Journal Article

Diagnosis of <i>Pneumocystis carinii</i> Pneumonia in Human Immunodeficiency Virus—Infected Patients with Polymerase Chain Reaction: A Blinded Comparison to Standard Methods

Juan Torres, Mitchell Goldman, L. Joseph Wheat, Xing Tang, Marilyn S. Bartlett, James W. Smith, Stephen D. Allen and Chao-Hung Lee

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 30, issue 1, pages 141-145
Published in print January 2000 | ISSN: 1058-4838
Published online January 2000 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/313584
Diagnosis of Pneumocystis carinii Pneumonia in Human Immunodeficiency Virus—Infected Patients with Polymerase Chain Reaction: A Blinded Comparison to Standard Methods

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Pneumocystis carinii pneumonia (PCP) is an important cause of morbidity and death among persons with human immunodeficiency virus (HIV) infection. Polymerase chain reaction (PCR) analysis of respiratory specimens has been investigated as a rapid diagnostic method. We have previously reported on the utility of this technique for diagnosing PCP in HIV-infected patients. In this report we evaluate PCR used in a blinded study design to avoid biases inherent to retrospective and nonblinded studies. The diagnosis of PCP was established on the basis of clinical findings and morphological studies of bronchoalveolar lavage (BAL) and/or lung biopsy specimens before PCR testing. PCR was performed without knowledge of the diagnosis. PCR results were graded from “negative” to 3+ on the basis of intensity of the banding pattern. Forty-seven patients were enrolled in the study, including 18 with proven PCP and 29 with other conditions. PCR was positive at grade 1 or higher for all 18 patients with PCP (100% sensitivity), at grade 2 or higher for 13 patients (72.2% sensitivity), and at grade 1 or higher for 4 of the 29 control patients (specificity of 86.2%). If a grade 2 or higher was required for diagnosis, the specificity improved to 100%. Results were reproducible with testing of a second aliquot for 46 of 47 patients (97.8%). Our findings confirm that PCR is a sensitive and reproducible test for detection of P. carinii in BAL specimens. Problems with false-positive results for control patients, however, limit the applicability of this method.

Journal Article.  3509 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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