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

Detection of Pneumocystis jirovecii in oral wash from immunosuppressed patients as a diagnostic tool.
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Hviid CJ, Lund M, Sørensen A, Ellermann-Eriksen S, Jespersen B, Dam MY, Dahlerup JF, Benfield T, Jespersen S, Østergaard LJ, Laursen AL, ,


Hviid CJ, Lund M, Sørensen A, Ellermann-Eriksen S, Jespersen B, Dam MY, Dahlerup JF, Benfield T, Jespersen S, Østergaard LJ, Laursen AL, , (click to view)

Hviid CJ, Lund M, Sørensen A, Ellermann-Eriksen S, Jespersen B, Dam MY, Dahlerup JF, Benfield T, Jespersen S, Østergaard LJ, Laursen AL, ,

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PloS one 2017 03 3012(3) e0174012 doi 10.1371/journal.pone.0174012

Abstract
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.

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