Polymerase chain reaction for diagnosing pneumocystis pneumonia in non-HIV immunocompromised patients with pulmonary infiltrates
| Autor: | Jean Menotti, Elie Azoulay, Benoît Schlemmer, Nicolas Bele, Sylvie Chevret, Anne Bergeron |
|---|---|
| Přispěvatelé: | Service de réanimation médicale, Université Paris Diderot - Paris 7 (UPD7)-Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Pulmonology Department, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot - Paris 7 (UPD7), Biostatistique et épidemiologie clinique, Université Paris Diderot - Paris 7 (UPD7)-Institut National de la Santé et de la Recherche Médicale (INSERM), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot - Paris 7 (UPD7)-Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Vesin, Aurélien |
| Jazyk: | angličtina |
| Rok vydání: | 2009 |
| Předmět: |
Pathology
medicine.medical_treatment Critical Care and Intensive Care Medicine Pneumocystis pneumonia Pneumocystis carinii Polymerase Chain Reaction 0302 clinical medicine MESH: Sputum MESH: Immunocompromised Host 030212 general & internal medicine MESH: HIV Seronegativity 0303 health sciences Pneumonia Pneumocystis Respiratory disease Immunosuppression MESH: Predictive Value of Tests 3. Good health medicine.anatomical_structure Predictive value of tests medicine.symptom Cardiology and Cardiovascular Medicine Bronchoalveolar Lavage Fluid Pulmonary and Respiratory Medicine medicine.medical_specialty Opportunistic Infections Sensitivity and Specificity 03 medical and health sciences Immunocompromised Host MESH: Pneumocystis jirovecii Predictive Value of Tests HIV Seronegativity medicine Humans Lung MESH: Humans 030306 microbiology business.industry MESH: Bronchoalveolar Lavage Fluid Sputum MESH: Opportunistic Infections MESH: Polymerase Chain Reaction medicine.disease MESH: Sensitivity and Specificity Transplantation Pneumonia [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie business MESH: Pneumonia Pneumocystis |
| Zdroj: | Chest Chest, American College of Chest Physicians, 2009, 135 (3), pp.655-61. ⟨10.1378/chest.08-1309⟩ |
| ISSN: | 0012-3692 1931-3543 |
| DOI: | 10.1378/chest.08-1309⟩ |
| Popis: | International audience; 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. |
| Databáze: | OpenAIRE |
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