title: The use of oral washes to diagnose Pneumocystis carinii pneumonia: a blinded prospective study using a polymerase chain reaction-based detection system.
abstract: Pneumocystis carinii pneumonia (PCP) can be diagnosed by direct microscopic examination of induced sputum or by bronchoalveolar lavage (BAL). However, many institutions have little diagnostic success with induced sputum, and BAL is invasive and expensive. This prospective, blinded study assessed oral washes as a more convenient specimen than either sputum or BAL fluid and used a dissociation-enhanced lanthanide fluoroimmunoassay time-resolved fluorescent hybridization polymerase chain reaction (PCR) detection system that is feasible for clinical laboratories. The study assessed 175 oral washes, each paired with either an induced sputum that was positive for Pneumocystis or a BAL sample. The PCR test based on the Pneumocystis major surface glycoprotein primers had a sensitivity of 91% and a specificity of 94%, compared with a test based on mitochondrial large subunit rRNA primers, which had a sensitivity of 75% and a specificity of 96%. These results suggest that oral washes can provide a useful sample for diagnosis of PCP when a sensitive PCR detection system is used.
authors.affiliation: Department of Laboratory Medicine, Clinical Center, National Institutes of Health and Division of Infectious Diseases, Washington, DC 20892, USA.
authors.forename: S
authors.initials: S
authors.lastname: Fischer
authors.forename: V J
authors.initials: VJ
authors.lastname: Gill
authors.forename: J
authors.initials: J
authors.lastname: Kovacs
authors.forename: P
authors.initials: P
authors.lastname: Miele
authors.forename: J
authors.initials: J
authors.lastname: Keary
authors.forename: V
authors.initials: V
authors.lastname: Silcott
authors.forename: S
authors.initials: S
authors.lastname: Huang
authors.forename: L
authors.initials: L
authors.lastname: Borio
authors.forename: F
authors.initials: F
authors.lastname: Stock
authors.forename: G
authors.initials: G
authors.lastname: Fahle
authors.forename: D
authors.initials: D
authors.lastname: Brown
authors.forename: B
authors.initials: B
authors.lastname: Hahn
authors.forename: E
authors.initials: E
authors.lastname: Townley
authors.forename: D
authors.initials: D
authors.lastname: Lucey
authors.forename: H
authors.initials: H
authors.lastname: Masur
mesh_terms: D018893:Bronchoalveolar Lavage; D004269:DNA, Bacterial / Q000032:analysis; D003951:Diagnostic Errors; D006801:Humans; D009055:Mouth / Q000382:microbiology*; D009067:Mouthwashes; D011010:Pneumocystis / Q000235:genetics / Q000302:isolation & purification*; D011020:Pneumonia, Pneumocystis / Q000175:diagnosis* / Q000382:microbiology; D016133:Polymerase Chain Reaction / Q000379:methods*; D012680:Sensitivity and Specificity; D016037:Single-Blind Method; D013183:Sputum / Q000382:microbiology
chemical_list: D004269:DNA, Bacterial; D009067:Mouthwashes