Diagnóstico de neumonía por Pneumocystis jirovecii por PCR

Abstract

Introduction: Pneumocystis pneumonia is an opportunistic infection caused by Pneumocystis jirovecii (Pj) in immunocompromised patients, especially in patients with HIV. Objective: to describe the clinical, radiological characteristics and the clinical course of immunocompromised patients diagnosed with Pj pneumonia by means of PCR in bronchoalveolar lavage (BAL). Methods: a cross-sectional, descriptive study was carried out that included immunocompromised patients, with a clinical and radiological suspicion of Pj pneumonia, diagnosed only by PCR in a BAL sample. Results: 141 patients underwent BAL between March 2017 and December 2019, for clinical and radiological suspicion for Pj pneumonia. Twenty-two patients whose diagnosis was confirmed only by PCR on a BAL sample were included in the analysis. All patients presented with coughs. 17 patients had dyspnea (77%) and the most frequent radiological pattern was interstitial infiltrate and bilateral ground glass. Pulmonary coinfection was observed in 4 patients (18.8%), with isolation of Mycobacterium tuberculosis (n = 2) and Streptococcus pneumoniae (n = 2). The length of hospital stay was 13 days (SD±11). Six patients (27%) required mechanical ventilation. In-hospital mortality was 23%. Conclusions: the use of PCR in BAL samples could be a useful method for the diagnosis of Pj pneumonia. However, its value must be interpreted in the context of the illness history, clinical, and radiological picture.