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Quantitative Real Time Pcr Assay For Differentiation Between Pneumocystis Jirovecii Pneumonia And Colonization

1128 words - 5 pages

From 355 patients enrolled, there were only 80 patients positive for P. jirovecii specific DNA using qPCR assay and were included for the further analysis. The four patients that were positive by c-PCR and negative by qPCR were considered negative for PCP. Thus, the remaining 275 patients were considered as negative for PCP. The demographics profile and clinical characteristics of PCP positive and negative patients were shown in Table No. 1.
On comparing demographic and clinical characteristics the mean age of PCP positive patients was observed to be 25.94 ± 20.12, while the mean age of PCP negative patients was 22.09 ± 19.78, (p ≤ 0.001, Table No.1). There were no significant differences when the male to female ratio of PCP positives and negatives patients were compared. Anti-Pneumocystis prophylaxis with sulfa drugs could be documented only in 15.6% (43/275) of PCP negative patients and 22.5% (18/80) of PCP positive patients and were found to be statistically non-significant in occurrence of PCP. However, dyspnoea (p=0.01) and abnormal CXR/CT findings (p=0.001) were significantly associated with PCP positive patients compared to PCP negatives. In addition, ICU admission and mechanical ventilation were also found to be significantly associated with PCP positive patients compared to negatives (p=0.01).

All these 80 c-PCR and qPCR assay positive patients were further stratified into definite PCP (n=14), probable PCP (n=54) and colonization (n=12) with P. jirovecii as per the criteria used above. As the detailed clinical and laboratory findings could be obtained only for 68 (85.00%, 68/80) of these 80 patients, therefore, these 68 patients were included for the final analyses. These 68 PCP positive patients were stratified into ‘definite PCP’ (n = 12), ‘probable PCP’ (n = 47) and ‘colonizers’ with P. jirovecii (n=09) (Table No. 2). Demographic profiles and clinical characteristics of these definite PCP, probable PCP and colonizer were also analyzed. Among them 49 were male and 19 were female. Definite group of patients comprised of one (n=1) HIV infected individuals, nine (n=9) PRT recipients and two (n=2) from other immunocompromised conditions respectively. Probable group of patients included eighteen (n=18) HIV infected individuals, eight (n=08) PRT recipients, seven (n=07) patients were with malignant disorders and two (n=02) from other immunocompromised conditions. Only nine individuals belongs to colonizers that included two (n=02) PRT recipients, one (n=01) patient with malignant disorders and six (n=06) from other immunocompromised conditions.

The final diagnosis among colonizers included CMV infection among both the PRT patients, M. tuberculosis was present among four (n=04) of these patients and two were having C. albicans along with M. tuberculosis. Pseudomonas was present in one of them and bacterial pneumonia with Staphylococcus aureus (n=01), Streptococcus pneumoniae (n=01) and Haemophilus influenzae (n=01) was also present as...

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