title: Utility of adding Pneumocystis jirovecii DNA detection in nasopharyngeal aspirates in immunocompromised adult patients with febrile pneumonia.
abstract: Detection of viral and bacterial DNA in nasopharyngeal aspirates (NPAs) is now a routine practice in emergency cases of febrile pneumonia. We investigated whether Pneumocystis jirovecii DNA could also be detected in these cases by conducting retrospective screening of 324 consecutive NPAs from 324 adult patients (198 or 61% were immunocompromised) admitted with suspected pulmonary infections during the 2012 influenza epidemic season, using a real-time quantitative polymerase chain reaction (PCR) assay (PjqPCR), which targets the P. jirovecii mitochondrial large subunit ribosomal RNA gene. These NPAs had already been tested for 22 respiratory pathogens (18 viruses and 4 bacteria), but we found that 16 NPAs (4.9%) were PjqPCR-positive, making P. jirovecii the fourth most prevalent of the 23 microorganisms in the screen. Eleven of the 16 PjqPCR-positive patients were immunocompromised, and five had underlying pulmonary conditions. Nine NPAs were also positive for another respiratory pathogen. Six had PjqPCR-positive induced sputa less than 3 days after the NPA procedure, and five were diagnosed with pneumocystis pneumonia (four with chronic lymphoproliferative disorders and one AIDS patient). In all six available pairs quantification of P. jirovecii DNA showed fewer copies in NPA than in induced sputum and three PjqPCR-negative NPAs corresponded to PjqPCR-positive bronchoalveolar lavage fluids, underscoring the fact that a negative PjqPCR screen does not exclude a diagnosis of pneumocystosis. Including P. jirovecii DNA detection to the panel of microorganisms included in screening tests used for febrile pneumonia may encourage additional investigations or support use of anti-pneumocystis pneumonia prophylaxis in immunocompromised patients.
authors.affiliation: Laboratoire de Parasitologie et de Mycologie, APHP, Hôpital Saint Louis Université Paris Diderot, Sorbonne Paris Cité
authors.forename: Nicolas
authors.initials: N
authors.lastname: Guigue
authors.affiliation: Laboratoire de Parasitologie et de Mycologie, APHP, Hôpital Saint Louis Université Paris Diderot, Sorbonne Paris Cité CNRS URA3012 Institut Pasteur, Unité de Mycologie Moléculaire, Centre National de Référence Mycoses Invasives et Antifongiques, Paris, France.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Alanio
authors.affiliation: Laboratoire de Parasitologie et de Mycologie, APHP, Hôpital Saint Louis Université Paris Diderot, Sorbonne Paris Cité CNRS URA3012.
authors.forename: Jean
authors.initials: J
authors.lastname: Menotti
authors.affiliation: Université Paris Diderot, Sorbonne Paris Cité Service de maladies infectieuses, APHP, Hôpital Saint Louis.
authors.forename: Nathalie De
authors.initials: ND
authors.lastname: Castro
authors.affiliation: Laboratoire de Parasitologie et de Mycologie, APHP, Hôpital Saint Louis.
authors.forename: Samia
authors.initials: S
authors.lastname: Hamane
authors.affiliation: Service des urgences, APHP, Hôpital Saint Louis.
authors.forename: Olivier
authors.initials: O
authors.lastname: Peyrony
authors.affiliation: Université Paris Diderot, Sorbonne Paris Cité Laboratoire de Microbiologie, APHP, Hôpital Saint Louis.
authors.forename: Jérôme
authors.initials: J
authors.lastname: LeGoff
authors.affiliation: Laboratoire de Parasitologie et de Mycologie, APHP, Hôpital Saint Louis Université Paris Diderot, Sorbonne Paris Cité CNRS URA3012 Institut Pasteur, Unité de Mycologie Moléculaire, Centre National de Référence Mycoses Invasives et Antifongiques, Paris, France stephane.bretagne@sls.aphp.fr.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Bretagne
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004271:DNA, Fungal / Q000235:genetics / Q000302:isolation & purification*; D004275:DNA, Ribosomal / Q000737:chemistry / Q000235:genetics; D005260:Female; D005335:Fever of Unknown Origin / Q000175:diagnosis* / Q000382:microbiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D025202:Molecular Diagnostic Techniques / Q000379:methods*; D009305:Nasopharynx / Q000382:microbiology*; D045363:Pneumocystis carinii / Q000235:genetics / Q000302:isolation & purification*; D011014:Pneumonia / Q000175:diagnosis* / Q000382:microbiology; D012335:RNA, Ribosomal / Q000235:genetics; D060888:Real-Time Polymerase Chain Reaction / Q000379:methods*; D055815:Young Adult
chemical_list: D004271:DNA, Fungal; D004275:DNA, Ribosomal; D012335:RNA, Ribosomal; C065096:RNA, ribosomal, 26S
keywords: Pneumocystis jirovecii; Pneumocystis pneumonia; influenza; nasopharyngeal aspirates; quantitative real-time PCR