scholarly journals Diagnosis of Pneumocystis jirovecii pneumonia with serum cell-free DNA in non-HIV-infected immunocompromised patients

Oncotarget ◽  
2017 ◽  
Vol 8 (42) ◽  
pp. 71946-71953 ◽  
Author(s):  
Dong Wang ◽  
Yang Hu ◽  
Ting Li ◽  
Heng-Mo Rong ◽  
Zhao-Hui Tong
Keyword(s):  
Pneumocystis Jirovecii ◽  
Pneumocystis Jirovecii Pneumonia ◽  
Immunocompromised Patients ◽  
Cell Free Dna ◽  
Free Dna

scholarly journals Pneumocystis pneumonia and rheumatic disease: diagnostic potential of circulating microbial cell-free DNA sequencing

2021 ◽  
Author(s):  
Jia Li ◽  
Jun Li ◽  
Yuetian Yu ◽  
Rongsheng Wang ◽  
Mi Zhou ◽  
...  
Keyword(s):  
Rheumatic Disease ◽  
Microbial Cell ◽  
Pneumocystis Jirovecii ◽  
Control Group ◽  
Pneumocystis Jirovecii Pneumonia ◽  
Cell Free Dna ◽  
Invasive Approach ◽  
Cell Counts ◽  
Free Dna ◽  
Significant Difference

Abstract Objectives This study aimed to explore the clinical utility of circulating microbial cell-free DNA (cfDNA) sequencing as a non-invasive approach for diagnosing Pneumocystis jirovecii pneumonia (PJP) in immunocompromised patients with rheumatic disease (RD). Methods The study included 72 RD patients with suspected lung infections admitted to Renji hospital. Eighteen individuals were diagnosed with PJP, and 54 patients without PJP were enrolled as control group. All patients had undergone pulmonary computed tomography scans, and blood and respiratory tract specimens had been subjected to metagenomic next-generation sequencing (mNGS) and conventional microbiological tests. The clinical and laboratory parameters were collected and efficacy of circulating microbial cfDNA of PJP was evaluated. Results Of the 18 patients with PJP, the average age was 53.0 years and the median time between RD diagnosis and PJP presentation was 126 days (IQR 84.0–176.3). Low circulating CD4+ cell counts and a lack of PJP prophylaxis were observed in the patients. Metagenomic NGS of circulating microbial cfDNA was performed in 69 patients including 15 cases with PJP and 54 controls. Twelve (80%) of 15 analysed blood samples contained Pneumocystis jirovecii (PJ) sequences in PJP group with PJ not detected among controls. There was a significant difference between PJP and non-PJP groups (p < 0.001) with a sensitivity of 83.3% and specificity of 100% when using plasma cfDNA sequencing. Higher β-D-glucan levels were found in patients with positive results for PJ in plasma cfDNA sequencing. Conclusion Metagenomic NGS of circulating microbial cfDNA is a potential tool for diagnosing PJP in RD patients.

scholarly journals Point-Counterpoint: Should Serum β-d-Glucan Testing Be Used for the Diagnosis of Pneumocystis jirovecii Pneumonia?

2019 ◽  
Vol 58 (1) ◽  
Author(s):  
Gabriela Corsi-Vasquez ◽  
Luis Ostrosky-Zeichner ◽  
Edward F. Pilkington ◽  
Paul E. Sax
Keyword(s):  
High Risk ◽  
Prophylactic Antibiotics ◽  
Induced Sputum ◽  
Pneumocystis Jirovecii ◽  
Outpatient Clinics ◽  
Pneumocystis Jirovecii Pneumonia ◽  
Immunocompromised Patients ◽  
Content Type ◽  
Aids Epidemic

Despite the widespread use of prophylactic antibiotics in high-risk individuals, Pneumocystis jirovecii remains an important cause of pneumonia in immunocompromised patients. During the peak of the AIDS epidemic, many hospitals and outpatient clinics were very proficient at collecting induced sputum specimens for the diagnosis of Pneumocystis jirovecii pneumonia (PJP).

scholarly journals Is It Possible to Differentiate Pneumocystis jirovecii Pneumonia and Colonization in the Immunocompromised Patients with Pneumonia?

2021 ◽  
Vol 7 (12) ◽  
pp. 1036
Author(s):  
Yudy A. Aguilar ◽  
Zulma Vanessa Rueda ◽  
María Angélica Maya ◽  
Cristian Vera ◽  
Jenniffer Rodiño ◽  
...  
Keyword(s):  
Qpcr Assay ◽  
Pneumocystis Jirovecii ◽  
Pneumocystis Jirovecii Pneumonia ◽  
Rrna Gene ◽  
Immunocompromised Patients ◽  
Lung Cancer Patients ◽  
Molecular Tests ◽  
Cancer Group ◽  
Diagnostic Characteristics ◽  
Immunosuppressed Patients

Respiratory sample staining is a standard tool used to diagnose Pneumocystis jirovecii pneumonia (PjP). Although molecular tests are more sensitive, their interpretation can be difficult due to the potential of colonization. We aimed to validate a Pneumocystis jirovecii (Pj) real-time PCR (qPCR) assay in bronchoscopic bronchoalveolar lavage (BAL) and oropharyngeal washes (OW). We included 158 immunosuppressed patients with pneumonia, 35 lung cancer patients who underwent BAL, and 20 healthy individuals. We used a SYBR green qPCR assay to look for a 103 bp fragment of the Pj mtLSU rRNA gene in BAL and OW. We calculated the qPCR cut-off as well as the analytical and diagnostic characteristics. The qPCR was positive in 67.8% of BAL samples from the immunocompromised patients. The established cut-off for discriminating between disease and colonization was Ct 24.53 for BAL samples. In the immunosuppressed group, qPCR detected all 25 microscopy-positive PjP cases, plus three additional cases. Pj colonization in the immunocompromised group was 66.2%, while in the cancer group, colonization rates were 48%. qPCR was ineffective at diagnosing PjP in the OW samples. This new qPCR allowed for reliable diagnosis of PjP, and differentiation between PjP disease and colonization in BAL of immunocompromised patients with pneumonia.

scholarly journals Pneumocystis jirovecii pneumonia in AIDS and non-AIDS immunocompromised patients – an update

2018 ◽  
Vol 12 (10) ◽  
pp. 824-834 ◽  
Author(s):  
Yuan-Ti Lee ◽  
Ming-Lung Chuang
Keyword(s):  
Mortality Rate ◽  
Clinical Manifestations ◽  
Lactic Dehydrogenase ◽  
Diagnosis And Treatment ◽  
Pneumocystis Jirovecii ◽  
Pneumocystis Jirovecii Pneumonia ◽  
Immunocompromised Patients ◽  
Aids Patients ◽  
Chain Reactions ◽  
Increased Risk

Introduction: Pneumocystis jirovecii (PJ) pneumonia (PJP) is an important opportunistic infection affecting various types of immunocompromised patients and is associated with an increased risk of mortality. PJ is a unique fungal pathogen which is increasingly common and maybe associated with a higher mortality rate in patients without AIDS. We present the characteristics of PJP, diagnosis, and treatment outcomes between AIDS and non-AIDS patients. Methodology: We conducted a review of studies of AIDS and non-AIDS patients with PJP using PubMed to search for studies until December 2017. Results: The annual incidence of AIDS-PJP decreased from 13.4 to 3.3 per 1000 person-years in industrialized countries, while the incidence of non-AIDS-PJP varied widely. Both groups had similar clinical manifestations and radiological features, but the non-AIDS-PJP group potentially had a more fulminant course, more diffuse ground glass opacities, and fewer cystic lesions. The mortality rate decreased in the AIDS-PJP group after the advent of antiretroviral therapy; however, the mortality rate remained high in both groups. A laboratory diagnosis was usually nonspecific; CD4+ T-cell < 200 cells/mL or < 14% favored AIDS-PJP. Serum 1,3-β-D-glucan (BDG) had a high diagnostic odds ratio. Combining BDG and lactic dehydrogenase improved the diagnosis of AIDS-PJP. Histopathological staining and polymerase chain reactions could not discriminate infection from colonization when the result was positive. The use of antibiotics, prophylaxis, and adjunctive corticosteroids was controversial. Conclusions: Early diagnosis and treatment can be achieved through vigilance, thereby improving the survival rate for PJP in immunocompromised patients.

scholarly journals Prevalence and Genotyping of Pneumocystis jirovecii Pneumonia in Patients with Previously Untreated Acute Myeloid Leukemia

2021 ◽  
Vol 5 (1) ◽  
pp. 3
Author(s):  
Valentina Del Prete ◽  
Giovangiacinto Paterno ◽  
David Di Cave ◽  
Luca Guarnera ◽  
Raffaele Palmieri ◽  
...  
Keyword(s):  
Acute Myeloid Leukemia ◽  
High Risk ◽  
Bronchoalveolar Lavage ◽  
Myeloid Leukemia ◽  
Pneumocystis Jirovecii ◽  
Pneumocystis Jirovecii Pneumonia ◽  
Immunocompromised Patients ◽  
Genotype 1 ◽  
Genotype 3 ◽  
Acute Myeloid

Pneumocystis jirovecii pneumonia (PJP) is an opportunistic infection affecting immunocompromised patients. Patients with acute myeloid leukemia (AML) are not considered at high risk of PJP, thus, prophylaxis is not recommended. Between 2010 and 2020 we retrospectively analyzed 251 AML patients. We performed molecular diagnosis and genotyping of Pneumocystis jirovecii in 67 bronchoalveolar lavage samples. Eleven cases of PJP were diagnosed, with a prevalence of 4.3%. Our study confirms that the most widespread genotype in Europe is genotype 1; in our patients, 70% presented with genotype 1 and 30% the genotype 3.

Pneumocystis Jirovecii Pneumonia In Recipients Of Autologous Hematopoietic Stem Cell Transplantation: A 10-Year Cohort Study

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 3372-3372
Author(s):  
Kadee J Raser ◽  
Gregory A. Yanik ◽  
John M. Magenau ◽  
Steven C. Goldstein ◽  
Attaphol Pawarode ◽  
...  
Keyword(s):  
Risk Factors ◽  
Stem Cell ◽  
Hematopoietic Stem Cell ◽  
Pneumocystis Jirovecii ◽  
Pneumocystis Jirovecii Pneumonia ◽  
Immunocompromised Patients ◽  
University Of Michigan ◽  
Transplant Recipients ◽  
Hematopoietic Stem ◽  
The University

Abstract Background Pneumocystis jirovecii pneumonia (PJ), previously known as Pneumocystis carinii (PCP), is a potentially life-threatening disease in immunocompromised patients. The at-risk population includes patients with HIV infection and low CD4 counts, hematological malignancies, hematopoietic stem cell (HSC) and solid organ transplant recipients, and patients receiving glucocorticoids or other immunomodulatory agents. The highest-risk group of immunocompromised patients tends to be those with HIV (human immunodeficiency virus) infection, where PJ follows an indolent course. However, in non-HIV immunocompromised patients, such as HSC transplant recipients, the infection tends to present with respiratory failure. The incidence of Pneumocystic jirovecii pneumonia (PCP) in autologous BMT (bone marrow transplant) has not been clearly determined, and the indication for prophylaxis in this setting remains unclear. In this study we evaluate the incidence of PJ infection over a 10-year period in recipients of autologous transplants. Methods Retrospective analysis of 1191 consecutive autologous HSC transplants performed between 1/1/2000 and 6/30/2011 at the University of Michigan Blood and Marrow Transplantation Program. The data was obtained from the BMT Program Database at The University of Michigan Comprehensive Cancer Center. The diagnosis of PJ pneumonia was established by both bronchoscopy with brochoaveolar lavage (BAL) with polymerase chain reaction (PCR). We analyzed the following risk factors for the development of PJ pneumonia: diabetes, glucocorticoid use (in the setting of primary disease relapse, chemotherapy-induced pneumonitis, or idiopathic thrombocytopenic purpura), infections (Pseudomonal urinary tract infection, candidiasis, herpes simplex virus), cutaneous T-cell lymphoma, hypertension, and seizure disorder. Results A total number of 5 PJ infections were diagnosed during study period, resulting in a cumulative incidence incidence of 0.42% (95%CI [0.136449% -- 0.976969%]) over the 10 year period. All cases occurred between 2001 and 2006, and 3 months or later following transplantation. Most patients (n=4) were older than 50 years old, and all of them were on steroids. Diagnoses included non-Hodgkin’s lymphoma (n=3), Hodgkin’s lymphoma (n=1) and multiple myeloma (n=1). Conditioning regimen was BEAM (BCNU, etoposide, cytarabine, melphalan, n=4) and high dose melphalan (n=1). Only 2/5 patients were neutropenic at the time of the pneumonia, and this did not correlate with the CD34+ cell infused, which was ≥2.2x10E6/kg for all patients. Four patients were on corticosteroids for relapsed lymphoma (n=2), ITP (n=1), BCNU pneumonitis (n=1). The remainder patient was on florinef and was coinfected with candida and herpes virus. There were no particular comorbidities associated with the diagnosis of PJ pneumonia. One patient died of PJ, the remainder were treated successfully. Conclusion This is the largest cohort of patients undergoing autologous transplantation evaluated for PJ pneumonia over a long period of time. Our low incidence and successful therapy suggest that PJ prophylaxis is not routinely warranted in patients undergoing autologous HSCT. Special consideration may be given to patients with additional risk factors such as corticosteroids. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Pneumocystis jirovecii Pneumonia Prophylaxis for Cancer Patients during Chemotherapy

Pathogens ◽  
2021 ◽  
Vol 10 (2) ◽  
pp. 237
Author(s):  
Kazuto Takeuchi ◽  
Yoshihiro Yakushijin
Keyword(s):  
Cancer Treatment ◽  
Treatment Outcomes ◽  
Cancer Patients ◽  
Potential Problem ◽  
Corticosteroid Treatment ◽  
Pneumocystis Jirovecii ◽  
Pneumocystis Jirovecii Pneumonia ◽  
Immunocompromised Patients ◽  
Healthy Individuals ◽  
Life Threatening

Pneumocystis jirovecii pneumonia (PJP) is one type of life-threatening pneumonia in immunocompromised patients. PJP development should be considered in not only immunocompromised individuals, but also patients undergoing intensive chemotherapies and immunotherapies, organ transplantation, or corticosteroid treatment. Past studies have described the clinical manifestation of PJP in patients during chemotherapy and reported that PJP affects cancer treatment outcomes. Therefore, PJP could be a potential problem for the management of cancer patients during chemotherapy, and PJP prophylaxis would be important during cancer treatment. This review discusses PJ colonization in outpatients during cancer chemotherapy, as well as in healthy individuals, and provides an update on PJP prophylaxis for cancer patients during chemotherapy.

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