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VOLUME 21 , ISSUE 4 ( 2017 ) > List of Articles

RESEARCH ARTICLE

Respiratory multiplex polymerase chain reaction: An important diagnostic tool in immunocompromised patients

Sharmila Sengupta, Navin Kumar, Amarjeet Kaur

Keywords : Cytomegalovirus, immunocompromised patients, multiplex polymerase chain reaction, Pneumocystis jirovecii

Citation Information : Sengupta S, Kumar N, Kaur A. Respiratory multiplex polymerase chain reaction: An important diagnostic tool in immunocompromised patients. Indian J Crit Care Med 2017; 21 (4):192-198.

DOI: 10.4103/ijccm.IJCCM_2_17

License: CC BY-ND 3.0

Published Online: 01-04-2018

Copyright Statement:  Copyright © 2017; The Author(s).


Abstract

Background: Viruses and atypical pathogens can cause significant respiratory illness in immunocompromised patients. Multiplex polymerase chain reaction (MPCR) has improved the diagnostic yield of pathogens, and it is easier to identify the co-infections also. The present study was done to evaluate the performance of MPCR on bronchoalveolar lavage (BAL) samples in immunocompromised patients. Methods: Atotal of 177 BAL specimens collected over a 19 months period from immunocompromised patients with respiratory illness were analyzed with the MPCR and aerobic culture. Patients were divided into four according to the pathogens. Category V (only viral), Category NV (nonviral, i.e., bacteria and atypical), Category M (mixed, i.e., both viral and nonviral pathogen), and Category UK (unknown etiology). Results: MPCR identified the causative pathogen in 59.3% of patients while culture could identify only in 37.8% of patients. Most frequent etiological agent was Klebsiella pneumoniae (32%), followed by cytomegalovirus (21%), and Pneumocystis jirovecii (10%). Numbers of patients in each category were Category V (9.6%), Category NV (43.5%), Category M (19.8%), and Category UK (27.1%). Mortality was significantly higher in patients of Category M having mixed infections. Conclusion: MPCR is highly sensitive and rapid tool which can be considered in the routine diagnostic algorithm of respiratory illness in immunocompromised patients.


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  1. Franquet T. High-resolution computed tomography (HRCT) of lung infections in non-AIDS immunocompromised patients. Eur Radiol 2006;16:707-18.
  2. Jepson SL, Pakkal M, Bajaj A, Raj V. Pulmonary complications in the non-HIV immunocompromised patient. Clin Radiol 2012;67:1001-10.
  3. Cereser L, Zuiani C, Graziani G, Girometti R, Como G, Zaja F, et al. Impact of clinical data on chest radiography sensitivity in detecting pulmonary abnormalities in immunocompromised patients with suspected pneumonia. Radiol Med 2010;115:205-14.
  4. Safadi AR, Soubani AO. Diagnostic approach of pulmonary disease in the HIV negative immunocompromised host. Eur J Intern Med 2009;20:268-79.
  5. Corti M, Palmero D, Eiguchi K. Respiratory infections in immunocompromised patients. Curr Opin Pulm Med 2009;15:209-17.
  6. Baughman RP. The lung in the immunocompromised patient. Infectious complications Part 1. Respiration 1999;66:95-109.
  7. Bollée G, Sarfati C, Thiéry G, Bergeron A, de Miranda S, Menotti J, et al. Clinical picture of Pneumocystis jiroveci pneumonia in cancer patients. Chest 2007;132:1305-10.
  8. Monnet X, Vidal-Petiot E, Osman D, Hamzaoui O, Durrbach A, Goujard C, et al. Critical care management and outcome of severe Pneumocystis pneumonia in patients with and without HIV infection. Crit Care 2008;12:R28.
  9. Mansharamani NG, Garland R, Delaney D, Koziel H. Management and outcome patterns for adult Pneumocystis carinii pneumonia, 1985 to 1995: Comparison of HIV-associated cases to other immunocompromised states. Chest 2000;118:704-11.
  10. Japanese Respiratory Society. Pneumonia in immunocompromised patients. Respirology 2009;14 Suppl 2:S44-50.
  11. Tregoning JS, Schwarze J. Respiratory viral infections in infants: Causes, clinical symptoms, virology, and immunology. Clin Microbiol Rev 2010;23:74-98.
  12. Brittain-Long R, Westin J, Olofsson S, Lindh M, Andersson LM. Prospective evaluation of a novel multiplex real-time PCR assay for detection of fifteen respiratory pathogens-duration of symptoms significantly affects detection rate. J Clin Virol 2010;47:263-7.
  13. Ren L, Gonzalez R, Wang Z, Xiang Z, Wang Y, Zhou H, et al. Prevalence of human respiratory viruses in adults with acute respiratory tract infections in Beijing, 2005-2007. Clin Microbiol Infect 2009;15:1146-53.
  14. Marcos MA, Esperatti M, Torres A. Viral pneumonia. Curr Opin Infect Dis 2009;22:143-7.
  15. Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC, et al. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis 2007;44 Suppl 2:S27-72.
  16. Baudel JL, Tankovic J, Dahoumane R, Carrat F, Galbois A, Ait-Oufella H, et al. Multiplex PCR performed of bronchoalveolar lavage fluid increases pathogen identification rate in critically ill patients with pneumonia: A pilot study. Ann Intensive Care 2014;4:35.
  17. Hiatt JR, Gong H, Mulder DG, Ramming KP. The value of open lung biopsy in the immunosuppressed patient. Surgery 1982;92:285-91.
  18. Vu DL, Bridevaux PO, Aubert JD, Soccal PM, Kaiser L. Respiratory viruses in lung transplant recipients: A critical review and pooled analysis of clinical studies. Am J Transplant 2011;11:1071-8.
  19. Soccal PM, Aubert JD, Bridevaux PO, Garbino J, Thomas Y, Rochat T, et al. Upper and lower respiratory tract viral infections and acute graft rejection in lung transplant recipients. Clin Infect Dis 2010;51:163-70.
  20. Kumar D, Husain S, Chen MH, Moussa G, Himsworth D, Manuel O, et al. A prospective molecular surveillance study evaluating the clinical impact of community-acquired respiratory viruses in lung transplant recipients. Transplantation 2010;89:1028-33.
  21. Gambarino S, Mantovani S, Astegiano S, Libertucci D, Solidoro P, Baldi S, et al. Lower respiratory tract viral infections in hospitalized adult patients. Minerva Med 2009;100:349-55.
  22. Barton TD, Blumberg EA. Viral pneumonias other than cytomegalovirus in transplant recipients. Clin Chest Med 2005;26:707-20, viii.
  23. López-Giraldo A, Sialer S, Esperatti M, Torres A. Viral-reactivated pneumonia during mechanical ventilation: Is there need for antiviral treatment? Front Pharmacol 2011;2:66.
  24. Azoulay E, Bergeron A, Chevret S, Bele N, Schlemmer B, Menotti J. Polymerase chain reaction for diagnosing pneumocystis pneumonia in non-HIV immunocompromised patients with pulmonary infiltrates. Chest 2009;135:655-61.
  25. Mühlethaler K, Bögli-Stuber K, Wasmer S, von Garnier C, Dumont P, Rauch A, et al. Quantitative PCR to diagnose Pneumocystis pneumonia in immunocompromised non-HIV patients. Eur Respir J 2012;39:971-8.
  26. Li MC, Lee NY, Lee CC, Lee HC, Chang CM, Ko WC. Pneumocystis jiroveci pneumonia in immunocompromised patients: Delayed diagnosis and poor outcomes in non-HIV-infected individuals. J Microbiol Immunol Infect 2014;47:42-7.
  27. Danés C, González-Martín J, Pumarola T, Rañó A, Benito N, Torres A, et al. Pulmonary infiltrates in immunosuppressed patients: Analysis of a diagnostic protocol. J Clin Microbiol 2002;40:2134-40.
  28. Vigil KJ, Adachi JA, Chemaly RF. Viral pneumonias in immunocompromised adult hosts. Intensive Care Med 2010;25:307-26.
  29. Chemaly RF, Yen-Lieberman B, Chapman J, Reilly A, Bekele BN, Gordon SM, et al. Clinical utility of cytomegalovirus viral load in bronchoalveolar lavage in lung transplant recipients. Am J Transplant 2005;5:544-8.
  30. Michaelides A, Liolios L, Glare EM, Spelman DW, Bailey MJ, Walters EH, et al. Increased human cytomegalovirus (HCMV) DNA load in peripheral blood leukocytes after lung transplantation correlates with HCMV pneumonitis. Transplantation 2001;72:141-7.
  31. Sanchez JL, Kruger RM, Paranjothi S, Trulock EP, Lynch JP, Hicks C, et al. Relationship of cytomegalovirus viral load in blood to pneumonitis in lung transplant recipients. Transplantation 2001;72:733-5.
  32. Jennings LC, Anderson TP, Beynon KA, Chua A, Laing RT, Werno AM, et al. Incidence and characteristics of viral community-acquired pneumonia in adults. Thorax 2008;63:42-8.
  33. Templeton KE, Scheltinga SA, van den Eeden WC, Graffelman AW, van den Broek PJ, Claas EC. Improved diagnosis of the etiology of community-acquired pneumonia with real-time polymerase chain reaction. Clin Infect Dis 2005;41:345-51.
  34. Polaczek MM, Zych J, Oniszh K, Szopinski J, Grudny J, Roszkowski-Sliz K. Pneumocystis pneumonia in HIV-infected patients with cytomegalovirus co-infection. Two case reports and a literature review. Pneumonol Alergol Pol 2014;82:458-66.
  35. Vetter M, Battegay M, Trendelenburg M. Primary cytomegalovirus infection with accompanying Pneumocystis jiroveci pneumonia in a patient with large-vessel vasculitis. Infection 2010;38:331-4.
  36. Johnstone J, Majumdar SR, Fox JD, Marrie TJ. Viral infection in adults hospitalized with community-acquired pneumonia: Prevalence, pathogens, and presentation. Chest 2008;134:1141-8.
  37. Johansson N, Kalin M, Hedlund J. Clinical impact of combined viral and bacterial infection in patients with community-acquired pneumonia. Scand J Infect Dis 2011;43:609-15.
  38. Choi SH, Hong SB, Ko GB, Lee Y, Park HJ, Park SY, et al. Viral infection in patients with severe pneumonia requiring intensive care unit admission. Am J Respir Crit Care Med 2012;186:325-32.
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