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首页> 外文期刊>AIDS Research and Human Retroviruses >Short Communication: Diagnosis of Pneumocystis jirovecii Pneumonia by Detection of DNA in Blood and Oropharyngeal Wash, Compared with Sputum
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Short Communication: Diagnosis of Pneumocystis jirovecii Pneumonia by Detection of DNA in Blood and Oropharyngeal Wash, Compared with Sputum

机译：简短交流：通过检测血液和口咽洗液中的DNA与痰液比较，诊断吉罗威氏肺炎性肺炎

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摘要

Molecular diagnostic methods on lower respiratory specimens for Pneumocystis pneumonia (PCP) are recommended, but specimens can be difficult to obtain. This study examined the diagnostic use of PCP polymerase chain reaction (PCR) on oropharyngeal wash (OPW) and blood versus sputum (spontaneous and induced) to find faster, simpler, and less invasive diagnostic methods. We prospectively recruited consenting adults with symptoms consistent with PCP. Real-time PCR targeted the Pneumocystis mitochondrial large subunit ribosomal RNA gene, using the aforementioned specimens. Clinical data were collected from routine records. Forty-five participants provided 45 sputa, 31 OPW, and 41 blood samples. Median age was 39 years and 41 (91%) were male, with median CD4 count being 64 cells/L. Sputum PCR was positive in 27/45 (60%) participants. Comparative sensitivity of OPW was 9/19 (47%, 95% confidence interval [CI] 23-71) and blood 12/24 (50%, 95% CI 29-71) participants, both with specificity 100%. Including only samples obtained 2 days after start of treatment, sensitivity of OPW was 80% (8/10, 95% CI 51-100), that of blood was 57% (8/14, 95% CI 29-86), and that of combined tests was 88% (14/16, 95% CI 70-100). In 14/16 individuals with PCP and specimens obtained 2 days after start of treatment, diagnosis was possible using nonrespiratory samples. Despite moderate sensitivity of individual tests, combined PCP PCR on early blood and OPW specimens had high sensitivity and could reduce the need for invasive procedures. There were no false-positive results on nonrespiratory samples. Sampling and laboratory methods use routine technology and so require few additional resources.
机译：建议对下呼吸道标本进行肺囊虫性肺炎（PCP）的分子诊断，但可能难以获得标本。这项研究检查了PCP聚合酶链反应（PCR）在口咽冲洗液（OPW）和血液与痰液（自发性和诱发性）之间的诊断用途，以找到更快，更简单且侵入性更小的诊断方法。我们前瞻性征募了同意的成年人，其症状与PCP一致。使用上述标本，实时PCR靶向肺孢子虫线粒体大亚基核糖体RNA基因。从常规记录中收集临床数据。四十五名参与者提供了45个痰液，31个OPW和41个血液样本。中位年龄为39岁，男性为41岁（91％），中位CD4计数为64细胞/ L。 27/45（60％）参与者的痰PCR阳性。 OPW的比较敏感性为9/19（47％，95％置信区间[CI] 23-71）和血液12/24（50％，95％CI 29-71）参与者，两者的特异性均为100％。仅包括开始治疗后2天获得的样品，OPW的敏感性为80％（8/10，95％CI 51-100），血液的敏感性为57％（8/14，95％CI 29-86），并且综合测试的结果为88％（14 / 16，95％CI 70-100）。在开始治疗后2天获得PCP的14/16个人和标本中，使用非呼吸性样本可以进行诊断。尽管单个测试的敏感性中等，但对早期血液和OPW标本进行联合PCP PCR仍具有较高的敏感性，并且可以减少对侵入性手术的需求。非呼吸性样本没有假阳性结果。采样和实验室方法使用常规技术，因此需要很少的额外资源。

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