Are Members of the Fungal Genus Pneumocystis (a) Commensals; (b) Opportunists; (c) Pathogens; or (d) All of the Above?

Cushion, Melanie T.

doi:10.1371/journal.ppat.1001009

Cited by 50 publications

(43 citation statements)

References 20 publications

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“…The most likely explanation of these PCR-positive test results is low-level colonization with P. jirovecii and carriage of the organism in the patient with the lung transplant. Transmission of infection between individuals, via environmental contamination, is a known risk (5,15,27). If colonization can be confirmed for an asymptomatic subject, this opens the possibility of treatment and targeted reduction of the reservoir of P. jirovecii.…”

Section: Discussionmentioning

confidence: 99%

“…Pneumocystis pneumonia (PCP) remains a formidable infection for both AIDS and non-AIDS patients, with mortality rates in excess of 20% (5,9). The clinical presentations of the two groups differ, as do the principal differential diagnoses (9,13,30).…”

mentioning

confidence: 99%

“…Therapy with high-dose trimethoprim plus sulfamethoxazole with oral or intravenous corticosteroids may be given empirically, but these treatments are not without toxicity or immunosuppressive penalties. A worsening status, common early in the course of therapy, may precipitate a shift to pentamidine or a combination of primaquine and clindamycin, again with significant toxicities (3,5,34). Transfer to a high-dependency unit or ventilatory support may be required.…”

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confidence: 99%

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Multicenter, Prospective Clinical Evaluation of Respiratory Samples from Subjects at Risk for Pneumocystis jirovecii Infection by Use of a Commercial Real-Time PCR Assay

et al. 2011

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Pneumocystis jirovecii pneumonia (PCP) is a common opportunistic infection. Microscopic diagnosis, including diagnosis using the Merifluor-Pneumocystis direct fluorescent antigen (MP-DFA) test, has limitations.Real-time PCR may assist in diagnosis, but no commercially validated real-time PCR assay has been available to date. MycAssay Pneumocystis is a commercial assay that targets the P. jirovecii mitochondrial large subunit (analytical detection limit, <3.5 copies/l of sample). A multicenter trial recruited 110 subjects: 54 with transplants (40 with lung transplants), 32 with nonmalignant conditions, 13 with leukemia, and 11 with solid tumors; 9 were HIV positive. A total of 110 respiratory samples (92% of which were bronchoalveolar lavage [BAL] specimens) were analyzed by PCR. Performance was characterized relative to investigator-determined clinical diagnosis of PCP (including local diagnostic tests), and PCR results were compared with MP-DFA test results for 83 subjects. Thirteen of 14 subjects with PCP and 9/96 without PCP (including 5 undergoing BAL surveillance after lung transplantation) had positive PCR results; sensitivity, specificity, and positive and negative predictive values (PPV and NPV, respectively) were 93%, 91%, 59%, and 99%, respectively. Fourteen of 83 subjects for whom PCR and MP-DFA test results were available had PCP; PCR sensitivity, specificity, PPV, and NPV were 93%, 90%, 65%, and 98%, respectively, and MP-DFA test sensitivity, specificity, PPV, and NPV were 93%, 100%, 100%, and 98%. Of the 9 PCR-positive subjects without PCP, 1 later developed PCP. The PCR diagnostic assay compares well with clinical diagnosis using nonmolecular methods. Additional positive results compared with the MP-DFA test may reflect low-level infection or colonization.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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Multicenter, Prospective Clinical Evaluation of Respiratory Samples from Subjects at Risk for Pneumocystis jirovecii Infection by Use of a Commercial Real-Time PCR Assay

et al. 2011

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“…The organism is host-obligate and species specific: it cannot be grown outside the host and organisms from one host cannot infect other mammalian hosts [1].…”

Section: Introductionmentioning

confidence: 99%

Pneumocystis Pneumonia Associated with Human Immunodeficiency Virus

Miller

Huang

Walzer

2013

Clinics in Chest Medicine

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“…neumocystis pneumonia (PCP) is a severe respiratory infection that affects immunocompromised individuals (6). It is the most prevalent opportunistic infection among AIDS patients, with a mortality rate ranging from 10% to 20% (12).…”

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confidence: 99%

Validation of the MycAssay Pneumocystis Kit for Detection of Pneumocystis jirovecii in Bronchoalveolar Lavage Specimens by Comparison to a Laboratory Standard of Direct Immunofluorescence Microscopy, Real-Time PCR, or Conventional PCR

2012

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dPneumocystis jirovecii pneumonia is a significant cause of morbidity and mortality in AIDS patients as well as those with non-HIV immunosuppressive diseases. To aid diagnosis, the commercial MycAssay Pneumocystis real-time PCR assay (Myconostica, Ltd., Manchester, United Kingdom) targeting the mitochondrial ribosomal large subunit (mtLSU) has been developed to detect P. jirovecii in bronchoalveolar lavage (BAL) specimens. Here, we validated this assay against a laboratory standard of direct immunofluorescence microscopy, a cdc2 real-time PCR assay, or conventional PCR and sequencing of mtLSU. While more sensitive than any of these three assays analyzed individually, the MycAssay Pneumocystis assay demonstrated 100% sensitivity, 100% specificity, a 100% negative predictive value, and a 100% positive predictive value for detecting the presence of P. jirovecii in BAL specimens compared to the laboratory standard. Of note, two samples with positive cycle threshold (C T ) values according to the MycAssay Pneumocystis assay lacked exponential amplification curves and thus were deemed negative. Also negative according to the laboratory standard, these samples highlight the importance of examining the amplification curves, in addition to noting the C T values, when interpreting positive results. Comparison of the MycAssay Pneumocystis assay to a laboratory standard establishes this assay to be a highly sensitive and specific method for the detection of P. jirovecii in bronchoalveolar lavage specimens. The approach may also be useful for the clinical laboratory validation of other sensitive real-time PCR assays.

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Are Members of the Fungal Genus Pneumocystis (a) Commensals; (b) Opportunists; (c) Pathogens; or (d) All of the Above?

Cited by 50 publications

References 20 publications

Multicenter, Prospective Clinical Evaluation of Respiratory Samples from Subjects at Risk for Pneumocystis jirovecii Infection by Use of a Commercial Real-Time PCR Assay

Multicenter, Prospective Clinical Evaluation of Respiratory Samples from Subjects at Risk for Pneumocystis jirovecii Infection by Use of a Commercial Real-Time PCR Assay

Pneumocystis Pneumonia Associated with Human Immunodeficiency Virus

Validation of the MycAssay Pneumocystis Kit for Detection of Pneumocystis jirovecii in Bronchoalveolar Lavage Specimens by Comparison to a Laboratory Standard of Direct Immunofluorescence Microscopy, Real-Time PCR, or Conventional PCR

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