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Detection of Pneumocystis jirovecii by Quantitative PCR To Differentiate Colonization and Pneumonia in Immunocompromised HIV-Positive and HIV-Negative Patients.
J Clin Microbiol. 2016 06; 54(6):1487-1495.JC

Abstract

Pneumocystis jirovecii pneumonia (PCP) is an acute and life-threatening lung disease caused by the fungus Pneumocystis jirovecii The presentation of PCP in HIV-positive patients is well-known and consists of a triad of dyspnea, fever, and cough, whereas the presentation of PCP in HIV-negative patients is atypical and consists of a sudden outbreak, O2 desaturation, and a rapid lethal outcome without therapy. Despite the availability of direct and indirect identification methods, the diagnosis of PCP remains difficult. The cycle threshold (CT) values obtained by quantitative PCR (qPCR) allow estimation of the fungal burden. The more elevated that the fungal burden is, the higher the probability that the diagnosis is pneumonia. The purposes of the present study were to evaluate the CT values to differentiate colonization and pneumonia in a population of immunocompromised patients overall and patients stratified on the basis of their HIV infection status. Testing of bronchoalveolar lavage (BAL) fluid samples from the whole population of qPCR-positive patients showed a mean CT value for patients with PCP of 28 (95% confidence interval [CI], 26 to 30) and a mean CT value for colonized patients of 35 (95% CI, 34 to 36) (P < 10(-3)). For the subgroup of HIV-positive patients, we demonstrated that a CT value below 27 excluded colonization and a CT value above 30 excluded PCP with a specificity of 100% and a sensitivity of 80%, respectively. In the subgroup of HIV-negative patients, we demonstrated that a CT value below 31 excluded colonization and a CT value above 35 excluded PCP with a specificity of 80% and a sensitivity of 80%, respectively. Thus, qPCR of BAL fluid samples is an important tool for the differentiation of colonization and pneumonia in P. jirovecii-infected immunocompromised patients and patients stratified on the basis of HIV infection status with different CT values.

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Authors+Show Affiliations

Fauchier T
Laboratoire de Parasitologie-Mycologie, CHU l'Archet 2, Nice, France thomas.fauchier@gmail.com.
Hasseine L
Laboratoire de Parasitologie-Mycologie, CHU l'Archet 2, Nice, France.
Gari-Toussaint M
Laboratoire de Parasitologie-Mycologie, CHU l'Archet 2, Nice, France.
Casanova V
Département d'Information Médicale, Hôpital Cimiez, CHU Nice, Nice, France.
Marty PM
Laboratoire de Parasitologie-Mycologie, CHU l'Archet 2, Nice, France. INSERM, U1065, Centre Méditerranéen de Médecine Moléculaire, C3M, Toxines Microbiennes dans la Relation Hôte-Pathogènes, Nice, France. Université de Nice Sophia Antipolis, Faculté de Médecine, Nice, France.
Pomares C
Laboratoire de Parasitologie-Mycologie, CHU l'Archet 2, Nice, France. INSERM, U1065, Centre Méditerranéen de Médecine Moléculaire, C3M, Toxines Microbiennes dans la Relation Hôte-Pathogènes, Nice, France. Université de Nice Sophia Antipolis, Faculté de Médecine, Nice, France.

MeSH

Bronchoalveolar Lavage FluidFemaleHIV InfectionsHumansMaleMiddle AgedMolecular Diagnostic TechniquesPneumocystis cariniiPneumonia, PneumocystisProspective StudiesReal-Time Polymerase Chain ReactionSensitivity and Specificity

Pub Type(s)

Evaluation Study
Journal Article

Language

eng

PubMed ID

27008872

Citation

Fauchier, T, et al. "Detection of Pneumocystis Jirovecii By Quantitative PCR to Differentiate Colonization and Pneumonia in Immunocompromised HIV-Positive and HIV-Negative Patients." Journal of Clinical Microbiology, vol. 54, no. 6, 2016, pp. 1487-1495.
Fauchier T, Hasseine L, Gari-Toussaint M, et al. Detection of Pneumocystis jirovecii by Quantitative PCR To Differentiate Colonization and Pneumonia in Immunocompromised HIV-Positive and HIV-Negative Patients. J Clin Microbiol. 2016;54(6):1487-1495.
Fauchier, T., Hasseine, L., Gari-Toussaint, M., Casanova, V., Marty, P. M., & Pomares, C. (2016). Detection of Pneumocystis jirovecii by Quantitative PCR To Differentiate Colonization and Pneumonia in Immunocompromised HIV-Positive and HIV-Negative Patients. Journal of Clinical Microbiology, 54(6), 1487-1495. https://doi.org/10.1128/JCM.03174-15
Fauchier T, et al. Detection of Pneumocystis Jirovecii By Quantitative PCR to Differentiate Colonization and Pneumonia in Immunocompromised HIV-Positive and HIV-Negative Patients. J Clin Microbiol. 2016;54(6):1487-1495. PubMed PMID: 27008872.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Detection of Pneumocystis jirovecii by Quantitative PCR To Differentiate Colonization and Pneumonia in Immunocompromised HIV-Positive and HIV-Negative Patients. AU - Fauchier,T, AU - Hasseine,L, AU - Gari-Toussaint,M, AU - Casanova,V, AU - Marty,P M, AU - Pomares,C, Y1 - 2016/03/23/ PY - 2015/12/02/received PY - 2016/03/14/accepted PY - 2016/3/25/entrez PY - 2016/3/25/pubmed PY - 2017/7/18/medline SP - 1487 EP - 1495 JF - Journal of clinical microbiology JO - J Clin Microbiol VL - 54 IS - 6 N2 - Pneumocystis jirovecii pneumonia (PCP) is an acute and life-threatening lung disease caused by the fungus Pneumocystis jirovecii The presentation of PCP in HIV-positive patients is well-known and consists of a triad of dyspnea, fever, and cough, whereas the presentation of PCP in HIV-negative patients is atypical and consists of a sudden outbreak, O2 desaturation, and a rapid lethal outcome without therapy. Despite the availability of direct and indirect identification methods, the diagnosis of PCP remains difficult. The cycle threshold (CT) values obtained by quantitative PCR (qPCR) allow estimation of the fungal burden. The more elevated that the fungal burden is, the higher the probability that the diagnosis is pneumonia. The purposes of the present study were to evaluate the CT values to differentiate colonization and pneumonia in a population of immunocompromised patients overall and patients stratified on the basis of their HIV infection status. Testing of bronchoalveolar lavage (BAL) fluid samples from the whole population of qPCR-positive patients showed a mean CT value for patients with PCP of 28 (95% confidence interval [CI], 26 to 30) and a mean CT value for colonized patients of 35 (95% CI, 34 to 36) (P < 10(-3)). For the subgroup of HIV-positive patients, we demonstrated that a CT value below 27 excluded colonization and a CT value above 30 excluded PCP with a specificity of 100% and a sensitivity of 80%, respectively. In the subgroup of HIV-negative patients, we demonstrated that a CT value below 31 excluded colonization and a CT value above 35 excluded PCP with a specificity of 80% and a sensitivity of 80%, respectively. Thus, qPCR of BAL fluid samples is an important tool for the differentiation of colonization and pneumonia in P. jirovecii-infected immunocompromised patients and patients stratified on the basis of HIV infection status with different CT values. SN - 1098-660X UR - https://www.unboundmedicine.com/medline/citation/27008872/Detection_of_Pneumocystis_jirovecii_by_Quantitative_PCR_To_Differentiate_Colonization_and_Pneumonia_in_Immunocompromised_HIV_Positive_and_HIV_Negative_Patients_ DB - PRIME DP - Unbound Medicine ER -