Skip to main content
NCBI home page
Journal of Clinical Microbiology logoLink to Journal of Clinical Microbiology
. 1997 Jun;35(6):1445–1449. doi: 10.1128/jcm.35.6.1445-1449.1997

Usefulness of PCR for diagnosis of Pneumocystis carinii pneumonia in different patient groups.

M Weig 1, H Klinker 1, B H Bögner 1, A Meier 1, U Gross 1
PMCID: PMC229764  PMID: 9163459

Abstract

Pneumocystis carinii pneumonia (PCP) is one of the most predominant opportunistic infectious diseases in patients with AIDS. Nested PCR has been described as a sensitive and specific tool for detecting P. carinii DNA in clinical specimens. Little is known about the correlation of positive PCR results and clinical evidence of PCP in patients with different forms of immunosuppression. One hundred and thirty-six sputum samples, 26 tracheal-bronchial aspirate samples, 35 bronchoalveolar lavage samples, and 11 lung biopsy samples from (i) human immunodeficiency virus (HIV)-infected patients with AIDS, (ii) immunocompromised patients with leukemia or lymphoma, and (iii) immunocompetent control patients were investigated by a nested PCR amplifying DNA from the mitochondrial large subunit of P. carinii. All patients suffered from acute episodes of respiratory disease. The resulting data were correlated with clinical evidence of PCP. A high degree of association of positive P. carinii PCR results and clinical evidence of PCP in HIV-infected patients with AIDS was found. When calculated for bronchoalveolar lavage and lung biopsy samples, the positive and the negative predictive values of P. carinii PCR for PCP diagnosis in HIV-infected patients with AIDS were 1 and the specificity and the sensitivity were 100%. In contrast, in the group of patients with leukemia or lymphoma, the positive predictive value of the nested PCR for these materials was found to be as low as 0.09, the negative predictive value was 0.73, the specificity was 44.4%, and the sensitivity was 25.0%. No P. carinii DNA could be detected in specimens from immunocompetent patients. In summary, in contrast to patients with leukemia and lymphoma, nested PCR seems to be a sensitive and specific tool for PCP diagnosis in HIV-infected patients with AIDS.

Full Text

The Full Text of this article is available as a PDF (565.2 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Adachi N. [Polymerase chain reaction assay for the diagnosis of pneumocystis carinii and cytomegalovirus pneumonia]. Nihon Kyobu Shikkan Gakkai Zasshi. 1994 May;32(5):433–440. [PubMed] [Google Scholar]
  2. Armbruster C., Pokieser L., Hassl A. Diagnosis of Pneumocystis carinii pneumonia by bronchoalveolar lavage in AIDS patients. Comparison of Diff-Quik, fungifluor stain, direct immunofluorescence test and polymerase chain reaction. Acta Cytol. 1995 Nov-Dec;39(6):1089–1093. [PubMed] [Google Scholar]
  3. Bartlett M. S., Lee C. H., Lu J. J., Bauer N. L., Bettz J. F., McLaughlin G. L., Smith J. W. Pneumocystis carinii detected in air. J Eukaryot Microbiol. 1994 Sep-Oct;41(5):75S–75S. [PubMed] [Google Scholar]
  4. Bartlett M. S., Smith J. W. Pneumocystis carinii, an opportunist in immunocompromised patients. Clin Microbiol Rev. 1991 Apr;4(2):137–149. doi: 10.1128/cmr.4.2.137. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Beck J. M., Liggitt H. D., Brunette E. N., Fuchs H. J., Shellito J. E., Debs R. J. Reduction in intensity of Pneumocystis carinii pneumonia in mice by aerosol administration of gamma interferon. Infect Immun. 1991 Nov;59(11):3859–3862. doi: 10.1128/iai.59.11.3859-3862.1991. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Blumenfeld W., McCook O., Holodniy M., Katzenstein D. A. Correlation of morphologic diagnosis of Pneumocystis carinii with the presence of pneumocystis DNA amplified by the polymerase chain reaction. Mod Pathol. 1992 Mar;5(2):103–106. [PubMed] [Google Scholar]
  7. Chen W., Gigliotti F., Harmsen A. G. Latency is not an inevitable outcome of infection with Pneumocystis carinii. Infect Immun. 1993 Dec;61(12):5406–5409. doi: 10.1128/iai.61.12.5406-5409.1993. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Chen W., Havell E. A., Moldawer L. L., McIntyre K. W., Chizzonite R. A., Harmsen A. G. Interleukin 1: an important mediator of host resistance against Pneumocystis carinii. J Exp Med. 1992 Sep 1;176(3):713–718. doi: 10.1084/jem.176.3.713. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Eisen D., Ross B. C., Fairbairn J., Warren R. J., Baird R. W., Dwyer B. Comparison of Pneumocystis carinii detection by toluidine blue O staining, direct immunofluorescence and DNA amplification in sputum specimens from HIV positive patients. Pathology. 1994 Apr;26(2):198–200. doi: 10.1080/00313029400169471. [DOI] [PubMed] [Google Scholar]
  10. Elvin K. Laboratory diagnosis and occurrence of Pneumocystis carinii. Scand J Infect Dis Suppl. 1994;94:1–34. [PubMed] [Google Scholar]
  11. Evans R., Joss A. W., Pennington T. H., Ho-Yen D. O. The use of a nested polymerase chain reaction for detecting Pneumocystis carinii from lung and blood in rat and human infection. J Med Microbiol. 1995 Mar;42(3):209–213. doi: 10.1099/00222615-42-3-209. [DOI] [PubMed] [Google Scholar]
  12. Ezekowitz R. A., Williams D. J., Koziel H., Armstrong M. Y., Warner A., Richards F. F., Rose R. M. Uptake of Pneumocystis carinii mediated by the macrophage mannose receptor. Nature. 1991 May 9;351(6322):155–158. doi: 10.1038/351155a0. [DOI] [PubMed] [Google Scholar]
  13. Follansbee S. E., Busch D. F., Wofsy C. B., Coleman D. L., Gullet J., Aurigemma G. P., Ross T., Hadley W. K., Drew W. L. An outbreak of Pneumocystis carinii pneumonia in homosexual men. Ann Intern Med. 1982 Jun;96(6 Pt 1):705–713. doi: 10.7326/0003-4819-96-6-705. [DOI] [PubMed] [Google Scholar]
  14. Galan F., Oliver J. L., Roux P., Poirot J. L., Bereziat G. Detection of Pneumocystis carinii DNA by polymerase chain reaction compared to direct microscopy and immunofluorescence. J Protozool. 1991 Nov-Dec;38(6):199S–200S. [PubMed] [Google Scholar]
  15. Hagler D. N., Deepe G. S., Pogue C. L., Walzer P. D. Blastogenic responses to Pneumocystis carinii among patients with human immunodeficiency (HIV) infection. Clin Exp Immunol. 1988 Oct;74(1):7–13. [PMC free article] [PubMed] [Google Scholar]
  16. Hughes W. T. Natural mode of acquisition for de novo infection with Pneumocystis carinii. J Infect Dis. 1982 Jun;145(6):842–848. doi: 10.1093/infdis/145.6.842. [DOI] [PubMed] [Google Scholar]
  17. Ishimine T., Nakamoto A., Higa F., Koide M., Inadome J., Kawakami K., Fukuhara H., Kusano N., Kitsukawa K., Saito A. [Usefulness of polymerase chain reaction method in the early diagnosis of Pneumocystis carinii pneumonia]. Kansenshogaku Zasshi. 1994 Jun;68(6):751–758. doi: 10.11150/kansenshogakuzasshi1970.68.751. [DOI] [PubMed] [Google Scholar]
  18. Kwok S., Higuchi R. Avoiding false positives with PCR. Nature. 1989 May 18;339(6221):237–238. doi: 10.1038/339237a0. [DOI] [PubMed] [Google Scholar]
  19. Latouche S., Roux P., Poirot J. L., Lavrard I., Hermelin B., Bertrand V. Preliminary results of Pneumocystis carinii strain differentiation by using molecular biology. J Clin Microbiol. 1994 Dec;32(12):3052–3053. doi: 10.1128/jcm.32.12.3052-3053.1994. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Leigh T. R., Wakefield A. E., Peters S. E., Hopkin J. M., Collins J. V. Comparison of DNA amplification and immunofluorescence for detecting Pneumocystis carinii in patients receiving immunosuppressive therapy. Transplantation. 1992 Sep;54(3):468–470. doi: 10.1097/00007890-199209000-00016. [DOI] [PubMed] [Google Scholar]
  21. Lu J. J., Chen C. H., Bartlett M. S., Smith J. W., Lee C. H. Comparison of six different PCR methods for detection of Pneumocystis carinii. J Clin Microbiol. 1995 Oct;33(10):2785–2788. doi: 10.1128/jcm.33.10.2785-2788.1995. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Meuwissen J. H., Tauber I., Leeuwenberg A. D., Beckers P. J., Sieben M. Parasitologic and serologic observations of infection with Pneumocystis in humans. J Infect Dis. 1977 Jul;136(1):43–49. doi: 10.1093/infdis/136.1.43. [DOI] [PubMed] [Google Scholar]
  23. Millard P. R., Heryet A. R. Observations favouring Pneumocystis carinii pneumonia as a primary infection: a monoclonal antibody study on paraffin sections. J Pathol. 1988 Apr;154(4):365–370. doi: 10.1002/path.1711540413. [DOI] [PubMed] [Google Scholar]
  24. Nogués A., García M., Rivas C., Falguera M., Puig T., Ruiz A. Detección de Pneumocystis carinii en muestras clínicas por la reacción en cadena de la polimerasa. Comparación con la técnica de metenamina de plata. Enferm Infecc Microbiol Clin. 1993 Mar;11(3):143–146. [PubMed] [Google Scholar]
  25. Peters S. E., Wakefield A. E., Sinclair K., Millard P. R., Hopkin J. M. A search for Pneumocystis carinii in post-mortem lungs by DNA amplification. J Pathol. 1992 Feb;166(2):195–198. doi: 10.1002/path.1711660217. [DOI] [PubMed] [Google Scholar]
  26. Santiago-Delpín E. A., Mora E., González Z. A., Morales-Otero L. A., Bermudez R. Factors in an outbreak of Pneumocystis carinii in a transplant unit. Transplant Proc. 1988 Feb;20(1 Suppl 1):462–465. [PubMed] [Google Scholar]
  27. Shellito J., Suzara V. V., Blumenfeld W., Beck J. M., Steger H. J., Ermak T. H. A new model of Pneumocystis carinii infection in mice selectively depleted of helper T lymphocytes. J Clin Invest. 1990 May;85(5):1686–1693. doi: 10.1172/JCI114621. [DOI] [PMC free article] [PubMed] [Google Scholar]
  28. Sinclair K., Wakefield A. E., Banerji S., Hopkin J. M. Pneumocystis carinii organisms derived from rat and human hosts are genetically distinct. Mol Biochem Parasitol. 1991 Mar;45(1):183–184. doi: 10.1016/0166-6851(91)90042-5. [DOI] [PubMed] [Google Scholar]
  29. Singer C., Armstrong D., Rosen P. P., Schottenfeld D. Pneumocystis carinii pneumonia: a cluster of eleven cases. Ann Intern Med. 1975 Jun;82(6):772–777. doi: 10.7326/0003-4819-82-6-722. [DOI] [PubMed] [Google Scholar]
  30. Smulian A. G., Theus S. A., Denko N., Walzer P. D., Stringer J. R. A 55 kDa antigen of Pneumocystis carinii: analysis of the cellular immune response and characterization of the gene. Mol Microbiol. 1993 Mar;7(5):745–753. doi: 10.1111/j.1365-2958.1993.tb01165.x. [DOI] [PubMed] [Google Scholar]
  31. Tamburrini E., Mencarini P., De Luca A., Antinori A., Visconti E., Ammassari A., Ortona L., Ortona E., Siracusano A., Vicari G. Simple and rapid two-step polymerase chain reaction for diagnosis of Pneumocystis carinii infection. J Clin Microbiol. 1993 Oct;31(10):2788–2789. doi: 10.1128/jcm.31.10.2788-2789.1993. [DOI] [PMC free article] [PubMed] [Google Scholar]
  32. Tamburrini E., Mencarini P., De Luca A., Maiuro G., Ventura G., Antinori A., Ammassari A., Visconti E., Ortona L., Siracusano A. Diagnosis of Pneumocystis carinii pneumonia: specificity and sensitivity of polymerase chain reaction in comparison with immunofluorescence in bronchoalveolar lavage specimens. J Med Microbiol. 1993 Jun;38(6):449–453. doi: 10.1099/00222615-38-6-449. [DOI] [PubMed] [Google Scholar]
  33. Theus S. A., Sullivan D. W., Walzer P. D., Smulian A. G. Cellular responses to a 55-kilodalton recombinant Pneumocystis carinii antigen. Infect Immun. 1994 Aug;62(8):3479–3484. doi: 10.1128/iai.62.8.3479-3484.1994. [DOI] [PMC free article] [PubMed] [Google Scholar]
  34. Vargas S. L., Hughes W. T., Wakefield A. E., Oz H. S. Limited persistence in and subsequent elimination of Pneumocystis carinii from the lungs after P. carinii pneumonia. J Infect Dis. 1995 Aug;172(2):506–510. doi: 10.1093/infdis/172.2.506. [DOI] [PubMed] [Google Scholar]
  35. Wakefield A. E. Detection of DNA sequences identical to Pneumocystis carinii in samples of ambient air. J Eukaryot Microbiol. 1994 Sep-Oct;41(5):116S–116S. [PubMed] [Google Scholar]
  36. Wakefield A. E., Pixley F. J., Banerji S., Sinclair K., Miller R. F., Moxon E. R., Hopkin J. M. Detection of Pneumocystis carinii with DNA amplification. Lancet. 1990 Aug 25;336(8713):451–453. doi: 10.1016/0140-6736(90)92008-6. [DOI] [PubMed] [Google Scholar]

Articles from Journal of Clinical Microbiology are provided here courtesy of American Society for Microbiology (ASM)

RESOURCES