Quantitative PCR to diagnose Pneumocystis pneumonia in immunocompromised non-HIV patients

Mühlethaler, K; Bögli-Stuber, K; Wasmer, S; von Garnier, C; Dumont, P; Rauch, A; Mühlemann, K; Garzoni, C (2012). Quantitative PCR to diagnose Pneumocystis pneumonia in immunocompromised non-HIV patients. European respiratory journal, 39(4), pp. 971-8. Sheffield, UK: European Respiratory Society 10.1183/09031936.00095811

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The utility of quantitative Pneumocystis jirovecii PCR in clinical routine for diagnosing Pneumocystis pneumonia (PCP) in immunocompromised non-HIV patients is unknown. We analysed bronchoalveolar lavage fluid with real-time quantitative P. jirovecii PCR in 71 cases with definitive PCP defined by positive immunofluorescence (IF) tests and in 171 randomly selected patients with acute lung disease. In those patients, possible PCP cases were identified by using a novel standardised PCP probability algorithm and chart review. PCR performance was compared with IF testing, clinical judgment and the PCP probability algorithm. Quantitative P. jirovecii PCR values >1,450 pathogens·mL(-1) had a positive predictive value of 98.0% (95% CI 89.6-100.0%) for diagnosing definitive PCP. PCR values of between 1 and 1,450 pathogens·mL(-1) were associated with both colonisation and infection; thus, a cut-off between the two conditions could not be identified and diagnosis of PCP in this setting relied on IF and clinical assessment. Clinical PCP could be ruled out in 99.3% of 153 patients with negative PCR results. Quantitative PCR is useful for diagnosing PCP and is complementary to IF. PCR values of >1,450 pathogens·mL(-1) allow reliable diagnosis, whereas negative PCR results virtually exclude PCP. Intermediate values require additional clinical assessment and IF testing. On the basis of our data and for economic and logistical limitations, we propose a clinical algorithm in which IF remains the preferred first test in most cases, followed by PCR in those patients with a negative IF and strong clinical suspicion for PCP.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Service Sector > Institute for Infectious Diseases
04 Faculty of Medicine > Department of Gastro-intestinal, Liver and Lung Disorders (DMLL) > Clinic of Pneumology
04 Faculty of Medicine > Department of Haematology, Oncology, Infectious Diseases, Laboratory Medicine and Hospital Pharmacy (DOLS) > Clinic of Infectiology

UniBE Contributor:

Mühlethaler, Konrad; Wasmer Rueff, Sarah Patricia; von Garnier, Christophe; Rauch, Andri; Mühlemann, Kathrin and Garzoni, Christian

ISSN:

0903-1936

Publisher:

European Respiratory Society

Language:

English

Submitter:

Factscience Import

Date Deposited:

04 Oct 2013 14:24

Last Modified:

06 Dec 2013 13:29

Publisher DOI:

10.1183/09031936.00095811

PubMed ID:

21920890

Web of Science ID:

000302354900026

URI:

https://boris.unibe.ch/id/eprint/8292 (FactScience: 213809)

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