Lars Jørgen Østergaard

Detection of Pneumocystis jirovecii in oral wash from immunosuppressed patients as a diagnostic tool

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  • Cecilie Juul Hviid
  • ,
  • Marianne Lund
  • ,
  • Allan Sørensen, The Bissau HIV Cohort Study Group, Bandim Health Project, Bissau, Guinea Bissau.
  • ,
  • Svend Ellermann-Eriksen
  • Bente Jespersen
  • Mette Yde Dam, i Department of Rheumatology , Aarhus University Hospital , Aarhus , Denmark.
  • ,
  • Jens Frederik Dahlerup
  • Thomas Benfield, c Department of Infectious Diseases , Hvidovre Hospital , Hvidovre , Denmark.
  • ,
  • Sanne Jespersen, The Bissau HIV Cohort Study Group, Bandim Health Project, Bissau, Guinea Bissau.
  • ,
  • Lars Jørgen Østergaard
  • Alex Lund Laursen
  • Bissau HIV cohort study group

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.

Original languageEnglish
Article numbere0174012
JournalP L o S One
Volume12
Issue3
Number of pages14
ISSN1932-6203
DOIs
Publication statusPublished - 2017

    Research areas

  • POLYMERASE-CHAIN-REACTION, REAL-TIME PCR, ASYMPTOMATIC CARRIAGE, PULMONARY INFECTIONS, IMMUNOCOMPROMISED PATIENTS, BRONCHOALVEOLAR LAVAGE, CLINICAL-SIGNIFICANCE, DNA AMPLIFICATION, PNEUMONIA, COLONIZATION

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