Hélène Guegan1, Florence Robert-Gangneux. 1. Laboratoire de Parasitologie, Faculté de Médecine, Université Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé Environnement et Travail) - UMR_S 1085, Rennes, France.
Abstract
PURPOSE OF REVIEW: Pneumocystis pneumonia (PCP) is a frequent opportunistic infection associated with a high mortality rate. PCP is of increasing importance in non-HIV immunocompromised patients, who present with severe respiratory distress with low fungal loads. Molecular detection of Pneumocystis in broncho-alveolar lavage (BAL) has become an important diagnostic tool, but quantitative PCR (qPCR) needs standardization. RECENT FINDINGS: Despite a high negative predictive value, the positive predictive value of qPCR is moderate, as it also detects colonized patients. Attempts are made to set a cut-off value of qPCR to discriminate between PCP and colonization, or to use noninvasive samples or combined strategies to increase specificity. SUMMARY: It is easy to set a qPCR cut-off for HIV-infected patients. In non-HIV IC patients, a gain in specificity could be obtained by combining strategies, that is, qPCR on BAL and a noninvasive sample, or qPCR and serum beta-1,3-D-glucan dosage.
PURPOSE OF REVIEW: Pneumocystis pneumonia (PCP) is a frequent opportunistic infection associated with a high mortality rate. PCP is of increasing importance in non-HIV immunocompromised patients, who present with severe respiratory distress with low fungal loads. Molecular detection of Pneumocystis in broncho-alveolar lavage (BAL) has become an important diagnostic tool, but quantitative PCR (qPCR) needs standardization. RECENT FINDINGS: Despite a high negative predictive value, the positive predictive value of qPCR is moderate, as it also detects colonized patients. Attempts are made to set a cut-off value of qPCR to discriminate between PCP and colonization, or to use noninvasive samples or combined strategies to increase specificity. SUMMARY: It is easy to set a qPCR cut-off for HIV-infectedpatients. In non-HIV ICpatients, a gain in specificity could be obtained by combining strategies, that is, qPCR on BAL and a noninvasive sample, or qPCR and serum beta-1,3-D-glucan dosage.
Authors: José Luis Piñana; Eliseo Albert; María Dolores Gómez; Ariadna Pérez; Juan Carlos Hernández-Boluda; Juan Montoro; Miguel Salavert; Eva María González; Mar Tormo; Estela Giménez; Marta Villalba; Aitana Balaguer-Roselló; Rafael Hernani; Felipe Bueno; Rafael Borrás; Jaime Sanz; Carlos Solano; David Navarro Journal: J Infect Date: 2020-01-10 Impact factor: 6.072