Non-invasive diagnosis of Pneumocystis jirovecii pneumonia: a systematic review and meta-analysis

Senécal, Julien; Smyth, Elizabeth; Corpo, Olivier Del; Hsu, Jimmy Ming-Yang; Amar‐Zifkin, Alexandre; Bergeron, Amy; Cheng, Matthew P.; Butler‐Laporte, Guillaume; McDonald, Emily G.; Lee, Todd C.

doi:10.1016/j.cmi.2021.08.017

Cited by 32 publications

(19 citation statements)

References 67 publications

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“…According to PCR positive, 4 cases of PJP were proven, among these,one was heart transplant, one was HIV infection, others were taking prednisone (data were not shown). BALF PCR had a sensitivity of 100% in our study, this value is similar to those reported at 99% [28] and 98%. [29] This study found that serum GM test for the detection of yeast infection has a sensitivity of 50% and a fairly low PPV of 35.7%, partly because the subject enrolled are non-neutropenic patients with COPD.…”

Section: Discussionsupporting

confidence: 91%

Diagnosis of invasive pulmonary fungal infections by a real-time panfungal PCR assay in non-neutropenic patients

Chen,

Chi

et al. 2023

Medicine

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This study explored the utility of quantitative real-time panfungal PCR assay in diagnosing invasive pulmonary fungal diseases (IPFD) in non-neutropenic patients. Panfungal PCR assay was performed on respiratory tract specimens from patients whose clinical signs could not exclude fungal infection. At the same time, the samples were subjected to bacterial and fungal culture, microscopic examination and galactomannan antigen (GM) test in order to find the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of the 4 diagnostic methods in proven and probable cases. 518 specimens were collected while 63 respiratory tract specimens tested by PCR had positive results. According to diagnostic criteria, 40 patients were diagnosed with IPFD, with 12 proven, 20 probable and 8 possible cases. Among these, 33 patients of PCR results were positive, most of which were from BALF samples (44.12%). 23 cases were caused by Aspergillus species, with Aspergillus fumigatus was the major cause. Other Aspergillus species, including Aspergillus flavus, Aspergillus terreus and Aspergillus nidulans were found in 1 sample respectively. Candida species were found in 5 samples, Pneumocystis jeroveci pneumonia (PJP) in 4 samples and Mucormycosis in 1 sample. An analysis of proven/probable diagnosis showed a sensitivity of 78.13%, specificity of 92.18%, PPV of 39.68% and NPV of 98.46% for PCR and 50%, 85.27%, 35.7%, 95.65% for GM test respectively. The Ct value difference between proven/probable and possible cases had no statistical significance (P = .824). Fungal culture showed a sensitivity of 17.5% while microscopic examination sensitivity of 32.5%. Through stratified analysis, no apparent correlation was found between the Ct value of the PCR assay and GM value (r: 0.223, P = .294). But a conjunction of the 2 tests raised the PPV of Aspergillus to 90%. As shown in this study, the panfungal RT-PCR assay has high sensitivity and consistency with serological test and culture. Its high PPV in the detection of Aspergillus and PJP were also evident.

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Section: Discussionsupporting

confidence: 91%

Diagnosis of invasive pulmonary fungal infections by a real-time panfungal PCR assay in non-neutropenic patients

Chen,

Chi

et al. 2023

Medicine

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“…Despite being simple and inexpensive, traditional microscopic examination is less sensitive for PJP because of the low fungal load. Despite having 100% specificity for the diagnosis of PJP, immunofluorescence and cytological staining only exhibited a 74% and 50% sensitivity, respectively, according to a meta-analysis ( Senécal et al, 2022 ). In this study, PJ was detected among alveolar lavage fluid in only two children due to the limited sensitivity of the conventional assay.…”

Section: Discussionmentioning

confidence: 99%

Clinical features and diagnostic value of metagenomic next -generation sequencing in five cases of non-HIV related Pneumocystis jirovecii pneumonia in children

Niu

Wang

Jia

et al. 2023

Front. Cell. Infect. Microbiol.

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BackgroundPneumocystis jirovecii (PJ) is an opportunistic pathogenic fungus, and PJ pneumonia (PJP) is a commonly problem in HIV-positive patients. While PJP is not caused by HIV, it generally advances rapidly and can quickly lead to severe respiratory failure. To improve pediatricians’ understanding of the condition and aid early accurate diagnoses and therapy, we examined the clinical characteristics of five instances of non-HIV related PJP (NH-PJP) in children and the efficacy of metagenomic next-generation sequencing (mNGS) in its diagnosis.MethodsFrom January 2020 to June 2022, five children with NH-PJP were admitted to the PICU of the First Affiliated Hospital of Zhengzhou University. We retrospectively summarize the clinical presentation, previous histories, routine laboratory findings, treatment, outcome of regression, and results of mNGS in these five children.ResultsFive male children between the ages of 11 months and 14 years had an acute onset on NH-PJP, three of the children had chest tightness after activity, shortness of breath and paroxysmal dry cough, — and two had high fever and dry cough. All five of the children had several flocculent high-density pictures in both lungs at the beginning of the disease, and lung auscultation revealed coarse breath sounds in both lungs, one of which was accompanied by a modest quantity of dry rales. PJ nuclear sequences were found in one patient and four patients’ blood and alveolar lavage fluid. All five children were treated with Trimethoprim-sulfamethoxazole (TMP-SMX) in combination with Caspofungin and corresponding symptomatic treatment. Four patients were cured and one patient died.ConclusionChildren commonly encounter an initial exposure to NH-PJP, which manifests as a high fever, dry cough, chest discomfort, dyspnea that worsens over time, fast disease progression, and a high death rate. The clinical presentation of children with PJ infection should be taken into consideration along with the results for diagnose. mNGS has higher sensitivity and a shorter detection period compared to identification of PJP.

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“…Second, most of the PLWH who were included in our study used sputum or gargling specimens to detect P. jirovecii with the use of PCR assays. In a meta-analysis, minimally invasive PCP diagnostic tests that used induced sputum and oral wash showed good specificities in PLWH (98% and 95%, respectively) ( 38 ); however, the oral wash specimens had a lower sensitivity (74%). Therefore, the diagnosis of PCP in our study might have been underestimated.…”

Section: Discussionmentioning

confidence: 99%

Immune Reconstitution Inflammatory Syndrome in People Living with HIV Who Presented with Interstitial Pneumonitis: an Emerging Challenge in the Era of Rapid Initiation of Antiretroviral Therapy

et al. 2023

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Our study of PLWH who presented with IP mainly due to Pneumocystis jirovecii demonstrates that a high rate of paradoxical IRIS and a rapid decline of PVL with the initiation of ART, a CD4-to-CD8 ratio of <0.1 at baseline, and a short interval (<7 days) between the diagnosis of IP and the initiation of ART were associated with paradoxical IP-IRIS in PLWH. Paradoxical IP-IRIS was not associated with mortality or respiratory failure with heightened awareness among the HIV-treating physicians, rigorous investigations to exclude the possibilities of concomitant infections, or the malignancies and adverse effects of medications, including the cautious use of corticosteroids.

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Non-invasive diagnosis of Pneumocystis jirovecii pneumonia: a systematic review and meta-analysis

Cited by 32 publications

References 67 publications

Diagnosis of invasive pulmonary fungal infections by a real-time panfungal PCR assay in non-neutropenic patients

Diagnosis of invasive pulmonary fungal infections by a real-time panfungal PCR assay in non-neutropenic patients

Clinical features and diagnostic value of metagenomic next -generation sequencing in five cases of non-HIV related Pneumocystis jirovecii pneumonia in children

Immune Reconstitution Inflammatory Syndrome in People Living with HIV Who Presented with Interstitial Pneumonitis: an Emerging Challenge in the Era of Rapid Initiation of Antiretroviral Therapy

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