title: Evaluation of a new commercial real-time PCR assay for diagnosis of Pneumocystis jirovecii pneumonia and identification of dihydropteroate synthase (DHPS) mutations.
abstract: The PneumoGenius® real-time PCR assay is a new commercial multiplex real-time PCR method, which detects the Pneumocystis mitochondrial ribosomal large subunit (mtLSU) and two dihydropteroate synthase (DHPS) point mutations. To evaluate the clinical performance of this new real-time PCR assay we tested 120 extracted DNA samples from bronchoalveolar lavage specimens. These set of extracted DNA samples had already tested positive for Pneumocystis and patients had been classified in probable and unlikely PCP in a previous study. To evaluate de accuracy of the DHPS mutant's identification, an "in house" PCR and sequencing was performed. The sensitivity and specificity of PneumoGenius® PCR in discriminating between probable and unlikely Pneumocystis pneumonia (PCP) were 70% and 82% respectively. PneumoGenius® PCR was able to genotype more samples than "in house" DHPS PCR and sequencing. The same DHPS mutations were observed by both methods in four patients: two patients with a single mutation in position 171 (Pro57Ser) and two patients with a double mutation in position 165 (Thr55Ala) and in position 171 (Pro57Ser). A low rate of P. jirovecii (4.5%) harboring DHPS mutations was found, comparable to rates observed in other European countries. The PneumoGenius® real-time PCR is a suitable real-time PCR for PCP diagnosis and detection of DHPS mutants. The added value of DHPS mutation identification can assist in understanding the role of these mutations in prophylaxis failure or treatment outcome.
authors: Microbiology Department, Hopital Erasme, Université Libre de Bruxelles, Route de Lennik 808. 1070 Brussels, Belgium. Electronic address: Carlota.Montesinos@erasme.ulb.ac.be.
authors: Isabel
authors: I
authors: Montesinos
authors: Microbiology Department, Hopital Erasme, Université Libre de Bruxelles, Route de Lennik 808. 1070 Brussels, Belgium. Electronic address: Marie-Luce.Delforge@erasme.ulb.ac.be.
authors: Marie-Luce
authors: ML
authors: Delforge
authors: Microbiology Department, Hopital Erasme, Université Libre de Bruxelles, Route de Lennik 808. 1070 Brussels, Belgium. Electronic address: Farida.Ajjaham@erasme.ulb.ac.be.
authors: Farida
authors: F
authors: Ajjaham
authors: Microbiology Department, Hopital Erasme, Université Libre de Bruxelles, Route de Lennik 808. 1070 Brussels, Belgium. Electronic address: francoise.brancart@uclouvain.be.
authors: Françoise
authors: F
authors: Brancart
authors: Infectious Diseases, Hopital Erasme, Université Libre de Bruxelles, Route de Lennik 808, 1070 Brussels, Belgium. Electronic address: Maya.Hites@erasme.ulb.ac.be.
authors: Maya
authors: M
authors: Hites
authors: Infectious Diseases, Hopital Erasme, Université Libre de Bruxelles, Route de Lennik 808, 1070 Brussels, Belgium. Electronic address: Frederique.Jacobs@erasme.ulb.ac.be.
authors: Frederique
authors: F
authors: Jacobs
authors: Microbiology Department, Hopital Erasme, Université Libre de Bruxelles, Route de Lennik 808. 1070 Brussels, Belgium. Electronic address: odenis@ulb.ac.be.
authors: Olivier
authors: O
authors: Denis
mesh_terms: D001992:Bronchoalveolar Lavage Fluid / Q000382:microbiology; D004094:Dihydropteroate Synthase / Q000235:genetics*; D025141:Drug Resistance, Fungal; D005787:Gene Frequency; D005838:Genotype; D006801:Humans; D025202:Molecular Diagnostic Techniques / Q000379:methods*; D060885:Multiplex Polymerase Chain Reaction / Q000379:methods; D009154:Mutation; D045363:Pneumocystis carinii / Q000201:enzymology / Q000235:genetics / Q000302:isolation & purification*; D011020:Pneumonia, Pneumocystis / Q000175:diagnosis*; D012335:RNA, Ribosomal / Q000235:genetics; D060888:Real-Time Polymerase Chain Reaction / Q000379:methods*; D012680:Sensitivity and Specificity
chemical_list: D012335:RNA, Ribosomal; D004094:Dihydropteroate Synthase
keywords: Commercial real-time PCR; DHPS mutations; Pneumocystis jirovecii pneumonia; Trimethoprim-sulfamethoxazole resistance