Is it possible to differentiate pneumocystis jirovecii pneumonia and colonization in the immunocompromised patients with pneumonia?

Yudy A. Aguilar, Zulma Vanessa Rueda, María Angélica Maya, Cristian Vera, Jenniffer Rodiño, Carlos Muskus, Lázaro A. Vélez

    Research output: Contribution to journalArticlepeer-review

    Abstract

    Respiratory sample staining is a standard tool used to diagnose Pneumocystis jirovecii pneumonia (PjP). Although molecular tests are more sensitive, their interpretation can be difficult due to the potential of colonization. We aimed to validate a Pneumocystis jirovecii (Pj) real-time PCR (qPCR) assay in bronchoscopic bronchoalveolar lavage (BAL) and oropharyngeal washes (OW). We included 158 immunosuppressed patients with pneumonia, 35 lung cancer patients who underwent BAL, and 20 healthy individuals. We used a SYBR green qPCR assay to look for a 103 bp fragment of the Pj mtLSU rRNA gene in BAL and OW. We calculated the qPCR cut-off as well as the analytical and diagnostic characteristics. The qPCR was positive in 67.8% of BAL samples from the immunocompro-mised patients. The established cut-off for discriminating between disease and colonization was Ct 24.53 for BAL samples. In the immunosuppressed group, qPCR detected all 25 microscopy-positive PjP cases, plus three additional cases. Pj colonization in the immunocompromised group was 66.2%, while in the cancer group, colonization rates were 48%. qPCR was ineffective at diagnosing PjP in the OW samples. This new qPCR allowed for reliable diagnosis of PjP, and differentiation between PjP disease and colonization in BAL of immunocompromised patients with pneumonia.

    Original languageEnglish
    Article number1036
    JournalJournal of Fungi
    Volume7
    Issue number12
    DOIs
    StatePublished - Dec 2021

    Bibliographical note

    Funding Information:
    This research was funded by Colciencias (Currently, Minciencias, Administrative Department of Science, Technology and Innovation) and Universidad de Antioquia (grant no. 111534319142), Fundaci?n Investigando en Salud y Enfermedades Infecciosas, and the Universidad de Antioquia, through the Estrategia de Sostenibilidad. Y.A.A. was awarded with a Ph.D. scholarship from Mincien-cias (Programa de Doctorado Nacional a?o 2008). The funders had no role in the study design, data collection and analysis, decision to publish the results, or preparation of the manuscript. The open access fee of this paper was paid by Universidad Pontificia Bolivariana, Universidad de Antioquia and Asociaci?n Colombiana de Infectolog?a, Cap?tulo Antioquia.

    Funding Information:
    Funding: This research was funded by Colciencias (Currently, Minciencias, Administrative Department of Science, Technology and Innovation) and Universidad de Antioquia (grant no. 111534319142), Fundación Investigando en Salud y Enfermedades Infecciosas, and the Universidad de Antioquia, through the Estrategia de Sostenibilidad. Y.A.A. was awarded with a Ph.D. scholarship from Mincien-cias (Programa de Doctorado Nacional año 2008). The funders had no role in the study design, data collection and analysis, decision to publish the results, or preparation of the manuscript. The open access fee of this paper was paid by Universidad Pontificia Bolivariana, Universidad de Antioquia and Asociación Colombiana de Infectología, Capítulo Antioquia.

    Publisher Copyright:
    © 2021 by the authors. Licensee MDPI, Basel, Switzerland.

    Keywords

    • Bronchoalve-olar lavage (BAL)
    • Colonization
    • Oropharyngeal washes (OW)
    • Pneumocystis jirovecii
    • Pneumonia
    • Quantitative real time PCR

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