Pneumocystis jirovecii pneumonia in non-HIV-infected patients

Reid, Alistair; Chen, Sharon C.‐A.; Worth, Leon J

doi:10.1097/qco.0b013e32834cac17

Cited by 111 publications

(89 citation statements)

References 126 publications

(93 reference statements)

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“…Some authors support the initiation of a specific therapy when immunosuppression is persistent, considering that colonization could represent an early stage of the disease (27,28). However, this risk was found to be low in HIVinfected patients (29) and has only occasionally been reported in other immunocompromised patients (28,30,31). In our study, there was one case of an HIV-positive patient, diagnosed as colonized based on a first BAL fluid analysis, who was not treated with anti-Pneumocystis therapy, and whose second BAL fluid sample, 10 days later, was negative for P. jirovecii by qPCR.…”

Section: Discussionmentioning

confidence: 99%

Impact of HIV Infection Status on Interpretation of Quantitative PCR for Detection of Pneumocystis jirovecii

et al. 2015

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Quantitative PCR (qPCR) is now a key diagnostic tool forPneumocystispneumonia. However, cutoffs to distinguish between infected and colonized patients according to their HIV status have not yet been determined. According to clinical, radiological, and biological data, we retrospectively classified bronchoalveolar lavage (BAL) samples subjected to qPCR over a 3-year period into four categories, i.e., definite PCP, probable PCP,Pneumocystiscolonization, and no infection. Fungal burden was then analyzed according to the HIV status of the patients. Among 1,212 episodes of pneumonia screened in immunocompromised patients, 52 and 27 HIV-positive patients were diagnosed with a definite and probable PCP, whereas 4 and 22 HIV-negative patients had definite and probable PCP, respectively. Among patients with definite or a probable PCP, HIV-negative patients had a significantly lower burden than HIV-positive patients (P< 10−4). In both groups, the median fungal burden was significantly higher in patients with definite PCP than in colonized patients. A single cutoff at 1.5 × 104copies/ml allowed to differentiate colonized and infected HIV-positive patients with 100% sensitivity and specificity. In HIV-negative patients, cutoff values of 2.87 × 104and 3.39 × 103copies/ml resulted in 100% specificity and sensitivity, respectively. Using cutoffs determined for the whole population would have led us to set aside the diagnosis of PCP in 9 HIV-negative patients with definite or probable PCP. qPCR appeared to be the most sensitive test to detectPneumocystisin BAL samples. However, because of lower inocula in HIV-negative patients, different cutoffs must be used according to the HIV status to differentiate between colonized and infected patients.

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Section: Discussionmentioning

confidence: 99%

Impact of HIV Infection Status on Interpretation of Quantitative PCR for Detection of Pneumocystis jirovecii

et al. 2015

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“…12 HIV-negative patients present with a lower burden of pathogen, which limits the diagnostic sensitivity of staining methods. 12 Although some controversy remains regarding the significance of a positive PCR with a negative stain, 13,14 in our cases, the presence of a compatible clinical picture, lack of other likely pathogens, and response to anti-Pneumocystis treatment allow us to make the diagnosis of PCP by PCR only. Of note, the 1 case with positive DFA (case #4) was quite similar to the others.…”

Section: Case #2mentioning

confidence: 99%

Atypical Pneumocystis jirovecii pneumonia in previously untreated patients with CLL on single-agent ibrutinib

Ahn

Jerussi

Farooqui³

et al. 2016

Blood

152

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“…The clinical significance of P. jiroveci in respiratory specimens and viability of organisms detected only by PCR were unknown. In the study of Reid et al (2011), conventional PCR increased diagnostic sensitivity but may have detected asymptomatic colonization. They claimed that quantitative PCR demonstrated potential for distinguishing colonization from infection, but clinical validation was required.…”

Section: Discussionmentioning

confidence: 99%

Evidence of Pneumocystis jiroveci in human clinical samples in southwestern Slovakia over a 10-year period (2001–2010)

Boldiš¹,

Ondriska²,

Kováč³

et al. 2013

Biologia

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In the past, Pneumocystis jiroveci (formerly P. carinii) belonged to the Protozoa group, but the studies on structure of the cell wall and nucleotide sequence resulted in the reclassification of this organism in the kingdom Fungi. P. jiroveci is an opportunistic pathogen, responsible for pneumocystis pneumonia with frequent complications of immunocompromised patients. Delayed initiation of appropriate therapy increases the risk of death in immunocompromised patient. The aim of this work was to determine the prevalence of P. jiroveci from patients suspected of having respiratory tract infections in southwestern Slovakia over a 10-year period. Due to the increasing number of immunosuppressed persons, the diagnostic of P. jiroveci in patients with pulmonary complications is essential to improve recovery onsets. Effective diagnosis is currently based on microscopic examination and detection of parasite DNA by polymerase chain reaction (PCR) in bronchoalveolar lavage (BAL) and induced sputum. In total, 386 clinical samples originated from patients suspected of pneumocystis infection were tested within ten years. Requirements for diagnosis of the pathogen were growing during the period. Three hundred and sixteen BALs, 59 induced sputa, 10 lung biopsies and 1 liquor were subjected to the detection of P. jiroveci. P. jiroveci DNA was detected in 30 patients using PCR, but cysts of microorganism were present only in 4 cases by microscopy. The pathogen was confirmed in 24 BALs and 6 sputa samples. The presence of P. jiroveci has been demonstrated mainly in immunocompromised individuals with cancer (20), but also in patients with pneumonia (6+1 HIV), with unspecified parasitic diseases (1+1HIV) and with systemic lupus erythematosus (1).

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Pneumocystis jirovecii pneumonia in non-HIV-infected patients

Cited by 111 publications

References 126 publications

Impact of HIV Infection Status on Interpretation of Quantitative PCR for Detection of Pneumocystis jirovecii

Impact of HIV Infection Status on Interpretation of Quantitative PCR for Detection of Pneumocystis jirovecii

Atypical Pneumocystis jirovecii pneumonia in previously untreated patients with CLL on single-agent ibrutinib

Evidence of Pneumocystis jiroveci in human clinical samples in southwestern Slovakia over a 10-year period (2001–2010)

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