Positive Pneumocystis jirovecii Sputum PCR Results with Negative Bronchoscopic PCR Results in Suspected Pneumocystis Pneumonia

Canadian Respiratory Journal : Journal of the Canadian Thoracic Society
Kelly PenningtonPatricio Escalante

Abstract

The diagnostic standard for Pneumocystis jirovecii pneumonia (PCP) is direct microscopic identification; however, in recent years, polymerase chain reaction (PCR) from bronchoalveolar lavage (BAL) samples to detect Pneumocystis nucleic acids has proven to be more sensitive and specific. Sputum samples have been presumed inferior to bronchoscopic samples secondary to variability and adequacy of sample collection. We observed several cases of positive sputum PCP-PCR results with negative PCP-PCR BAL results. The aim of the current study was to further characterize the clinical setting and outcomes in patients with positive sputum PCP-PCR samples and negative BAL PCP-PCR samples. We identified all patients who underwent P. jirovecii-PCR testing at Mayo Clinic between 2011 and 2016. Patients with a positive sputum and negative BAL sample collected within a 14-day time frame were identified and underwent further chart review for demographics, immunocompromised state, and clinical outcome. From 2011 to 2016, 4431 respiratory samples from 3021 unique patients were tested for the presence of P. jirovecii by PCR. Fifty-five samples (1.2% of all samples collected) belonging to 24 unique patients (0.79% of patients tested) were identified...Continue Reading

References

Apr 1, 1992·Molecular and Cellular Probes·S E PetersJ M Hopkin
Oct 1, 1995·Journal of Clinical Microbiology·J J LuC H Lee
Jun 11, 2004·The New England Journal of Medicine·Charles F Thomas, Andrew H Limper
Jan 21, 2006·Diagnostic Microbiology and Infectious Disease·Rodney C ArcenasNancy L Wengenack
May 9, 2006·Diagnostic Microbiology and Infectious Disease·Míriam J Alvarez-MartínezUNKNOWN Spanish PCP Working Group
Aug 26, 2016·The Journal of Infectious Diseases·Kate BuchaczUNKNOWN North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) of IeDEA

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Methods Mentioned

BETA
bronchoalveolar
biopsy
PCR
bronchoalveolar lavage

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