Chest
Volume 135, Issue 3, March 2009, Pages 655-661
Journal home page for Chest

Original Research
Respiratory Infection
Polymerase Chain Reaction for Diagnosing Pneumocystis Pneumonia in Non-HIV Immunocompromised Patients With Pulmonary Infiltrates

https://doi.org/10.1378/chest.08-1309Get rights and content

Rationale

Pneumocystis jiroveci polymerase chain reaction (PCR) has higher sensitivity than conventional stains but cannot distinguish colonization from infection.

Methods

We compared P jiroveci PCR and conventional stains in HIV-uninfected immunocompromised patients.

Results

Among the 448 patients, 296 (66%) patients had hematologic malignancies; 72 (16.1%), bone marrow transplants; 44 (9.8%), solid tumors; 21 (4.7%), renal transplants; and 15 (3.4%) were taking immunosuppressants for systemic diseases. Diagnostic strategy consisted of BAL in 351 patients and induced sputum (IS) in 97 patients. Conventional pneumocystic pneumonia (PCP) stain was positive in 39 (8.7%) patients, including 34 with positive PCR. In addition, PCR was positive in 32 patients, including 21 with complete follow-up, of whom 14 were diagnosed with probable or definitive PCP (a 36% increase). PCR was 87.2% sensitive and 92.2% specific; positive and negative predictive values were 51.5% and 98.7%, respectively. Sensitivity and negative predictive value were 100% on IS.

Conclusions

In HIV-uninfected immunocompromised patients with acute pulmonary infiltrates, P jiroveci PCR correlates with clinical evidence of PCP. A negative PCR allows withdrawing anti-PCP therapy.

Section snippets

Materials and Methods

This study was approved by the ethics committee of the Pitié-Salpêtrière Teaching Hospital in Paris, France. All consecutive HIV-uninfected immunocompromised patients admitted between January 2002 and October 2005 to the ICU or pulmonology department with pulmonary infiltrates and respiratory failure were included prospectively. All patients had undergone HIV testing that was negative. Patients were admitted to the ICU if their Pao2 on room air was < 60 mm Hg or they required invasive or

Results

From January 2002 to October 2005, 448 immunocompromised patients without AIDS underwent respiratory specimen collection to evaluate pulmonary infiltrates. BAL fluid was obtained in 351 patients and IS in 97 patients (Fig 1). As shown in Table 1, at the time the pulmonary infiltrates developed, 296 (66%) patients were receiving treatment for hematologic malignancies, 72 (16.1%) were bone marrow or stem cell transplant recipients (47 autologous and 25 allogeneic), 44 (9.8%) were receiving

Discussion

Although efforts to understand the life cycle of P jiroveci have been stymied by the lack of culture methods, important insights into the biology of the organism have been obtained, and knowledge of its genomic organization has improved.1, 16 These advances allowed the development of a PCR assay for P jiroveci DNA. In this study, we evaluated the effectiveness of the PCR assay for diagnosing PCP in a large cohort of HIV-uninfected patients with pulmonary infiltrates. Compared to IFA,

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  • Cited by (0)

    Sources of support: This study was supported by a grant from the Assistance-Publique Hôpitaux de Paris (AOM 04139), a nonprofit institution.

    The authors declare no conflict of interest.

    Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).

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