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Combined quantification of pulmonary Pneumocystis jirovecii DNA and serum (1->3)-β-D-glucan for differential diagnosis of pneumocystis pneumonia and Pneumocystis colonization.
J Clin Microbiol. 2013 Oct; 51(10):3380-8.JC

Abstract

This study assessed a quantitative PCR (qPCR) assay for Pneumocystis jirovecii quantification in bronchoalveolar lavage (BAL) fluid samples combined with serum (1→3)-β-d-glucan (BG) level detection to distinguish Pneumocystis pneumonia (PCP) from pulmonary colonization with P. jirovecii. Forty-six patients for whom P. jirovecii was initially detected in BAL fluid samples were retrospectively enrolled. Based on clinical data and results of P. jirovecii detection, 17 and 29 patients were diagnosed with PCP and colonization, respectively. BAL fluid samples were reassayed using a qPCR assay targeting the mitochondrial large subunit rRNA gene. qPCR results and serum BG levels (from a Fungitell kit) were analyzed conjointly. P. jirovecii DNA copy numbers were significantly higher in the PCP group than in the colonization group (1.3 × 10(7) versus 3.4 × 10(3) copies/μl, P < 0.05). A lower cutoff value (1.6 × 10(3) copies/μl) achieving 100% sensitivity for PCP diagnosis and an upper cutoff value (2 × 10(4) copies/μl) achieving 100% specificity were determined. Applying these two values, 13/17 PCP patients and 19/29 colonized patients were correctly assigned to their patient groups. For the remaining 14 patients with P. jirovecii DNA copy numbers between the cutoff values, PCP and colonization could not be distinguished on the basis of qPCR results. Four of these patients who were initially assigned to the PCP group presented BG levels of ≥100 pg/ml. The other 10 patients, who were initially assigned to the colonization group, presented BG levels of <100 pg/ml. These results suggest that the combination of the qPCR assay, applying cutoff values of 1.6 × 10(3) and 2 × 10(4) copies/μl, and serum BG detection, applying a 100 pg/ml threshold, can differentiate PCP and colonization diagnoses.

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Authors+Show Affiliations

Damiani C
Parasitology and Mycology Department, Amiens University Hospital, Amiens, France.
Le Gal S
No affiliation info available
Da Costa C
No affiliation info available
Virmaux M
No affiliation info available
Nevez G
No affiliation info available
Totet A
No affiliation info available

MeSH

AdolescentAdultAgedAged, 80 and overBronchoalveolar Lavage FluidCarrier StateChildDNA, FungalDiagnosis, DifferentialFemaleHumansLungMaleMiddle AgedMolecular Diagnostic TechniquesPneumocystis cariniiPneumonia, PneumocystisReal-Time Polymerase Chain ReactionSensitivity and SpecificitySerumYoung Adultbeta-Glucans

Pub Type(s)

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

Language

eng

PubMed ID

23903553

Citation

Damiani, Céline, et al. "Combined Quantification of Pulmonary Pneumocystis Jirovecii DNA and Serum (1->3)-β-D-glucan for Differential Diagnosis of Pneumocystis Pneumonia and Pneumocystis Colonization." Journal of Clinical Microbiology, vol. 51, no. 10, 2013, pp. 3380-8.
Damiani C, Le Gal S, Da Costa C, et al. Combined quantification of pulmonary Pneumocystis jirovecii DNA and serum (1->3)-β-D-glucan for differential diagnosis of pneumocystis pneumonia and Pneumocystis colonization. J Clin Microbiol. 2013;51(10):3380-8.
Damiani, C., Le Gal, S., Da Costa, C., Virmaux, M., Nevez, G., & Totet, A. (2013). Combined quantification of pulmonary Pneumocystis jirovecii DNA and serum (1->3)-β-D-glucan for differential diagnosis of pneumocystis pneumonia and Pneumocystis colonization. Journal of Clinical Microbiology, 51(10), 3380-8. https://doi.org/10.1128/JCM.01554-13
Damiani C, et al. Combined Quantification of Pulmonary Pneumocystis Jirovecii DNA and Serum (1->3)-β-D-glucan for Differential Diagnosis of Pneumocystis Pneumonia and Pneumocystis Colonization. J Clin Microbiol. 2013;51(10):3380-8. PubMed PMID: 23903553.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Combined quantification of pulmonary Pneumocystis jirovecii DNA and serum (1->3)-β-D-glucan for differential diagnosis of pneumocystis pneumonia and Pneumocystis colonization. AU - Damiani,Céline, AU - Le Gal,Solène, AU - Da Costa,Cécilia, AU - Virmaux,Michèle, AU - Nevez,Gilles, AU - Totet,Anne, Y1 - 2013/07/31/ PY - 2013/8/2/entrez PY - 2013/8/2/pubmed PY - 2014/4/8/medline SP - 3380 EP - 8 JF - Journal of clinical microbiology JO - J Clin Microbiol VL - 51 IS - 10 N2 - This study assessed a quantitative PCR (qPCR) assay for Pneumocystis jirovecii quantification in bronchoalveolar lavage (BAL) fluid samples combined with serum (1→3)-β-d-glucan (BG) level detection to distinguish Pneumocystis pneumonia (PCP) from pulmonary colonization with P. jirovecii. Forty-six patients for whom P. jirovecii was initially detected in BAL fluid samples were retrospectively enrolled. Based on clinical data and results of P. jirovecii detection, 17 and 29 patients were diagnosed with PCP and colonization, respectively. BAL fluid samples were reassayed using a qPCR assay targeting the mitochondrial large subunit rRNA gene. qPCR results and serum BG levels (from a Fungitell kit) were analyzed conjointly. P. jirovecii DNA copy numbers were significantly higher in the PCP group than in the colonization group (1.3 × 10(7) versus 3.4 × 10(3) copies/μl, P < 0.05). A lower cutoff value (1.6 × 10(3) copies/μl) achieving 100% sensitivity for PCP diagnosis and an upper cutoff value (2 × 10(4) copies/μl) achieving 100% specificity were determined. Applying these two values, 13/17 PCP patients and 19/29 colonized patients were correctly assigned to their patient groups. For the remaining 14 patients with P. jirovecii DNA copy numbers between the cutoff values, PCP and colonization could not be distinguished on the basis of qPCR results. Four of these patients who were initially assigned to the PCP group presented BG levels of ≥100 pg/ml. The other 10 patients, who were initially assigned to the colonization group, presented BG levels of <100 pg/ml. These results suggest that the combination of the qPCR assay, applying cutoff values of 1.6 × 10(3) and 2 × 10(4) copies/μl, and serum BG detection, applying a 100 pg/ml threshold, can differentiate PCP and colonization diagnoses. SN - 1098-660X UR - https://www.unboundmedicine.com/medline/citation/23903553/Combined_quantification_of_pulmonary_Pneumocystis_jirovecii_DNA_and_serum__1_>3__β_D_glucan_for_differential_diagnosis_of_pneumocystis_pneumonia_and_Pneumocystis_colonization_ L2 - https://journals.asm.org/doi/10.1128/JCM.01554-13?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -