Pages 42-47 Investigation of Pneumocystis Jiroveci Carriage in Patients with Various Lung Diseases

Abstract

Pneumocyctis jiroveci is one of the major reasons of morbidity especially in immunosuppressive individuals. Recently, a large number of asymptomatic colonization has been noted. The aim is to investigate the frequency of P. jiroveci colonization in patients (Group I) with lung cancer who do not take oral corticosteroid and the patients (Group II) with other lung problems by using immunofluorescence (IF) method and polymerase chain reaction. Incidence of P. jiroveci has been investigated in the bronchoalveolar lavage samples taken by bronchoscopy for diagnose and treatment by using IF method and P. jiroveci DNA has been defined with PCR method. In Group I, 1 (1.8%) IF and 3 (5.5%) PCR positivism (one of them is the case which is found positive by using IF method) have been acquired. In Group II, both of the methods have produced no positivism. Colonization of P. jiroveci is noted in patients with HIV negative. The fact that the cases only with lung cancer have positivity supports the idea that lung cancer is important risk factor. The patients with lung cancer should be monitored closely for prophylaxis and treatment and the treatment should not be applied to each PCR positive case.

Keywords

• Pneumocyctis jiroveci,PCR,immunofluorescence,lung carcinoma

References

1. Walzer PD. Pneumocyctis carini. In: GL Mandell, JE Bennett, R Dolin (Eds), “Principles and Practice of Infectious Diseases” 5th Ed, Philadelphia: Churchill Livingstone. 2000: 278195.
2. Stringer JR, Beard CB, Miller RF, Wakefield AE. A New Name (Pneumocystis jiroveci) for Pneumocystis from Humans. Emerging Infectious Diseases 2002; 8 (9): 891-96.
3. Abrams EJ. Opportunistic infections and other clinical manifestations of HIV disease in children. Ped Clin N Amer 2000; 47: 79.
4. Contini C, Villa MP, Romani R, Merolla R, Delia S, Ronchetti R. Detection of Pneumocystis carinii among children with chronic respiratory disorders in the absence of HIV infection and immunodeficiency. J Med Microbiol 1998; 47:329–33.
5. Nevez G, Guyot K, Totet A, Raccurt C, Dei-Cas E. Pulmonary colonisation with Pneumocystis carinii in an immunosuppressed HIV-negative patient: detection and typing of the fungus by PCR. J Med Microbiol 2001; 50:198.
6. Nevez G, Raccurt C,1 Vincent P, Jounieaux V, Dei-Cas E.Pulmonary Colonization with Pneumocystis carini in Human Immunodeficiency Virus–Negative Patients: Assessing Risk with Blood CD4+ T Cell Counts. Clinical Infectious Diseases 1999; 29:1331–2.
7. Yale SH, Limper AH. Pneumocystis carinii pneumonia in patients without acquired immunodeficiency syndrome: associated illness and prior corticosteroid therapy. Mayo Clin Proc 1996, 71:5-13.
8. Maskell NA, Waine DJ, Lindley A, et al. Asymptomatic Pneumocyctis jiroveci in subjects undergoing broncoscopy: a prospective study. Thorax 2003; 58: 594-597.

9. Frenkel JK. Pneumocystis pneumonia, an immunodeficiency-dependent disease (IDD): a critical historical overview. J Eukaryot Microbiol 1999; 46:89S–92S.
10. Vargas SL, Hughes WT, Santolaya ME, Ulloa AV, Ponce CA, Cabrera CE, et al. Search for primary infection by Pneumocystis carinii in a cohort of normal, healthy infants. Clin Infect Dis 2001; 32:855–61.
11. Chen W, Gigliotti F, Harmsen AG. Latency is not an inevitable outcome of infection with P.carinii. Infect Immun 1993; 61 (12): 5406-09.
12. Helweg-Larsen T, Jensen JS, Dohn B, Benfield TL, Lungren B. Detection of Pneumocyctis DNA in samples from patients suspected of bacterial pneumonia- a case-control study. BMC Infect Dis 2002; 2: 28-33.
13. Schumann GB, Swensen JJ. Comparison.of Papanicolaou’s stain with the Gomori Methenamine Silver (GMS) stains for the cytodiagnosis of P.carinii in bronchoalveolar lavage (BAL) fluid. Am J Clin Pathol 1991; 95: 583-86.
14. Arast'eh KN, Simon V, Musch R et al. Sensivity and specificity of indrect immunofluorescence and Grocott-technique in comparison with immunocytology (alkaline phosphatase antialkaline phosphatase =PAAP) for the diagnosis of P. carinii in BAL. Eur J MedRes 1998; 3: 559-63.
15. Lorca M, Tasarsa R, Denegri M. PC infection various aspects on its clinical and laboratory diagnosis. Rev Med Clin 1992; 120 (6): 634-37.
16. Tiley SM, Marriot DJ, Harkness JL. An evaluation of four methods for the detection of P. Carini in clinical specimens. Pathology 1994; 26: 325-8.
17. Rigole P, Basset D, Dedet JP. Biological diagnosis of pneumocyctis infection. Evaluation and value of a new direct immunofluorescence technique. Pathol Biol 1997; 45: 19-23.
18. Alvarez F. Bandi V, Stager C, Guntupalli KK. Detection of P. carinii in tracheal aspirates of incubated patients using calcoflour-white (FungiFlour) and immunofluorescence antibody (Genetic System) stains. Crit Care Med, 1997; 25: 948-52.
19. Olsson M, Stralin K, Holmberg H. Clinical significance of nested polymerase chain reaction and immunofluorescence for detection of Pneumocystis carinii pneumonia Clin Microbiol Infect 2001; 7: 492–497
20. Oz HS, Hughes WT. Search for Pneumocystis carinii DNA in upper and lower respiratory tract of humans. Diagn Microbiol Infect Dis 2000, 37:161-164
21. Wakefield AE. DNA sequences identical to Pneumocystis carinii f. sp.carinii and Pneumocystis carinii f. sp. hominis in samples of air spora. J Clin Microbiol 1996; 34:1754–9.
22. Kaiser K, Rabadonirina M, Picot S. Real time quantitative PCR and RT-PCR for analysis of Pneumocystis carinii hominis. J Microbiol Meth 45:113 (2001).
23. Sing A, Trebesius K, Roggenkamp A, Rüssmann H, Tybus K, Pfaff F, et al. Evaluation of diagnostic value and epidemiological implications of PCR for Pneumocystis carinii in different immunosuppressed and immunocompetant patient groups. J Clin Microbiol 2000;38 (4):1461-7.
24. Visconti E, Marinaci S, Zolfo M, et al. Very low frequency of Pneumocystis carinii DNA detection by PCR in specimens from patients with lung damage. J Clin Microbiol 2000, 38:1307-1308.
25. Linssen CFM, Jacobs JA, Beckers P, et al. J. Med. Inter-laboratory comparison of three different real-time PCR assays for the detection of Pneumocystis jiroveci in bronchoalveolar lavage fluid samples. Microbiol 2006; 55, 1229– 35.
26. Peglow SL, Smulian AG, Linke MJ, et al. Serologic responses to Pneumocystis carinii antigens in health and disease. J Infect Dis 1990, 161:296-306
27. Peters SE, Wakefield AE, Sinclair K, Millard PR, Hopkin JM. A search for Pneumocystis carinii in post-mortem lungs by DNA amplification. J Pathol 1992; 166:195–8.
28. Nevez G, Jounieaux V, Linas MD, et al. High frequency of Pneumocystis carinii sp. f. hominis colonization in HIV-negative patients. Journal of Eukaryotic Microbiology 1997, 44:36S
29. Sing A, Roggenkamp A, Autenrieth IB, Heesemann J. Pneumocystis carinii carriage in immunocompetent patients with primary pulmonary disorders as detected by single or nested PCR. J Clin Microbiol 1999, 37:34093410
30. Takahashi T, Goto M, Endo T, et all. Pneumocystis carinii carriage in immunocompromised patients with and without human immunodeficiency virus infection J. Med. Microbiol 2002; 51: 611–614.
31. Fine MJ, Smith MA, Carson CA, et al. Prognosis and outcomes of patients with communityacquired pneumonia. A meta-analysis. JAMA 1996; 275: 134-141.
32. Wakefield AE, Pixley FJ, Banerji S, et al. Detection of Pneumocystis carinii with DNA amplification. Lancet 1990; 336:451–3.