title: Polymerase chain reaction for diagnosing pneumocystis pneumonia in non-HIV immunocompromised patients with pulmonary infiltrates.
abstract: BACKGROUND
  Pneumocystis jiroveci polymerase chain reaction (PCR) has higher sensitivity than conventional stains but cannot distinguish colonization from infection.
  
  
  METHODS
  We compared P jiroveci PCR and conventional stains in HIV-uninfected immunocompromised patients.
  
  
  RESULTS
  Among the 448 patients, 296 (66%) patients had hematologic malignancies; 72 (16.1%), bone marrow transplants; 44 (9.8%), solid tumors; 21 (4.7%), renal transplants; and 15 (3.4%) were taking immunosuppressants for systemic diseases. Diagnostic strategy consisted of BAL in 351 patients and induced sputum (IS) in 97 patients. Conventional pneumocystic pneumonia (PCP) stain was positive in 39 (8.7%) patients, including 34 with positive PCR. In addition, PCR was positive in 32 patients, including 21 with complete follow-up, of whom 14 were diagnosed with probable or definitive PCP (a 36% increase). PCR was 87.2% sensitive and 92.2% specific; positive and negative predictive values were 51.5% and 98.7%, respectively. Sensitivity and negative predictive value were 100% on IS.
  
  
  CONCLUSIONS
  In HIV-uninfected immunocompromised patients with acute pulmonary infiltrates, P jiroveci PCR correlates with clinical evidence of PCP. A negative PCR allows withdrawing anti-PCP therapy.
authors.affiliation: Intensive Care Unit, Paris 7 Diderot University, Saint-Louis Teaching Hospital, Paris, France. Electronic address: elie.azoulay@sls.ap-hop-paris.fr.
authors.forename: Élie
authors.initials: É
authors.lastname: Azoulay
authors.affiliation: Pulmonology Department, Paris 7 Diderot University, Saint-Louis Teaching Hospital, Paris, France.
authors.forename: Anne
authors.initials: A
authors.lastname: Bergeron
authors.affiliation: Intensive Care Unit, Paris 7 Diderot University, Saint-Louis Teaching Hospital, Paris, France.
authors.forename: Sylvie
authors.initials: S
authors.lastname: Chevret
authors.affiliation: Intensive Care Unit, Paris 7 Diderot University, Saint-Louis Teaching Hospital, Paris, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Bele
authors.affiliation: Intensive Care Unit, Paris 7 Diderot University, Saint-Louis Teaching Hospital, Paris, France.
authors.forename: Benoît
authors.initials: B
authors.lastname: Schlemmer
authors.affiliation: Intensive Care Unit, Paris 7 Diderot University, Saint-Louis Teaching Hospital, Paris, France.
authors.forename: Jean
authors.initials: J
authors.lastname: Menotti
mesh_terms: D001992:Bronchoalveolar Lavage Fluid / Q000382:microbiology; D018023:HIV Seronegativity; D006801:Humans; D016867:Immunocompromised Host; D009894:Opportunistic Infections / Q000175:diagnosis*; D045363:Pneumocystis carinii; D011020:Pneumonia, Pneumocystis / Q000175:diagnosis* / Q000276:immunology; D016133:Polymerase Chain Reaction; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D013183:Sputum / Q000382:microbiology