DNA amplification on induced sputum samples for diagnosis of Pneumocystis carinii pneumonia

doi:10.1016/0140-6736(91)93062-E

The Lancet

Volume 337, Issue 8754, 8 June 1991, Pages 1378-1379

https://doi.org/10.1016/0140-6736(91)93062-E Get rights and content

Abstract

DNA amplification and silver staining were used to identify Pneumocystis carinii in bronchoscopic lavage and induced sputum samples during 51 episodes of respiratory illness in 47 subjects with H IV infection. In 20 episodes, in which the clinical diagnosis was pneumocystis pneumonia (PCP), silver stain was positive in 14 lavage samples (70%) and 7 sputum samples (35%), whereas DNA amplification was positive in 19 lavage samples (95%) and 18 sputum samples (90%). DNA amplification was positive in only 1 of 31 patients without PCP (PCP developed in this patient within 10 weeks). DNA amplification on induced sputum offers a powerful technique for diagnosis of PCP.

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Citation Excerpt :
Of these, 314 were excluded for one or more of the following reasons: wrong publication type, no minimally invasive test performed, wrong population, no reference standard, no full-text, lack of data, and/or duplicate data (Fig. 1). Of the 52 eligible studies, 39 were part of the primary analysis [23–61] and 13 were part of the secondary analysis [15,62–73]. A complete description of eligible studies can be found in the Supplementary material (Table S1).
Pneumocystis jirovecii pneumonia (PCP) is an opportunistic infection commonly affecting immunocompromised people. Diagnosis usually requires invasive techniques to obtain respiratory specimens. Minimally invasive detection tests have been proposed, but their operating characteristics are poorly described.
To systematically review and meta-analyse the performance of minimally invasive PCP detection tests to inform diagnostic algorithms.
Medline, Embase, Cochrane Library (inception to 15 October 2020).
Studies of minimally invasive PCP detection tests were included if they contained a minimum of ten PCP cases.
Adults at risk of PCP.
Non-invasive PCP detection tests.
Diagnosis using the combination of clinical and radiographical features with invasive sampling.
Using the QUADAS-2 tool.
We used bivariate and, when necessary, univariate analysis models to estimate diagnostic test sensitivity and specificity.
Fifty-two studies were included; most studies (40) comprised exclusively human immunodeficiency virus (HIV) -infected individuals; nine were mixed (HIV and non-HIV), two were non-HIV and one study did not report HIV status. Sampling sites included induced sputum, nasopharyngeal aspirate, oral wash and blood. The four testing modalities evaluated were cytological staining, fluorescent antibody, PCR and lactate dehydrogenase. Induced sputum had the most data available; this modality was both highly sensitive at 99% (95% CI 51%–100%) and specific at 96% (95% CI 88%–99%). Induced sputum cytological staining had moderate sensitivity at 50% (95% CI 39%–61%) and high specificity at 100% (95% CI 100%–100%), as did fluorescent antibody testing with sensitivity 74% (95% CI 62%–87%) and specificity 100% (95% CI 91%–100%).
There are several promising minimally invasive PCP diagnostic tests available, some of which may reduce the need for invasive respiratory sampling. Understanding the operating characteristics of these tests can augment current diagnostic strategies and help establish a more confident clinical diagnosis of PCP. Further studies in non-HIV infected populations are needed.
Loop-mediated isothermal amplification method for diagnosing Pneumocystis pneumonia in HIV-uninfected immunocompromised patients with pulmonary infiltrates
2014, Journal of Infection and Chemotherapy
Citation Excerpt :
The decision to perform induced sputum (IS) or BAL was at the discretion of the attending physician. IS specimens were obtained according to a standard protocol, after inhalation of nebulized saline for 20 min [7]. IS samples and BAL fluids were stained using Grocott methenamine silver stain or Diff-Quick™ for detection of P. jirovecii trophozoites or cysts.
Loop-mediated isothermal ampliﬁcation (LAMP) is becoming an established nucleic acid ampliﬁcation method offering rapid, accurate, and cost-effective diagnosis of infectious diseases. We retrospectively evaluated 78 consecutive HIV-uninfected patients who underwent LAMP method for diagnosing Pneumocystis pneumonia (PCP). Diagnosis of PCP was made by the detection of Pneumocystis jirovecii (P. jirovecii) with positive LAMP or conventional staining (CS) (Grocott methenamine silver staining or Diff-Quick™) on the basis of compatible clinical symptoms and radiologic findings. Additionally, we reviewed HIV-uninfected immunocompromised patients who underwent subcontract PCR as a historical control. LAMP was positive in 10 (90.9%) of 11 positive-CS patients. Among 13 negative-CS patients with positive LAMP, 11 (84.6%) had PCP, and the remaining 2 were categorized as having P. jirovecii colonization. LDH levels in negative-CS PCP were higher than in positive-CS PCP (p = 0.026). (1 → 3)-β-D-glucan levels in negative-CS PCP were lower than in positive-CS PCP (p = 0.011). The interval from symptom onset to diagnosis as PCP in LAMP group (3.45 ± 1.77 days; n = 22) was shorter than in subcontract PCR group (6.90 ± 2.28 days; n = 10; p < 0.001). As for patients without PCP, duration of unnecessary PCP treatment in LAMP group (2; 2–3 days; n = 10) was shorter than in subcontract PCR group (7; 7–12.25 days; n = 6; p = 0.003). LAMP showed higher sensitivity (95.4%) and positive predictive value (91.3%) than subcontract PCR did. Pneumocystis LAMP method is a sensitive and cost-effective diagnostic method and is easy to administer in general hospitals. In-house LAMP method would realize early diagnosis of PCP, resulting in improving PCP prognosis and reducing unnecessary PCP-specific treatment.
Pneumocystis jirovecii pneumonia in non-HIV-infected patients in the era of novel immunosuppressive therapies
2012, Journal of Infection and Chemotherapy
In human immunodeficiency virus (HIV)-infected patients, Pneumocystis jirovecii pneumonia (PCP) is a well-known opportunistic infection, and its management has been established. However, PCP is an emerging threat to immunocompromised patients without HIV infection, such as those receiving novel immunosuppressive therapeutics for malignancy, organ transplantation, or connective tissue diseases. Clinical manifestations of PCP are quite different between patients with and without HIV infections. In patients without HIV infection, PCP rapidly progresses, is difficult to diagnose correctly, and causes severe respiratory failure with a poor prognosis. High-resolution computed tomography findings are different between PCP patients with HIV infection and those without. These differences in clinical and radiologic features are the result of severe or dysregulated inflammatory responses that are evoked by a relatively small number of Pneumocystis organisms in patients without HIV infection. In recent years, the usefulness of PCR and serum β-d-glucan assay for rapid and noninvasive diagnosis of PCP has been revealed. Although corticosteroid adjunctive to anti-Pneumocystis agents has been shown to be beneficial in some populations, the optimal dose and duration remain to be determined. Recent investigations revealed that Pneumocystis colonization is prevalent, and that asymptomatic carriers are at risk for developing PCP and can serve as the reservoir for the spread of Pneumocystis by person-to-person transmission. These findings suggest the need for chemoprophylaxis in immunocompromised patients without HIV infection, although its indication and duration are still controversial. Because a variety of novel immunosuppressive therapeutics have been emerging in medical practice, further innovations in the diagnosis and treatment of PCP are needed.
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ORIGINAL ARTICLESDNA amplification on induced sputum samples for diagnosis of Pneumocystis carinii pneumonia

Abstract

Mol Biochem Parasitol

Lancet

The usefulness of induced sputum in the diangosis of Pneumocystis carinii pneumonia in patients with the acquired immunodeficiency syndrome

Am Rev Resp Dis

Sputum examination for the diagnosis of Pneumocystis carinii pneumonia in the acquired immunodeficiency syndrome

Am Rev Resp Dis

ORIGINAL ARTICLES
DNA amplification on induced sputum samples for diagnosis of Pneumocystis carinii pneumonia