BACKGROUND: Pneumocystis pneumonia (PCP) is a major cause of hospitalization and mortality in HIV-infected African children. Microbiologic diagnosis relies predominantly on silver or immunofluorescent staining of a lower respiratory tract (LRT) specimens which are difficult to obtain in children. Diagnosis on upper respiratory tract (URT) specimens using PCR has been reported useful in adults, but data in children are limited. The main objectives of the study was (1) to compare the diagnostic yield of PCR with immunofluorescence (IF) and (2) to investigate the usefulness of upper compared to lower respiratory tract samples for diagnosing PCP in children. METHODS: Children hospitalised at an academic hospital with suspected PCP were prospectively enrolled. An upper respiratory sample (nasopharyngeal aspirate, NPA) and a lower respiratory sample (induced sputum, IS or bronchoalveolar lavage, BAL) were submitted for real-time PCR and direct IF for the detection of Pneumocystis jirovecii. A control group of children with viral lower respiratory tract infections were investigated with PCR for PCP. RESULTS: 202 children (median age 3.3 [inter-quartile range, IQR 2.2 - 4.6] months) were enrolled. The overall detection rate by PCR was higher than by IF [180/349 (52%) vs. 26/349 (7%) respectively; p < 0.0001]. PCR detected more infections compared to IF in lower respiratory tract samples [93/166 (56%) vs. 22/166 (13%); p < 0.0001] and in NPAs [87/183 (48%) vs. 4/183 (2%); p < 0.0001]. Detection rates by PCR on upper (87/183; 48%) compared with lower respiratory tract samples (93/166; 56%) were similar (OR, 0.71; 95% CI, 0.46 - 1.11). Only 2/30 (6.6%) controls were PCR positive. CONCLUSION: Real-time PCR is more sensitive than IF for the detection of P. jirovecii in children with PCP. NPA samples may be used for diagnostic purposes when PCR is utilised. Wider implementation of PCR on NPA samples is warranted for diagnosing PCP in children.
BACKGROUND:Pneumocystis pneumonia (PCP) is a major cause of hospitalization and mortality in HIV-infected African children. Microbiologic diagnosis relies predominantly on silver or immunofluorescent staining of a lower respiratory tract (LRT) specimens which are difficult to obtain in children. Diagnosis on upper respiratory tract (URT) specimens using PCR has been reported useful in adults, but data in children are limited. The main objectives of the study was (1) to compare the diagnostic yield of PCR with immunofluorescence (IF) and (2) to investigate the usefulness of upper compared to lower respiratory tract samples for diagnosing PCP in children. METHODS:Children hospitalised at an academic hospital with suspected PCP were prospectively enrolled. An upper respiratory sample (nasopharyngeal aspirate, NPA) and a lower respiratory sample (induced sputum, IS or bronchoalveolar lavage, BAL) were submitted for real-time PCR and direct IF for the detection of Pneumocystis jirovecii. A control group of children with viral lower respiratory tract infections were investigated with PCR for PCP. RESULTS: 202 children (median age 3.3 [inter-quartile range, IQR 2.2 - 4.6] months) were enrolled. The overall detection rate by PCR was higher than by IF [180/349 (52%) vs. 26/349 (7%) respectively; p < 0.0001]. PCR detected more infections compared to IF in lower respiratory tract samples [93/166 (56%) vs. 22/166 (13%); p < 0.0001] and in NPAs [87/183 (48%) vs. 4/183 (2%); p < 0.0001]. Detection rates by PCR on upper (87/183; 48%) compared with lower respiratory tract samples (93/166; 56%) were similar (OR, 0.71; 95% CI, 0.46 - 1.11). Only 2/30 (6.6%) controls were PCR positive. CONCLUSION: Real-time PCR is more sensitive than IF for the detection of P. jirovecii in children with PCP. NPA samples may be used for diagnostic purposes when PCR is utilised. Wider implementation of PCR on NPA samples is warranted for diagnosing PCP in children.
Authors: Hans Henrik Larsen; Henry Masur; Joseph A Kovacs; Vee J Gill; Victoria A Silcott; Palaniandy Kogulan; Janine Maenza; Margo Smith; Daniel R Lucey; Steven H Fischer Journal: J Clin Microbiol Date: 2002-02 Impact factor: 5.948
Authors: Chifumbe Chintu; Victor Mudenda; Sebastian Lucas; Andrew Nunn; Kennedy Lishimpi; Daniel Maswahu; Francis Kasolo; Peter Mwaba; Ganapati Bhat; Hiroshi Terunuma; Alimuddin Zumla Journal: Lancet Date: 2002-09-28 Impact factor: 79.321
Authors: S Fischer; V J Gill; J Kovacs; P Miele; J Keary; V Silcott; S Huang; L Borio; F Stock; G Fahle; D Brown; B Hahn; E Townley; D Lucey; H Masur Journal: J Infect Dis Date: 2001-11-13 Impact factor: 5.226
Authors: Anna R Huppler; Brian T Fisher; Thomas Lehrnbecher; Thomas J Walsh; William J Steinbach Journal: J Pediatric Infect Dis Soc Date: 2017-09-01 Impact factor: 3.164
Authors: Kelvin K W To; Sally C Y Wong; Ting Xu; Rosana W S Poon; Ka-Yi Mok; Jasper F W Chan; Vincent C C Cheng; Kwok-Hung Chan; Ivan F N Hung; Kwok-Yung Yuen Journal: J Clin Microbiol Date: 2013-02-13 Impact factor: 5.948
Authors: Daniel E Park; Henry C Baggett; Stephen R C Howie; Qiyuan Shi; Nora L Watson; W Abdullah Brooks; Maria Deloria Knoll; Laura L Hammitt; Karen L Kotloff; Orin S Levine; Shabir A Madhi; David R Murdoch; Katherine L O'Brien; J Anthony G Scott; Donald M Thea; Dilruba Ahmed; Martin Antonio; Vicky L Baillie; Andrea N DeLuca; Amanda J Driscoll; Wei Fu; Caroline W Gitahi; Emmanuel Olutunde; Melissa M Higdon; Lokman Hossain; Ruth A Karron; Abdoul Aziz Maiga; Susan A Maloney; David P Moore; Susan C Morpeth; John Mwaba; Musaku Mwenechanya; Christine Prosperi; Mamadou Sylla; Somsak Thamthitiwat; Scott L Zeger; Daniel R Feikin Journal: Clin Infect Dis Date: 2017-06-15 Impact factor: 9.079