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Molecular diagnosis of Pneumocystis pneumonia in immunocompromised patients

Hélène Guegan1, Florence Robert-Gangneux

  • 1Laboratoire 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.

Current Opinion in Infectious Diseases
|May 21, 2019
PubMed
Abstract

Insights

Quantitative PCR (qPCR) aids in diagnosing Pneumocystis pneumonia (PCP) in immunocompromised patients. Combining qPCR with other methods improves diagnostic accuracy, especially in non-HIV cases.

Area of Science:

  • Infectious Diseases
  • Mycology
  • Immunology

Background:

  • Pneumocystis pneumonia (PCP) is a significant opportunistic infection with high mortality.
  • PCP is increasingly prevalent in non-HIV immunocompromised individuals, often presenting with severe respiratory distress and low fungal loads.
  • Molecular detection of Pneumocystis via quantitative PCR (qPCR) in broncho-alveolar lavage (BAL) is crucial but requires standardization.

Purpose of the Study:

  • To review the role of molecular detection in diagnosing Pneumocystis pneumonia.
  • To address the challenges in standardizing quantitative PCR for Pneumocystis detection.
  • To explore strategies for improving the specificity of qPCR in diagnosing PCP.

Main Methods:

  • Review of current literature on Pneumocystis pneumonia diagnosis.
  • Analysis of quantitative PCR (qPCR) performance in detecting Pneumocystis.
  • Evaluation of strategies to differentiate PCP from colonization and enhance diagnostic specificity.

Main Results:

  • Quantitative PCR (qPCR) offers high negative predictive value but moderate positive predictive value, potentially detecting colonization.
  • Establishing a qPCR cut-off is feasible for HIV-infected patients.
  • In non-HIV immunocompromised patients, combining qPCR on BAL with noninvasive samples or serum beta-1,3-D-glucan assays can increase specificity.

Conclusions:

  • Standardization of qPCR for Pneumocystis detection is essential.
  • Combined diagnostic strategies improve specificity for PCP in non-HIV immunocompromised patients.
  • Further research is needed to optimize molecular diagnostic approaches for Pneumocystis pneumonia.

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