A clinical comparative study of polymerase chain reaction assay for diagnosis of pneumocystis pneumonia in non-AIDS patients

( views:68, downloads:0 )
MU Xiang-dong(Department of Respiratory Medicine,Peking University First Hospital,Beijing 100034,China)
WANG Guang-fa(Department of Respiratory Medicine,Peking University First Hospital,Beijing 100034,China)
SU Li(Department of Respiratory Medicine,Peking University First Hospital,Beijing 100034,China)
Journal Title:
Volume 124, Issue 17, 2011
Key Word:
Pneumocystis jirovecii pneumonia;sputum;bronchioalveolar lavage fluid;Gomori methenamine silver stains;polymerase chain reaction

Abstract´╝Ü Background Pneurnocystis jirovecii pneumonia (PCP) is one of the most common and fatal infections in non-AIDS immunocompromised patients,which is difficult to diagnose by traditional morphologic methods.This study evaluated polymerase chain reaction (PCR) assays of Pneumocystis jirovecii mitochondrial large subunits ribosomal RNA in sputum and bronchioalveolar lavage fluid (BALF) for diagnosing PCP.Methods Sputum and BALF specimens from two groups were collected:one group (PCP group) included 20 patients definitely diagnosed of PCP by Gomori methenamine silver (GMS) stains of BALF;the other group (non-PCP group) included 40 patients.Each specimen was examined by GMS stains and PCR assays.Results GMS stains of BALF in PCP group were 100% positive (20/20),GMS stains of sputum in PCP group were 35% positive (7/20);GMS stains of BALF in non-PCP group were 100% negative (40/40),GMS stains of sputum in non-PCP group were 100% negative (40/40).PCR assays of BALF in PCP group were 100% positive (20/20),PCR assays of sputum in PCP group were 100% positive (20/20);PCR assays of BALF in non-PCP group were 100% negative (40/40),PCR assays of sputum in non-PCP group were 100% negative (40/40).Sensitivity and specificity of PCR assays of sputum and BALF were both 100%;positive and negative predictive values were also both 100%.Conclusion The diagnostic value of PCR assays of Pneumocystisjirovecii mitochondrial large subunits ribosomal RNA on sputum and BALF for pneumocystis pneumonia are both high and equivalent.

  • [1]Van Oosterhout JJ,Laufer MK,Perez MA,Graham SM,Chimbiya N,Thesing PC,et al.Pneumocystis pneumonia in HIV-positive adults,Malawi.Emerg Infect Dis 2007;13:325-328.
  • [2]Stringer JR,Beard CB,Miller RF,Wakefield AE.A new name (Pneumocystis jiroveci) for Pneumocystis from humans.Emerg Infect Dis 2002;8:891-896.
  • [3]Cao B,Wang H,Wang P,Li MT,Zhu YJ.Clinical parameters and outcomes of Pneumocystis jiroveci pneumonia in non-HIV/AIDS patients.Chin Med J 2006;119:234-237.
  • [4]Mu XD,Que CL,He B,Wang GF,Li HC.Caspofungin in salvage treatment of severe pneumocystis pneumonia:case report and literature review.Chin Med J 2009;122:996-999.
  • [5]Russian DA,Levine SJ.Pneumocystis carinii pneumonia in patients without HIV infection.Am J Med Sci 2001;321:56-65.
  • [6]Boonsarugsuk V,Sirilak S,Kiatboonsri S.Acute respiratory failure due to Pneumocystis pneumonia:outcome and prognostic factors.Int J Infect Dis 2009;13:59-66.
  • [7]Wazir JF,Ansari NA.Pneumocystis carinii infection.Update and review.Arch Pathol Lab Med 2004;128:1023-1027.
  • [8]Krajicek B J,Thomas CF Jr,Limper AH.Pneumocystis pneumonia:current concepts in pathogenesis,diagnosis,and treatment.Clin Chest Med 2009;30:265-278.
  • [9]Turner D,Schwarz Y,Yust I.Induced sputum for diagnosing Pneumocystis carinii pneumonia in HIV patients:new data,new issues.Eur Respir J 2003;21:204-208.
  • [10]Raab SS,Cheville JC,Bottles K,Cohen MB.Utility of Gomori methenamine silver stains in bronchoalveolar lavage specimens.Mod Pathol 1994;7:599-604.
  • [11]Torres J,Goldman M,Lee CH,Bartlett MS,Tang X,Smith JW,et al.Diagnosis of Pneumocystis carinii pneumonia in human immunodeficiency virus-infected patients with PCR:a blinded comparison to standard methods.Clin Infect Dis 2000;30:141-145.
  • [12]Jarboui MA,Sellami A,Sellami H,Cheikhrouhou F,Makni F,Ben Arab N,et al.Molecular diagnosis of Pneumocystis jirovecii pneumonia in immunocompromised patients.Mycoses 2009:Epub ahead of print.
  • [13]Tasaka S,Hasegawa N,Kobayashi S,Yamada W,Nishimura T,Takeuchi T,et al.Serum indicators for the diagnosis of pneumocystis pneumonia.Chest 2007;131:1173-1180.
  • [14]Jiancheng W,Minjun H,Yi-jun A,Lan S,Zengzhu G,Jianrong S,et al.Screening Pneumocystis carinii pneumonia in non-HIV-infectedimmunocompromisedpatientsusing polymerase chain reaction.Diagn Microbiol Infect Dis 2009;64:396-401.
  • [15]Baughman RP,Liming JD.Diagnostic strategies in Pneumocystis carinii pneumonia.Front Biosci 1998;3:e1-e12.
  • [16]Maymind M,Thomas JG,Abrons HL,Riley RS.Laboratory implementation of a rapid three-stain technique for detection of microorganisms from lower respiratory specimens.J Clin LabAnal 1996;10:104-109.
  • [17]Wang Y,Doucette S,Qian Q,Kirby JE.Yield of primary and repeat induced sputum testing for Pneumocystis jiroveci in human immunodeficiency virus-positive and-negative patients.Arch Pathol Lab Med 2007;131:1582-1584.
  • [18]Smulian AG,Linke MJ,Cushion MT,Baughman RP,Frame PT,Dohn MN,et al.Analysis of Pneumocystis carinii organism burden,viability and antigens in bronchoalveolar lavage fluid in AIDS patients with pneumocystosis:correlation with disease severity.AIDS 1994;8:1555-1562.
  • [19]Rohner P,Jacomo V,Studer R,Schrenzel J,Graf JD.Detection of Pneumocystis jirovecii by two staining methods and two quantitative PCR assays.Infection 2009;37:261-265.
  • [20]Flori P,Bellete B,Durand F,Raberin H,Cazorla C,Hafid J,et al.Comparison between real-time PCR,conventional PCR and different staining techniques for diagnosing Pneumocystis jiroveci pneumonia from bronchoalveolar lavage specimens.J Med Microbiol 2004;53 Pt 7:603-607.
  • [21]Aderaye G,Woldeamanuel Y,Asrat D,Lebbad M,Beser J,Worku A,et al.Evaluation of Toluidine Blue O staining for the diagnosis of Pneumocystis jiroveci in expectorated sputum sample and bronchoalveolar lavage from HIV-infected patients in a tertiary care referral center in Ethiopia.Infection,2008;36:237-243.
  • [22]Morris A,Wei K,Afshar K,Huang L.Epidemiology and clinical significance of pneumocystis colonization.J Infect Dis 2008;197:10-17.
  • [23]Fillaux J,Malvy S,Alvarez M,Fabre R,Cassaing S,Marchou B,ct al.Accuracy of a routine real-time PCR assay for the diagnosis of Pneumocystis jirovecii pneumonia.J Microbiol Methods 2008;75:258-261.
WanfangData CO.,Ltd All Rights Reserved
About WanfangData | Contact US
Healthcare Department, Fuxing Road NO.15, Haidian District Beijing, 100038 P.R.China
Tel:+86-010-58882616 Fax:+86-010-58882615 Email:yiyao@wanfangdata.com.cn