Browsing by Author "Corcoran, Craig"

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    Improved detection of Pneumocystis jirovecii in upper and lower respiratory tract specimens from children with suspected pneumocystis pneumonia using real-time PCR: a prospective study
    (BioMed Central Ltd, 2011) Samuel, Catherine M; Whitelaw, Andrew; Corcoran, Craig; Morrow, Brenda; Hsiao, Nei-Yuan; Zampoli, Marco; Zar, Heather
    BACKGROUND: Pneumocystis pneumonia (PCP) is a major cause of hospitalization and mortality in HIV-infected African children. Microbiologic diagnosis relies predominantly on silver or immunofluorescent staining of a lower respiratory tract (LRT) specimens which are difficult to obtain in children. Diagnosis on upper respiratory tract (URT) specimens using PCR has been reported useful in adults, but data in children are limited. The main objectives of the study was (1) to compare the diagnostic yield of PCR with immunofluorescence (IF) and (2) to investigate the usefulness of upper compared to lower respiratory tract samples for diagnosing PCP in children. METHODS: Children hospitalised at an academic hospital with suspected PCP were prospectively enrolled. An upper respiratory sample (nasopharyngeal aspirate, NPA) and a lower respiratory sample (induced sputum, IS or bronchoalveolar lavage, BAL) were submitted for real-time PCR and direct IF for the detection of Pneumocystis jirovecii. A control group of children with viral lower respiratory tract infections were investigated with PCR for PCP. RESULTS: 202 children (median age 3.3 [inter-quartile range, IQR 2.2 - 4.6] months) were enrolled. The overall detection rate by PCR was higher than by IF [180/349 (52%) vs. 26/349 (7%) respectively; p < 0.0001]. PCR detected more infections compared to IF in lower respiratory tract samples [93/166 (56%) vs. 22/166 (13%); p < 0.0001] and in NPAs [87/183 (48%) vs. 4/183 (2%); p < 0.0001]. Detection rates by PCR on upper (87/183; 48%) compared with lower respiratory tract samples (93/166; 56%) were similar (OR, 0.71; 95% CI, 0.46 - 1.11). Only 2/30 (6.6%) controls were PCR positive. CONCLUSION: Real-time PCR is more sensitive than IF for the detection of P. jirovecii in children with PCP. NPA samples may be used for diagnostic purposes when PCR is utilised. Wider implementation of PCR on NPA samples is warranted for diagnosing PCP in children.
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    The molecular diagnosis of Pneumocystis pneumonia in children using nasopharyngeal aspirate samples
    (2011) Samuel, Catherine Mary; Whitelaw, Andrew; Corcoran, Craig
    Pneumocystis pneumonia (PCP) is an important opportunistic infection caused by thefungus Pneumocystis jirovecii. The incidence of PCP in sub-Saharan Africa is on theincrease. This is due to the progression of the HIV-pandemic and limited access to healthcare facilities, specific highly active anti-retroviral therapy and chemoprophylaxis. It is a major cause of hospitalization and mortality in HIV-infected children with in-hospital case-fatality rates ranging from 20-63%.