Diagnosis of Pneumocystis jirovecii Pneumonia by PCR
Article Sidebar
Main Article Content
Abstract
Introduction: Pneumocystis pneumonia is an opportunistic infection caused by Pneumocystis jirovecii (Pj) in immunocompromised patients, especially in patients with HIV. Objective: to describe the clinical, radiological characteristics and the clinical course of immunocompromised patients diagnosed with Pj pneumonia by means of PCR in bronchoalveolar lavage (BAL). Methods: a cross-sectional, descriptive study was carried out that included immunocompromised patients, with a clinical and radiological suspicion of Pj pneumonia, diagnosed only by PCR in a BAL sample. Results: 141 patients underwent BAL between March 2017 and December 2019, for clinical and radiological suspicion for Pj pneumonia. Twenty-two patients whose diagnosis was confirmed only by PCR on a BAL sample were included in the analysis. All patients presented with coughs. 17 patients had dyspnea (77%) and the most frequent radiological pattern was interstitial infiltrate and bilateral ground glass. Pulmonary coinfection was observed in 4 patients (18.8%), with isolation of Mycobacterium tuberculosis (n = 2) and Streptococcus pneumoniae (n = 2). The length of hospital stay was 13 days (SD±11). Six patients (27%) required mechanical ventilation. In-hospital mortality was 23%. Conclusions: the use of PCR in BAL samples could be a useful method for the diagnosis of Pj pneumonia. However, its value must be interpreted in the context of the illness history, clinical, and radiological picture.
Downloads
Article Details
This work is licensed under a Creative Commons Attribution 4.0 International License.
References
Cerón I, Rabagliati R, Langhaus J et al. Características clínicas, diagnósticas y pronósticas de pacientes con neumonía por Pneumocystis jiroveci en individuos infectados por virus de inmunodeficiencia humana e individuos inmunocomprometidos por otra etiología: comparative study of cases in HIV-infected patients and immunocompromised non-HIV-infected patients. Rev Chil Infectol 2014;31: 417- 424. Doi: doi.org/10.4067/S0716-10182014000400007
Latouche S, Poirot J L, Lavrard I, Miltgen M, Nigou M, Roux P. Usefulness of molecular biology for Pneumocystis carinii hominis pneumonia epidemiology. J Eukaryot Microbiol 1996;43:56S–57S.
Cortés-Télles A, Juárez Hernández F, Sagrario Peña Mirabal E. Neumonía por Pneumocystis jirovecii en pacientes con VIH. Neumol CirTorax 2011;70: 165-171.
Bateman M, Oladele R, Kolls JK. Diagnosing Pneumocystis jirovecii pneumonia: A review of current methods and novel approaches. Med Mycol 2020;58(8):1015-1028. Doi: 10.1093/mmy/myaa024.
Vera C, Rueda ZV. Transmission and Colonization of Pneumocystis jirovecii. J Fungi 2021: 7: 979. https://doi.org/10.3390/ jof7110979.
Azoulay E, Bergeron A, Chevret S, Bele N, Schlemmer B, Menotti J. Polymerase chain reaction for diagnosing Pneumocystis pneumonia in non-HIV immunocompromised patients with pulmonary infiltrates. Chest 2009; 135 (3): 655-61. Doi: 10.1378/chest.08-1309
Martinez Lamas L, Pérez Rodríguez MT, Alvarez Ramos I et al. Papel de Pneumocystis jirovecii en pacientes con diferentes patologías pulmonares subyacentes utilizando una PCR anidada. Rev Esp Quimioter 2018;31: 336-343.
Fauchier T, Hasseine L, Gari-Toussaint M, Casanova V, Marty PM, Pomares C. Detection of Pneumocystis jirovecii by Quantitative PCR To Differentiate Colonization and Pneumonia in Immunocompromised HIV-Positive and HIV-Negative Patients. J Clin Microbiol 2016;54:1487-1495. Doi: 10.1128/JCM.03174-15.
Khan MA, Farrag N, Butcher P. Diagnosis of Pneumocystis carinii pneumonia: immunofluorescence staining, simple PCR or nPCR. J Infect 1999;39:77-80. Doi: 10.1016/s0163-4453(99)90106-8.
Kaouech E, Kallel K, Anane S et al. Pneumocystose à Pneumocystis jiroveci: étu decomparée de la PCR et des techniques de coloration Pnemocystis jiroveci pneumonia: Comparison between conventional PCR and staining techniques]. Pathol Biol(Paris) 2009;57:373-377. Doi: doi.org/10.1016/j.patbio.2008.09.013.
Robert-Gangneux F, Belaz S, Revest M et al. Diagnosis of Pneumocystis jirovecii pneumonia in immunocompromised patients by real-time PCR: a 4-year prospective study. J Clin Microbiol 2014;52:3370-3376. Doi: 10.1128/JCM.01480-14.
Bava AJ, Cattaneo S, Bellegarde E. Diagnosis of pulmonary pneumocystosis by microscopy on wetmount preparations. Rev Inst Med Trop S Paulo 2002; 44:279-82, 2002. Doi: 10.1590/s0036-46652002000500009.
Mootsikapun P, Chetchotisakd P, Intarapoka B. Pulmonary infections in HIV infected patients. J Med Assoc Thai 1996 ;79(8):477-85.
Walzer PD, Evans HE, Copas AJ, Edwards SG, Grant AD, Miller RF. Early predictors of mortality from Pneumocystis jirovecii pneumonia in HIV-infected patients: 1985-2006. Clin InfectDis 2008;15;46:625-33. Doi: 10.1086/526778.
Solano M, Alvarez F, Grau S et al. Neumonía por Pneumocystis jiroveci: características clínicas y factores de riesgo asociados a mortalidad en una Unidad de Cuidados Intensivos. Med Intensiva 2015;39:13-19. Doi: 10.1016/j.medin.2013.11.006.