCR results, PCP was defined as the presence of host factors and clinical/radiological criteria consistent with PCP and (i) the presence of asci at direct examination of respiratory sample or (ii) anti-PCP treatment initiated with clinical response and absence of alternative diagnosis. Colonization was considered for cases who did not receive anti-PCP therapy with a favourable outcome or an alternative diagnosis. Cases who did not meet the above mentioned criteria were classified as 'undetermined'.Results. Seventy-one patients with positive P. jirovecii PCR were included (90 % non-HIV patients). Cases were classified as follows: 37 PCP, 22 colonization and 12 undetermined. Quantitative PCR values in BAL were significantly higher in patients with PCP versus colonization or undetermined (P<0.0001). The cut-off of 5×10 <sup>3</sup> copies/ml was able to discriminate PCP cases from colonization with 97 % sensitivity, 82 % specificity, 90 % positive predictive value and 95 % negative predictive value.Conclusions. Our quantitative PCR for P. jirovecii in BAL was reliable to distinguish PCP cases from colonization in this predominantly non-HIV population.
Keywords
Adolescent, Adult, Aged, Algorithms, Child, Child, Preschool, Coinfection, Female, Humans, Male, Middle Aged, Molecular Diagnostic Techniques, Pneumocystis carinii/classification, Pneumocystis carinii/genetics, Pneumonia, Pneumocystis/diagnosis, Pneumonia, Pneumocystis/drug therapy, Pneumonia, Pneumocystis/microbiology, Pneumonia, Pneumocystis/mortality, Real-Time Polymerase Chain Reaction/methods, Retrospective Studies, Young Adult, bronchoalveolar lavage fluid, molecular diagnosis, pneumocystosis
Pubmed
Open Access
Yes
Create date
16/06/2020 15:44
Last modification date
24/04/2023 19:38
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