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Journal of Clinical Microbiology, April 2000, p. 1461-1467, Vol. 38, No. 4
0095-1137/00/$04.00+0
Copyright © 2000, American Society for Microbiology. All rights reserved.

Evaluation of Diagnostic Value and Epidemiological Implications of PCR for Pneumocystis carinii in Different Immunosuppressed and Immunocompetent Patient Groups

Andreas Sing,1,* Karlheinz Trebesius,1 Andreas Roggenkamp,1 Holger Rüssmann,1 Karin Tybus,1 Friederike Pfaff,1 Johannes R. Bogner,2 Christoph Emminger,3 and Jürgen Heesemann1

Max von Pettenkofer-Institut für Hygiene und Medizinische Mikrobiologie,1 and Medizinische Poliklinik, Ludwig Maximilians-Universität München,2 80336 Munich, and Krankenhaus München Schwabing, 80804 Munich,3 Germany

Received 14 October 1999/Returned for modification 29 November 1999/Accepted 29 January 2000

To evaluate the value of single and nested PCRs for diagnosis of Pneumocystis carinii pneumonia (PCP) in a variety of respiratorily distressed patient groups, 574 respiratory samples from 334 patients (89 human immunodeficiency virus [HIV]-positive patients, 61 transplant recipients, 66 malignancy patients, 34 otherwise immunosuppressed patients, and 84 immunocompetent patients) were prospectively examined by microscopy and single and nested PCRs. The resulting data were correlated with clinical evidence of PCP. Microscopy and single PCR of bronchoalveolar lavage (BAL) specimens from HIV patients were 100% sensitive and specific in detecting PCP, whereas nested PCR, although being 100% sensitive, reached a specificity of only 97.5%. In the three non-HIV immunosuppressed patient groups, both single and nested PCR invariably produced lower positive predictive values than microscopy. Among immunocompetent patients, the positive predictive values of both PCRs were 0%. Therefore, the diagnostic values of the PCR methods tested do not seem to offer any additional advantage compared to that of conventional microscopy for these patient groups. However, nested PCR identified a significant percentage of clinically silent P. carinii colonizations in about 17 to 20% of immunocompetent and immunosuppressed non-HIV patients.

* Corresponding author. Mailing address: Max von Pettenkofer-Institut für Hygiene und Medizinische Mikrobiologie, Pettenkoferstraße 9a, 80336 Munich, Germany. Phone: 49-89-5160-5293. Fax: 49-89-5160-5223. E-mail: sing{at}m3401.mpk.med.uni-muenchen.de.

Journal of Clinical Microbiology, April 2000, p. 1461-1467, Vol. 38, No. 4
0095-1137/00/$04.00+0
Copyright © 2000, American Society for Microbiology. All rights reserved.


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