Tags

Type your tag names separated by a space and hit enter

Polymerase chain reaction for diagnosing pneumocystis pneumonia in non-HIV immunocompromised patients with pulmonary infiltrates.
Chest. 2009 Mar; 135(3):655-661.Chest

Abstract

RATIONALE

Pneumocystis jiroveci polymerase chain reaction (PCR) has higher sensitivity than conventional stains but cannot distinguish colonization from infection.

METHODS

We compared P jiroveci PCR and conventional stains in HIV-uninfected immunocompromised patients.

RESULTS

Among the 448 patients, 296 (66%) patients had hematologic malignancies; 72 (16.1%), bone marrow transplants; 44 (9.8%), solid tumors; 21 (4.7%), renal transplants; and 15 (3.4%) were taking immunosuppressants for systemic diseases. Diagnostic strategy consisted of BAL in 351 patients and induced sputum (IS) in 97 patients. Conventional pneumocystic pneumonia (PCP) stain was positive in 39 (8.7%) patients, including 34 with positive PCR. In addition, PCR was positive in 32 patients, including 21 with complete follow-up, of whom 14 were diagnosed with probable or definitive PCP (a 36% increase). PCR was 87.2% sensitive and 92.2% specific; positive and negative predictive values were 51.5% and 98.7%, respectively. Sensitivity and negative predictive value were 100% on IS.

CONCLUSIONS

In HIV-uninfected immunocompromised patients with acute pulmonary infiltrates, P jiroveci PCR correlates with clinical evidence of PCP. A negative PCR allows withdrawing anti-PCP therapy.

Links

Publisher Full Text
Aggregator Full Text

Authors+Show Affiliations

Azoulay É
Intensive Care Unit, Paris 7 Diderot University, Saint-Louis Teaching Hospital, Paris, France. Electronic address: elie.azoulay@sls.ap-hop-paris.fr.
Bergeron A
Pulmonology Department, Paris 7 Diderot University, Saint-Louis Teaching Hospital, Paris, France.
Chevret S
Intensive Care Unit, Paris 7 Diderot University, Saint-Louis Teaching Hospital, Paris, France.
Bele N
Intensive Care Unit, Paris 7 Diderot University, Saint-Louis Teaching Hospital, Paris, France.
Schlemmer B
Intensive Care Unit, Paris 7 Diderot University, Saint-Louis Teaching Hospital, Paris, France.
Menotti J
Intensive Care Unit, Paris 7 Diderot University, Saint-Louis Teaching Hospital, Paris, France.

MeSH

Bronchoalveolar Lavage FluidHIV SeronegativityHumansImmunocompromised HostOpportunistic InfectionsPneumocystis cariniiPneumonia, PneumocystisPolymerase Chain ReactionPredictive Value of TestsSensitivity and SpecificitySputum

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

19265086

Clinical Trial Links

Study of the Complications Associated With Certain Stem Cell Transplants

Citation

Azoulay, Élie, et al. "Polymerase Chain Reaction for Diagnosing Pneumocystis Pneumonia in non-HIV Immunocompromised Patients With Pulmonary Infiltrates." Chest, vol. 135, no. 3, 2009, pp. 655-661.
Azoulay É, Bergeron A, Chevret S, et al. Polymerase chain reaction for diagnosing pneumocystis pneumonia in non-HIV immunocompromised patients with pulmonary infiltrates. Chest. 2009;135(3):655-661.
Azoulay, É., Bergeron, A., Chevret, S., Bele, N., Schlemmer, B., & Menotti, J. (2009). Polymerase chain reaction for diagnosing pneumocystis pneumonia in non-HIV immunocompromised patients with pulmonary infiltrates. Chest, 135(3), 655-661. https://doi.org/10.1378/chest.08-1309
Azoulay É, et al. Polymerase Chain Reaction for Diagnosing Pneumocystis Pneumonia in non-HIV Immunocompromised Patients With Pulmonary Infiltrates. Chest. 2009;135(3):655-661. PubMed PMID: 19265086.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Polymerase chain reaction for diagnosing pneumocystis pneumonia in non-HIV immunocompromised patients with pulmonary infiltrates. AU - Azoulay,Élie, AU - Bergeron,Anne, AU - Chevret,Sylvie, AU - Bele,Nicolas, AU - Schlemmer,Benoît, AU - Menotti,Jean, PY - 2009/3/7/entrez PY - 2009/3/7/pubmed PY - 2009/4/10/medline SP - 655 EP - 661 JF - Chest JO - Chest VL - 135 IS - 3 N2 - RATIONALE: Pneumocystis jiroveci polymerase chain reaction (PCR) has higher sensitivity than conventional stains but cannot distinguish colonization from infection. METHODS: We compared P jiroveci PCR and conventional stains in HIV-uninfected immunocompromised patients. RESULTS: Among the 448 patients, 296 (66%) patients had hematologic malignancies; 72 (16.1%), bone marrow transplants; 44 (9.8%), solid tumors; 21 (4.7%), renal transplants; and 15 (3.4%) were taking immunosuppressants for systemic diseases. Diagnostic strategy consisted of BAL in 351 patients and induced sputum (IS) in 97 patients. Conventional pneumocystic pneumonia (PCP) stain was positive in 39 (8.7%) patients, including 34 with positive PCR. In addition, PCR was positive in 32 patients, including 21 with complete follow-up, of whom 14 were diagnosed with probable or definitive PCP (a 36% increase). PCR was 87.2% sensitive and 92.2% specific; positive and negative predictive values were 51.5% and 98.7%, respectively. Sensitivity and negative predictive value were 100% on IS. CONCLUSIONS: In HIV-uninfected immunocompromised patients with acute pulmonary infiltrates, P jiroveci PCR correlates with clinical evidence of PCP. A negative PCR allows withdrawing anti-PCP therapy. SN - 1931-3543 UR - https://www.unboundmedicine.com/medline/citation/19265086/Polymerase_chain_reaction_for_diagnosing_pneumocystis_pneumonia_in_non_HIV_immunocompromised_patients_with_pulmonary_infiltrates_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0012-3692(09)60191-4 DB - PRIME DP - Unbound Medicine ER -