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

 

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dc.contributor.author Samuel, Catherine M en_ZA
dc.contributor.author Whitelaw, Andrew en_ZA
dc.contributor.author Corcoran, Craig en_ZA
dc.contributor.author Morrow, Brenda en_ZA
dc.contributor.author Hsiao, Nei-Yuan en_ZA
dc.contributor.author Zampoli, Marco en_ZA
dc.contributor.author Zar, Heather en_ZA
dc.date.accessioned 2015-11-18T03:46:35Z
dc.date.available 2015-11-18T03:46:35Z
dc.date.issued 2011 en_ZA
dc.identifier.citation Samuel, C. M., Whitelaw, A., Corcoran, C., Morrow, B., Hsiao, N. Y., Zampoli, M., & Zar, H. J. (2011). 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. BMC infectious diseases, 11(1), 329. en_ZA
dc.identifier.uri http://hdl.handle.net/11427/15044
dc.identifier.uri http://dx.doi.org/10.1186/1471-2334-11-329
dc.description.abstract 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. en_ZA
dc.language.iso eng en_ZA
dc.publisher BioMed Central Ltd en_ZA
dc.rights This is an Open Access article distributed under the terms of the Creative Commons Attribution License en_ZA
dc.rights.uri http://creativecommons.org/licenses/by/2.0 en_ZA
dc.source BMC Infectious Diseases en_ZA
dc.source.uri http://www.biomedcentral.com/bmcinfectdis/ en_ZA
dc.subject.other Pneumocystis jirovecii en_ZA
dc.subject.other Pneumocystis pneumonia (PCP) en_ZA
dc.subject.other lower respiratory tract (LRT) en_ZA
dc.subject.other HIV-infected African children en_ZA
dc.title 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 en_ZA
dc.type Journal Article en_ZA
dc.rights.holder 2011 Samuel et al; licensee BioMed Central Ltd. en_ZA
uct.type.publication Research en_ZA
uct.type.resource Article en_ZA
dc.publisher.institution University of Cape Town
dc.publisher.faculty Faculty of Health Sciences en_ZA
dc.publisher.department Division of Medical Microbiology en_ZA
uct.type.filetype Text
uct.type.filetype Image
dc.identifier.apacitation Samuel, C. M., Whitelaw, A., Corcoran, C., Morrow, B., Hsiao, N., Zampoli, M., & Zar, H. (2011). 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. <i>BMC Infectious Diseases</i>, http://hdl.handle.net/11427/15044 en_ZA
dc.identifier.chicagocitation Samuel, Catherine M, Andrew Whitelaw, Craig Corcoran, Brenda Morrow, Nei-Yuan Hsiao, Marco Zampoli, and Heather Zar "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." <i>BMC Infectious Diseases</i> (2011) http://hdl.handle.net/11427/15044 en_ZA
dc.identifier.vancouvercitation Samuel CM, Whitelaw A, Corcoran C, Morrow B, Hsiao N, Zampoli M, et al. 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. BMC Infectious Diseases. 2011; http://hdl.handle.net/11427/15044. en_ZA
dc.identifier.ris TY - Journal Article AU - Samuel, Catherine M AU - Whitelaw, Andrew AU - Corcoran, Craig AU - Morrow, Brenda AU - Hsiao, Nei-Yuan AU - Zampoli, Marco AU - Zar, Heather AB - 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. DA - 2011 DB - OpenUCT DO - 10.1186/1471-2334-11-329 DP - University of Cape Town J1 - BMC Infectious Diseases LK - https://open.uct.ac.za PB - University of Cape Town PY - 2011 T1 - 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 TI - 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 UR - http://hdl.handle.net/11427/15044 ER - en_ZA


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