title: Detection of Pneumocystis jirovecii in oral wash from immunosuppressed patients as a diagnostic tool.
abstract: BACKGROUND
  Diagnosis of Pneumocystis jirovecii (PJ) pneumonia ordinarily requires invasive procedures that could be avoided by PCR methodologies, if these could be designed with adequate cut-off values for confounding background carriage.
  
  
  METHODS
  We designed a novel quantitative real-time PCR assay to detect the mitochondrial large subunit rRNA gene of PJ in oral washes. To benchmark levels of PJ carriage versus infection, we tested asymptomatic immunosuppressed patients including Danish (n = 88) and West African HIV-infected (n = 142) patients, renal transplant recipients (n = 51), rheumatologic patients (n = 102), patients with inflammatory bowel diseases (n = 98), and healthy blood donors (controls, n = 50). The fungal burden in patients with PJ pneumonia (PCP, n = 7) was also investigated.
  
  
  RESULTS
  Danish HIV-infected patients (with viremia/low CD4) and recent transplant recipients were at most risk of being carriers (prevalence of 23% and 16.7% respectively), whereas PJ was rarely detected among rheumatologic patients, patients with inflammatory bowel diseases, and untreated West African HIV patients. PJ was not detected among healthy controls. The fungal burden in patients with PCP fell rapidly on treatment.
  
  
  CONCLUSIONS
  The quantitative PCR method described could conceivably discriminate between carriage and disease, given suitable threshold values for the former, and predict treatment efficacy by measures of the fungal burden in daily oral washes.
authors.affiliation: Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Cecilie Juul
authors.initials: CJ
authors.lastname: Hviid
authors.affiliation: Department of Clinical Microbiology, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Marianne
authors.initials: M
authors.lastname: Lund
authors.affiliation: The Bissau HIV Cohort Study Group, Bandim Health Project, Bissau, Guinea Bissau.
authors.forename: Allan
authors.initials: A
authors.lastname: Sørensen
authors.affiliation: Department of Clinical Microbiology, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Svend
authors.initials: S
authors.lastname: Ellermann-Eriksen
authors.affiliation: Department of Nephrology, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Bente
authors.initials: B
authors.lastname: Jespersen
authors.affiliation: Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Mette Yde
authors.initials: MY
authors.lastname: Dam
authors.affiliation: Department of Hepatology and Gastroenterology, Aarhus Aarhus University Hospital, Denmark.
authors.forename: Jens Frederik
authors.initials: JF
authors.lastname: Dahlerup
authors.affiliation: Department of Infectious Diseases, Hvidovre Hospital, Hvidovre, Denmark.
authors.forename: Thomas
authors.initials: T
authors.lastname: Benfield
authors.affiliation: Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark.|The Bissau HIV Cohort Study Group, Bandim Health Project, Bissau, Guinea Bissau.
authors.forename: Sanne
authors.initials: S
authors.lastname: Jespersen
authors.affiliation: Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Lars Jørgen
authors.initials: LJ
authors.lastname: Østergaard
authors.affiliation: Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark.|The Bissau HIV Cohort Study Group, Bandim Health Project, Bissau, Guinea Bissau.
authors.forename: Alex Lund
authors.initials: AL
authors.lastname: Laursen
mesh_terms: D000328:Adult; D000354:Africa, Western; D004271:DNA, Fungal / Q000235:genetics / Q000302:isolation & purification*; D003718:Denmark; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy / Q000382:microbiology* / Q000821:virology; D006801:Humans; D016867:Immunocompromised Host / Q000235:genetics; D016030:Kidney Transplantation / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D045363:Pneumocystis carinii / Q000235:genetics / Q000276:immunology / Q000302:isolation & purification* / Q000472:pathogenicity; D011020:Pneumonia, Pneumocystis / Q000150:complications / Q000175:diagnosis* / Q000235:genetics / Q000382:microbiology
chemical_list: D004271:DNA, Fungal