Evaluation of Three Different Laboratory Methods for Identifi-cation of Pneumocystis jirovecii Pneumonia (PCP) among HIV Positive Asymptomatic Prisoners

  • Shohreh AZIMI Department of Microbiology, Karaj Branch, Islamic Azad University, Karaj, Iran
  • Azar SABOKBAR Department of Microbiology, Karaj Branch, Islamic Azad University, Karaj, Iran
  • Amir BAIRAMI Department of Medical Parasitology and Mycology, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
  • Mohammad Javad GHARAVI Department of Medical Parasitology and Mycology, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran Department of Parasitology, School of Allied Medicine, Iran University of Medical Sciences, Tehran, Iran
Keywords: Pneumocystis jirovecii, Pneumonia, β-D-glucan assay

Abstract

Background: Pneumocystis jirovecii pneumonia (PCP) remains a leading cause of mortality among HIV-infected patients. The aim of study was to find out P. jirovecii in versatile group of HIV-positive patients prisoners. Methods: Overall, 102 HIV positive patients from Ghezel Hesar Prison, Karaj, Iran from October 2016 to March 2017 without any respiratory symptoms were selected with different medication histories against HIV and PCP. Microscopic and molecular (qualitative real-time PCR) examination were applied on sputum specimens and serological investigation (β-D-glucan assay for fungal diseases) carried out on patient’s sera. Results: Only 3 and 1 patients were positive for PCP by microscopic and molecular testing, respectively. Twenty-four (23.5%) and 78 (76.5%) out of 102 patients were seropositive and seronegative for fungi disease, respectively. Seropositive patients were older than seronegative subjects (P<0.001). Most of seropositive individuals showed less mean value of CD4 counts compared to seronegative group (P<0.001). Of 54 patients who were under HIV therapy, 13 were seropositive compared to 11 out of 24 seropositives who were no adhere to treatment (P<0.001). In terms of prophylactic antibiotic therapy against PCP, of 24 patients who received prophylaxis, 3 (12.5%) and 21 (87.5%) were seropositive and seronegative, respectively (P<0.001). On the contrary, among 78 patients who did not receive prophylaxis, 21 (27%) and 57 (73%) belonged to seropositive and seronegative patients, respectively (P<0.001). Conclusion: There was no strong evidence for PCP infection/disease among symptomless, HIV positive patients. According to their mean CD4 counts, the hypothesis for being negative in a majority of applied tests would be the absence of severe immunosuppression in the patients.

References

1. Mühlethaler K, Bögli-Stuber K, Wasmer S et al. Quantitative PCR to diagnose Pneumocystis pneumonia in immunocompromised non-HIV patients. Eur Respir J. 2012; 39(4):971-8.
2. Juliano JJ, Barnett E, Parobek CM et al. Use of Oropharyngeal Washes to Diagnose and Genotype Pneumocystis jirovecii. Open Forum Infect Dis. 2015; 2(3):ofv080.
3. Hoffmann K, Voigt K. Molecular detection of human fungal pathogens. 1st ed. CRC Press; 2011.
4. Nowaseb V, Gaeb E, Fraczek MG et al. Frequency of Pneumocystis jirovecii in sputum from HIV and TB patients in Namibia. J Infect Dev Ctries. 2014; 8(3):349-57.
5. Robert-Gangneux F, Belaz S, Revest M et al. Diagnosis of Pneumocystis jirovecii pneumonia in immunocompromised patients by real-time PCR: a 4-year prospective study. J Clin Microbiol. 2014;52(9):3370-6.
6. Morris AM, Masur H. A serologic test to diagnose Pneumocystis pneumonia: are we there yet? Clin Infect Dis. 2011;53(2):203-4.
7. Wood BR, Komarow L, Zolopa AR et al. Test performance of blood beta-glucan for Pneumocystis jirovecii pneumonia in patients with AIDS and respiratory symptoms. AIDS. 2013;27(6):967-72.
8. Karageorgopoulos DE, Vouloumanou EK, Ntziora F et al. β-D-glucan assay for the diagnosis of invasive fungal infections: a meta-analysis. Clin Infect Dis. 2011; 52(6):750-70.
9. Revathy M, Therese KL, Bagyalakshmi R et al. Application of real time polymerase chain reaction targeting kex 1 gene & its comparison with the conventional methods for rapid detection of Pneumocystis jirovecii in clinical specimens. Indian J Med Res. 2014;140(3):406-13.
10. Khodadadi H, Mirhendi H, Mohebali M et al. Pneumocystis jirovecii colonization in non-HIV-infected patients based on nested-PCR detection in bronchoalveolar lavage samples. Iran J Public Health. 2013;42(3):298-305.
11. Huggett JF, Taylor MS, Kocjan G et al. Development and evaluation of a real-time PCR assay for detection of Pneumocystis jirovecii DNA in bronchoalveolar lavage fluid of HIV-infected patients. Thorax. 2008;63(2):154-9.
12. Sasso M, Chastang-Dumas E, Bastide S et al. Performances of four real-time PCR assays for diagnosis of Pneumocystis jirovecii pneumonia. J Clin Microbiol. 2016;54(3):625-30.
13. Hachem RY, Kontoyiannis DP, Chemaly RF et al. Utility of galactomannan enzyme immunoassay and (1, 3) β-d-glucan in diagnosis of invasive fungal infections: low sensitivity for Aspergillus fumigatus infection in hematologic malignancy patients. J Clin Microbiol. 2009;47(1):129-33.
14. Koo S, Bryar JM, Page JH et al. Diagnostic performance of the (1→ 3)-β-d-glucan assay for invasive fungal disease. Clin Infect Dis. 2009;49(11):1650-9.
15. Ellis M, Al-Ramadi B, Finkelman M et al. Assessment of the clinical utility of serial β-d-glucan concentrations in patients with persistent neutropenic fever. J Med Microbiol. 2008;57(Pt 3):287-95.
16. Persat F, Ranque S, Derouin F et al. Contribution of the (1→ 3)-β-d-glucan assay for diagnosis of invasive fungal infections. J Clin Microbiol. 2008; 46(3):1009-13.
17. Pickering JW, Sant HW, Bowles CA et al. Evaluation of a (1→ 3)-β-D-glucan assay for diagnosis of invasive fungal infections. J Clin Microbiol. 2005; 43(12):5957-62.
18. Ostrosky-Zeichner L, Alexander BD, Kett DH et al. Multicenter clinical evaluation of the (1→ 3) β-D-glucan assay as an aid to diagnosis of fungal infections in humans. Clin Infect Dis. 2005 Sep 1;41(5):654-9.
19. Alam FF, Mustafa AS, Khan ZU. Comparative evaluation of (1, 3)-β-D-glucan, mannan and anti-mannan antibodies, and Candida species-specific snPCR in patients with candidemia. BMC Infect Dis. 2007;7:103.
20. Odabasi Z, Mattiuzzi G, Estey E et al. β-D-glucan as a diagnostic adjunct for invasive fungal infections: validation, cutoff development, and performance in patients with acute myelogenous leukemia and myelodyspl-astic syndrome. Clin Infect Dis. 2004;39(2):199-205.
21. Helweg-Larsen J, Jensen JS, Dohn B et al. Detection of Pneumocystis DNA in samples from patients suspected of bacterial pneumonia-a case-control study. BMC Infect Dis. 2002;2:28.
22. Maskell NA, Waine DJ, Lindley A et al. Asymptomatic carriage of Pneumocystis jiroveci in subjects undergoing bronchoscopy: a prospective study. Thorax. 2003;58(7):594-7.
23. Theel E, Doern C. b-D-Glucan testing is important for diagnosis of invasive fungal. J Med Microbiol. 2013;57:287-95.
24. Phair J, Muñoz A, Detels R et al. The risk of Pneumocystis carinii pneumonia among men infected with human immunodeficiency virus type 1 . Multicenter AIDS Cohort Study Group. N Engl J Med. 1990;322(3):161-5.
25. Elliott I, Venkatesan P. Infections in the Secondary Immunocompromised Host. eLS. 2001:1-12.
26. Date AA, Vitoria M, Granich R et al. Implementation of co-trimoxazole prophylaxis and isoniazid preventive therapy for people living with HIV. Bull World Health Organ. 2010;88(4):253-9.
27. McLeod DT, Neill P, Robertson VJ et al. Pulmonary diseases in patients infected with the human immunodeficiency virus in Zimbabwe, Central Africa. Trans R Soc Trop Med Hyg. 1989; 83(5):694-7.
28. Atzori C, Bruno A, Chichino G et al. Pneumocystis carinii pneumonia and tuberculosis in Tanzanian patients infected with HIV. Trans R Soc Trop Med Hyg. 1993; 87(1):55-6.
29. Baughman RP, Dohn MN, Frame PT. The continuing utility of bronchoalveolar lavage to diagnose opportunistic infection in AIDS patients. Am J Med. 1994;97(6):515-22.
30. Paulson YJ, Gilman TM, Heseltine PN et al. Eflornithine treatment of refractory Pneumocystis carinii pneumonia in patients with acquired immunodeficiency syndrome. Chest. 1992; 101(1):67-74.
31. Orlovic D, Kularatne R, Ferraz V, Smego RA Jr. Dual pulmonary infection with Mycobacterium tuberculosis and Pneumocystis carinii in patients infected with human immunodeficiency virus. Clin Infect Dis. 2001;32(2):289-94.
Published
2019-06-18
How to Cite
1.
AZIMI S, SABOKBAR A, BAIRAMI A, GHARAVI MJ. Evaluation of Three Different Laboratory Methods for Identifi-cation of Pneumocystis jirovecii Pneumonia (PCP) among HIV Positive Asymptomatic Prisoners. Iran J Parasitol. 14(2):280-287.
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Original Article(s)