DNA amplification by the polymerase chain reaction to detect sub-clinical Pneumocystis carinii colonization in HIV-positive and HIV-negative male homosexuals with and without respiratory symptoms

Leigh, T R; Kangro, H. O.; Gazzard, Brian; Jeffries, Don; Collins, J.V.

doi:10.1016/0954-6111(93)90008-n

Cited by 80 publications

(58 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Indeed, the reference treatment is full-dose co-trimoxazole, whose hematological and dermatological toxicity is well established. Some authors support the initiation of a specific therapy when immunosuppression is persistent, considering that colonization could represent an early stage of the disease (27,28). However, this risk was found to be low in HIVinfected patients (29) and has only occasionally been reported in other immunocompromised patients (28,30,31).…”

Section: Discussionmentioning

confidence: 99%

“…Some authors support the initiation of a specific therapy when immunosuppression is persistent, considering that colonization could represent an early stage of the disease (27,28). However, this risk was found to be low in HIVinfected patients (29) and has only occasionally been reported in other immunocompromised patients (28,30,31). In our study, there was one case of an HIV-positive patient, diagnosed as colonized based on a first BAL fluid analysis, who was not treated with anti-Pneumocystis therapy, and whose second BAL fluid sample, 10 days later, was negative for P. jirovecii by qPCR.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Impact of HIV Infection Status on Interpretation of Quantitative PCR for Detection of Pneumocystis jirovecii

et al. 2015

View full text Add to dashboard Cite

Quantitative PCR (qPCR) is now a key diagnostic tool forPneumocystispneumonia. However, cutoffs to distinguish between infected and colonized patients according to their HIV status have not yet been determined. According to clinical, radiological, and biological data, we retrospectively classified bronchoalveolar lavage (BAL) samples subjected to qPCR over a 3-year period into four categories, i.e., definite PCP, probable PCP,Pneumocystiscolonization, and no infection. Fungal burden was then analyzed according to the HIV status of the patients. Among 1,212 episodes of pneumonia screened in immunocompromised patients, 52 and 27 HIV-positive patients were diagnosed with a definite and probable PCP, whereas 4 and 22 HIV-negative patients had definite and probable PCP, respectively. Among patients with definite or a probable PCP, HIV-negative patients had a significantly lower burden than HIV-positive patients (P< 10−4). In both groups, the median fungal burden was significantly higher in patients with definite PCP than in colonized patients. A single cutoff at 1.5 × 104copies/ml allowed to differentiate colonized and infected HIV-positive patients with 100% sensitivity and specificity. In HIV-negative patients, cutoff values of 2.87 × 104and 3.39 × 103copies/ml resulted in 100% specificity and sensitivity, respectively. Using cutoffs determined for the whole population would have led us to set aside the diagnosis of PCP in 9 HIV-negative patients with definite or probable PCP. qPCR appeared to be the most sensitive test to detectPneumocystisin BAL samples. However, because of lower inocula in HIV-negative patients, different cutoffs must be used according to the HIV status to differentiate between colonized and infected patients.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Impact of HIV Infection Status on Interpretation of Quantitative PCR for Detection of Pneumocystis jirovecii

et al. 2015

View full text Add to dashboard Cite

show abstract

“…P. carinii colonisation in HIV-positive homosexual men was shown to be associated with a low peripheral CD4+ cell count ,400=ìl [15]. The mean CD4+ cell counts among the colonised immunosuppressed individuals with and without HIV infection (58.6 and 281.5/ ìl, respectively) in the present study were consistent with the data from the latter reports [14,15]. No significant difference in the presence of PCP prophylaxis was found between the colonised patients with and without HIV infection in the present study.…”

Section: Discussionmentioning

confidence: 99%

Pneumocystis carinii carriage in immunocompromised patients with and without human immunodeficiency virus infection

Takahashi¹,

Goto²,

Endo³

et al. 2002

Journal of Medical Microbiology

View full text Add to dashboard Cite

Eighty-one bronchoalveolar lavage (BAL) specimens obtained from 26 HIV-infected, 45 non-HIV immunosuppressed and 10 immunocompetent patients with primary pulmonary diseases were analysed for the presence of Pneumocystis carinii by staining and by P. carinii 5S rDNA determined by PCR. P. carinii was observed by staining of BAL specimens from HIV-infected patients significantly more frequently than those from immunocompromised hosts without HIV infection (57.7% versus 20.0%, respectively). P. carinii 5S rDNA was detected by PCR assay in seven (26.9%) HIV-infected individuals, which was significantly more frequent than for four (8.9%) immunosuppressed patients without HIV infection, for whom staining was negative. None of these patients developed P. carinii pneumonia (PCP) within the follow-up period. BAL specimens from 10 immunocompetent patients with pulmonary disorders were negative for PCP by both staining and PCR assay.

show abstract

“…La RPC para P. jiroveci tuvo una sensibilidad cercana a 100%, tanto en esputo como LBA. La especifi cidad cayó debido a que algunos pacientes tuvieron un diagnóstico etiológico diferente y, por lo tanto, estaban colonizados por P. jiroveci, tal como ha sido extensamente descrito en la literatura médica [23][24][25][26] . Algunos de estos pacientes podrían desarrollar infección por P. jiroveci a futuro, según lo reportado por Elvin y cols 27 , quienes describieron que seis de ocho pacientes asintomáticos con una RPC positiva para P. jiroveci, desarrollaron neumonía por este agente entre los 164 y 352 días posteriores al resultado positivo del examen.…”

Section: Discussionunclassified

Etiología de la neumonía en pacientes chilenos infectados por el virus de la inmunodeficiencia humana

Carmona

et al. 2011

Rev. chil. infectol.

View full text Add to dashboard Cite

Objectives:To establish the etiology of pneumonia and to compare the yield of diagnostic techniques for diagnosis of Pneumocystis jiroveci and Mycobacterium tuberculosis infections in HIV-1-infected patients. Patients and Methods: Subjects underwent sputum induction and bronchoalveolar lavage (BAL). Gram, Ziehl-Neelsen, silver stain (SS) and immunofl uorescense staining (IF) for P. jiroveci, fl uorescent stain for mycobacteria, PCR for P. jiroveci and M. tuberculosis, aerobic, fungal and mycobacterial cultures, respiratory viruses and CMV cultures were performed on the sputum and BAL. IgM for Mycoplasma pneumoniae and Chlamydophyla pneumoniae, and Legionella pneumophila urinary antigen were also obtained. Results: Sixty patients were included. An etiologic diagnosis was made in 97%. Pneumocystis jiroveci was the most frequent etiology (58%) followed by Streptococcus pneumoniae (12%), and Mycobacterium avium complex (12%). Mycobacterium tuberculosis was found in 5%. Conclusions:The comparison of diagnostic methods for P. jiroveci showed a higher sensitivity of IF and SS in BAL than in sputum, however PCR was equally sensitive in both samples. With this approach a precise etiologic diagnosis was reached in the great majority of patients. The most common etiology was P. jiroveci. IF in BAL remains the gold standard for diagnosis of P. jiroveci pneumonia.Key words: Pneumonia, Acquired Immunodefi ciency Syndrome, HIV, AIDS-Related Opportunistic Infections, Etiology.Palabras clave: Neumonía, síndrome de inmunodefi ciencia adquirida, VIH, infecciones oportunistas, etiología. Pontificia Universidad Católica de ChileDepartamento de Medicina Interna (CPC,MCA, JLL, MBM, PGG, GAL). Departamento de LaboratorioClínico (PGC). Departamento de EnfermedadesRespiratorias (TBW, RMB)Departamento de Pediatría (PVC). Programa de EnfermedadesInfecciosas (CPC, PGC, JLL, GAL). . El sistema respiratorio es un sitio donde frecuentemente se producen infecciones fúngicas (Pneumocystis jiroveci, anteriormente denominado Pneumocystis carinii), bacterianas y por micobacterias. La tasa de neumonía por P. jiroveci en los pacientes con recuentos de linfocitos CD4 ≤ a 200 céls/mm 3 , sin uso de profi laxis, es de 8,08 casos por 100 personas-año 2 . La neumonía bacteriana se presenta con una incidencia entre 2,3 y 10,8 episodios por 100 personas-año en los pacientes infectados por VIH (comparado con 0,9 por 100 personasaño en individuos sanos) 3,4 . La broncoscopia con lavado bronco-alveolar (LBA) se considera el método estándar para el diagnóstico etiológico de la neumonía en pacientes infectados por VIH. No obstante, puesto que es un método invasor, el esputo inducido aparece como una estrategia diagnóstica sensible y costo-efectiva. Las nuevas técnicas de diagnóstico molecular podrían disminuir la necesidad de procedimientos invasores para el diagnóstico etiológico de la neumonía en estos pacientes.El objetivo primario de este estudio fue establecer el diagnóstico etiológico de la neumonía en pacientes infectados por VIH utilizando métodos tradic...

show abstract

DNA amplification by the polymerase chain reaction to detect sub-clinical Pneumocystis carinii colonization in HIV-positive and HIV-negative male homosexuals with and without respiratory symptoms

Cited by 80 publications

References 17 publications

Impact of HIV Infection Status on Interpretation of Quantitative PCR for Detection of Pneumocystis jirovecii

Impact of HIV Infection Status on Interpretation of Quantitative PCR for Detection of Pneumocystis jirovecii

Pneumocystis carinii carriage in immunocompromised patients with and without human immunodeficiency virus infection

Etiología de la neumonía en pacientes chilenos infectados por el virus de la inmunodeficiencia humana

Contact Info

Product

Resources

About