Diagnosis of Pneumocystis Carinii Pneumonia by Non-Experts

Dournon, E; Rajagopalan, P; Albert, Françoise; Camus, Françoise; Marche, C; McLauchlin, James; Samuel, Dhanraj; Taylor, A. J.

doi:10.1016/s0140-6736(89)91470-0

Cited by 7 publications

(4 citation statements)

References 2 publications

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“…Indeed, the P. jirovecii fungus is difficult to grow in culture, and the sensitivity of direct microscopic examination is low (26,27,(33)(34)(35). PCR has greatly increased the sensitivity of detection of P. jirovecii DNA.…”

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confidence: 99%

Detection of Pneumocystis jirovecii by Quantitative PCR To Differentiate Colonization and Pneumonia in Immunocompromised HIV-Positive and HIV-Negative Patients

et al. 2016

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dPneumocystis jirovecii pneumonia (PCP) is an acute and life-threatening lung disease caused by the fungus Pneumocystis jirovecii. The presentation of PCP in HIV-positive patients is well-known and consists of a triad of dyspnea, fever, and cough, whereas the presentation of PCP in HIV-negative patients is atypical and consists of a sudden outbreak, O 2 desaturation, and a rapid lethal outcome without therapy. Despite the availability of direct and indirect identification methods, the diagnosis of PCP remains difficult. The cycle threshold (C T ) values obtained by quantitative PCR (qPCR) allow estimation of the fungal burden. The more elevated that the fungal burden is, the higher the probability that the diagnosis is pneumonia. The purposes of the present study were to evaluate the C T values to differentiate colonization and pneumonia in a population of immunocompromised patients overall and patients stratified on the basis of their HIV infection status. Testing of bronchoalveolar lavage (BAL) fluid samples from the whole population of qPCR-positive patients showed a mean C T value for patients with PCP of 28 (95% confidence interval [CI], 26 to 30) and a mean C T value for colonized patients of 35 (95% CI, 34 to 36) (P < 10 ؊3 ). For the subgroup of HIV-positive patients, we demonstrated that a C T value below 27 excluded colonization and a C T value above 30 excluded PCP with a specificity of 100% and a sensitivity of 80%, respectively. In the subgroup of HIV-negative patients, we demonstrated that a C T value below 31 excluded colonization and a C T value above 35 excluded PCP with a specificity of 80% and a sensitivity of 80%, respectively. Thus, qPCR of BAL fluid samples is an important tool for the differentiation of colonization and pneumonia in P. jirovecii-infected immunocompromised patients and patients stratified on the basis of HIV infection status with different C T values.

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confidence: 99%

Detection of Pneumocystis jirovecii by Quantitative PCR To Differentiate Colonization and Pneumonia in Immunocompromised HIV-Positive and HIV-Negative Patients

et al. 2016

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“…We found IIF using the combination of the three monoclonal antibodies from NIH to be the most sensitive of five different staining techniques for detection of Pneumocystis carinii. Thus, as maintained by Dournon et al (19), the procedure may allow many laboratories with no special experience to diagnose Pneumocystis carinii pneumonia accurately. The sensitivity was significantly less and the fluorescence was not as bright using this monoclonal antibody as with the monoclonai antibodies from NIH.…”

Section: Discussionmentioning

confidence: 98%

Improved detection ofPneumocystis carinii by an immunofluorescence technique using monoclonal antibodies

Orholm

Holten-Andersen

Lundgren

1990

Eur. J. Clin. Microbiol. Infect. Dis.

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To assess whether a recently developed indirect immunofluorescent stain using monoclonal antibodies was more sensitive in detecting Pneumocystis carinii than the combination of Giemsa and methenamine silver nitrate stains which has routinely been used in the laboratory, 88 lavage fluid specimens and 34 induced sputum specimens were examined. All specimens were stained by five techniques: immunofluorescence using a combination of three monoclonal antibodies (from the National Institutes of Health, USA), immunofluorescence using a single monoclonal antibody (from Dakopatts), Giemsa, methenamine silver nitrate and toluidine blue O. Immunofluorescence using the monoclonal antibodies from the NIH was significantly more sensitive than any other single staining method and than the combination of Giemsa and methenamine silver nitrate staining. The study also showed that the cytospin centrifuge was very suitable for the preparation of slides with lavage fluid and processed induced sputum. Finally, the sensitivity of examination of induced sputum to detect Pneumocystis carinii was found to be 50% when compared with bronchoalveolar lavage fluid. However, this sensitivity may increase through practice.

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“…Initial experiences with IS were performed with conventional processing techniques for P. carinii visualization (Met-Ag, toluidine blue, Giemsa stain ... ) (table 4). Recently, monoclonal antibody-based stains, the effectiveness of which is similar for the previously mentioned techniques in BAL examination [7][8][9][10], have shown a higher sensitivity than conventional stains in samples obtained by IS [3][4][5]. In the series of MiooLEY et al [3], 15 out of 4 7 (31%) patients diagnosed by IS were positive by means of IFMoAb stain and negative by Met-Ag.…”

Section: P Carinii Infection Criteriamentioning

confidence: 99%

“…The results of IS examination in the diagnosis of P. carinii pneumonia are good [1][2][3][4][5][6], especially if the staining procedure includes monoclonal antibody to P. carinii [3][4][5]. Several monoclonal antibody techniques have been developed: immunofluorescence [3,5,[7][8][9][10], immunoperoxidase [ 4] and enzyme-linked immunoadsorbent assay (ELISA) [11].…”

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confidence: 99%

Pneumocystis carinii pneumonia in HIV-infected patients: diagnostic yield of induced sputum and immunofluorescent stain with monoclonal antibodies

Fortün

Navas²,

Martí-Belda³

et al. 1992

Eur Respir J

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The purpose of this study was to evaluate the diagnostic yield of induced sputum (IS), assessing the reliability of indirect immunofluorescent stain with monoclonal antibodies (IFMoAb) and methenamine silver (Met-Ag) and analysing factors likely to influence the sensitivity of these techniques. An analysis was prospectively carried out on IS specimens collected from 61 human immunodeficiency virus (HIV)-infected patients during 69 episodes of suspected Pneumocystis carinii pneumonia. Ultrasonic nebulizers with hypertonic 2% saline were used. IFMoAb to P. carinii and Met-Ag were performed after cytocentrifugation of the specimen. Results were compared with those of bronchoalveolar lavage (BAL) with/without transbronchial biopsy (TBB), performed not more than seven days after induction of sputum. P. carinii pneumonia was confirmed in 32 episodes, of which IS was diagnostic in 23. The sensitivity of the staining procedures was 69% for IFMoAb, and 28% for Met-Ag. The three episodes of P. carinii pneumonia in patients on oral chemoprophylaxis yielded negative IS results; in contrast, IS was negative in only 6 of the 29 cases not receiving chemoprophylaxis. IS is a non-aggressive procedure that diagnosed P. carinii pneumonia in 72% of our cases. The yield increased significantly when IFMoAb was used in patients not receiving oral chemoprophylaxis.

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Diagnosis of Pneumocystis Carinii Pneumonia by Non-Experts

Cited by 7 publications

References 2 publications

Detection of Pneumocystis jirovecii by Quantitative PCR To Differentiate Colonization and Pneumonia in Immunocompromised HIV-Positive and HIV-Negative Patients

Detection of Pneumocystis jirovecii by Quantitative PCR To Differentiate Colonization and Pneumonia in Immunocompromised HIV-Positive and HIV-Negative Patients

Improved detection ofPneumocystis carinii by an immunofluorescence technique using monoclonal antibodies

Pneumocystis carinii pneumonia in HIV-infected patients: diagnostic yield of induced sputum and immunofluorescent stain with monoclonal antibodies

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