The Use of Oral Washes to DiagnosePneumocystis cariniiPneumonia: A Blinded Prospective Study Using a Polymerase Chain Reaction–Based Detection System

Abstract

Pneumocystis carinii pneumonia (PCP) can be diagnosed by direct microscopic examination of induced sputum or by bronchoalveolar lavage (BAL). However, many institutions have little diagnostic success with induced sputum, and BAL is invasive and expensive. This prospective, blinded study assessed oral washes as a more convenient specimen than either sputum or BAL fluid and used a dissociation-enhanced lanthanide fluoroimmunoassay time-resolved fluorescent hybridization polymerase chain reaction (PCR) detection system that is feasible for clinical laboratories. The study assessed 175 oral washes, each paired with either an induced sputum that was positive for Pneumocystis or a BAL sample. The PCR test based on the Pneumocystis major surface glycoprotein primers had a sensitivity of 91% and a specificity of 94%, compared with a test based on mitochondrial large subunit rRNA primers, which had a sensitivity of 75% and a specificity of 96%. These results suggest that oral washes can provide a useful sample for diagnosis of PCP when a sensitive PCR detection system is used.

Establishment of a quantitative real-time PCR for the detection of Pneumocystis carinii f. sp. suis in bronchoalveolar lavage samples from pigs

“…Induced sputum has been described as a useful technique for the detection of Pneumocystis jirovecii in HIV patients. 6,17 Pneumocystis infections of immunocompromised humans can be severe. 19 The fungus concentration in the lungs is likely extremely high and, as a consequence, Pneumocystis is easily expectorated with the sputum by coughing.…”

Use of Nasopharyngeal Aspirate for Diagnosis of Pneumocystis Pneumonia

“…The result suggests that patients with higher Pneumocystis load in NPA specimens have a higher likelihood of true PCP rather than mere colonization. The use of upper respiratory tract specimens in the diagnosis of Pneumocystis infection has been evaluated in previous studies (18)(19)(20)(21)(22)(23)(24). Our study differs from these studies in several aspects.…”

Características clínicas, diagnósticas y pronosticas de pacientes con neumonía por Pneumocystis jiroveci en individuos infectados por virus de inmunodeficiencia humana e individuos inmunocomprometidos por otra etiología: comparative study of cases in HIV-infected patients and immunocompromised non-HIV-infected patients

“…29 o las muestras de gárgara para estudio con RPC con sensibilidad y especificidad descritas mayores a 90%, respectivamente 23,24 .…”

“…Se incluyeron todos los pacientes > 15 años con neumonía por P. jiroveci, definida como tal por sus médicos tratantes, dado la presencia de síntomas respiratorios bajos, imágenes pulmonares compatibles en radiografía o tomografía computada de tórax, y detección de P. jiroveci por técnica de inmunofluorescencia directa (IFD) y/o reacción de polimerasa en cadena, en tiempo real (RPC-TR) en una o más muestras respiratorias (expectoración inducida, gárgara, aspirado nasofaríngeo, aspirado endotraqueal o lavado bronquio-alveolar), según lo descrito en los reportes publicados 23,24 . Se excluyeron aquellos casos catalogados por sus tratantes como colonización o aquellos con registros clínicos incompletos que no permitieron dilucidar si se trataba de una colonización o de una infección clínica.…”