Polymerase Chain Reaction for Diagnosing Pneumocystis Pneumonia in Non-HIV Immunocompromised Patients With Pulmonary Infiltrates
Polymerase Chain Reaction for Diagnosing Pneumocystis Pneumonia in Non-HIV Immunocompromised Patients With Pulmonary Infiltrates
复制标题
DOI：
10.1378/chest.08-1309
复制
发表时间：
2009-03-01
期刊：
影响因子：
9.6
通讯作者：
Menotti, Jean
中科院分区：
文献类型：
--
作者：
Azoulay, Elie;Bergeron, Anne;Menotti, Jean
方法：对448例HIV感染的免疫缺陷患者进行比较。结果：在448例患者中，296例(66%)为恶性血液病，72例(16.1%)为骨髓移植，44例(9.8%)为实体瘤，21例(4.7%)为肾移植，15例(3.4%)因全身疾病而服用免疫抑制剂。诊断策略包括351例BAL和97例诱导痰(IS)。常规肺囊性肺炎(PCP)阳性39例(8.7%)，其中34例PCP阳性。此外，32名患者的聚合酶链式反应呈阳性，包括21名获得完全随访的患者，其中14名患者被诊断为可能或明确的PCP(增加了36%)。聚合酶链式反应的敏感性为87.2%，特异性为92.2%，阳性预测值为51.5%，阴性预测值为98.7%。其敏感性和阴性预测值均为100%。结论：在非HIV感染的免疫功能低下的急性肺浸润性疾病患者中，P-jirovei-PCR与PCP的临床证据相关。阴性的聚合酶链式反应允许撤销抗PCP治疗。
Rationale: Pneumocystis jiroveci polymerase chain reaction (PCR) has higher sensitivity than conventional stains but cannot distinguish colonization from infection.Methods: We compared P jiroveci PCR and conventional stains in HIV-uninfected immunocompromised patients.Results: Among the 448 patients, 296 (66%) patients had hematologic malignancies; 72 (16.1%), bone marrow transplants; 44 (9.8%), solid tumors; 21 (4.7%), renal transplants; and 15 (3.4%) were taking immunosuppressants for systemic diseases. Diagnostic strategy consisted of BAL in 351 patients and induced sputum (IS) in 97 patients. Conventional pneumocystic pneumonia (PCP) stain was positive in 39 (8.7%) patients, including 34 with positive PCR. In addition, PCR was positive in 32 patients, including 21 with complete follow-up, of whom 14 were diagnosed with probable or definitive PCP (a 36% increase). PCR was 87.2% sensitive and 92.2% specific; positive and negative predictive values were 51.5% and 98.7%, respectively. Sensitivity and negative predictive value were 100% on IS.Conclusions: in HIV-uninfected immunocompromised patients with acute pulmonary infiltrates, P jiroveci PCR correlates with clinical evidence of PCP. A negative PCR allows withdrawing anti-PCP therapy.