Sara Cederwall, Erik Ottander, David Björkhem, Karl Oldberg, Lisa I Påhlman
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The aim of this study was to assess the utility of P. jirovecii PCR Quantification Cycle (Cq) values in differentiating between PCP and colonisation in PCR-positive respiratory samples from immunocompromised patients.</p><p><strong>Methods: </strong>Adult patients with P. jirovecii detected by qPCR in respiratory samples (bronchoalveolar lavage (BAL), sputum and oral wash) collected between 2017 and 2023 were retrospectively enrolled in the study. Patients were classified as having PCP or P. jirovecii colonisation and Cq values were compared between the groups. Receiver-operating characteristics (ROC) curve analyses were used to assess the performance of Cq values to distinguish between PCP and colonisation, and to establish Cq cut-off values for the different sample types.</p><p><strong>Result: </strong>Of 520 included participants, 247 patients (47.5%) were classified as PCP and 273 (52.5%) as colonised. The median Cq value was significantly lower in the PCP group compared to colonised patients in BAL (33.0 vs. 36.6, p < 0.001) and sputum (33.4 vs. 36.0, p < 0.0001), yielding a ROC area under the curve of 0.75 and 0.73, respectively. Cq levels for oral wash did not differ between PCP and colonisation and lacked discriminatory power with a ROC AUC of 0.45. A Cq cut-off level at 31 for BAL and sputum could predict PCP with a positive predictive value of > 85% while Cq < 38 provided a negative predictive value of 89% for BAL and 73% for sputum.</p><p><strong>Conclusion: </strong>Different Cq cut-off values in BAL and sputum may support discrimination between PCP and colonisation and assist physicians in their clinical management of PCP.</p>","PeriodicalId":18797,"journal":{"name":"Mycoses","volume":"68 10","pages":"e70120"},"PeriodicalIF":3.4000,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12530012/pdf/","citationCount":"0","resultStr":"{\"title\":\"Performance of Quantitative PCR to Distinguish Pneumocystis jirovecii Pneumonia From Colonisation in Immunocompromised Patients.\",\"authors\":\"Sara Cederwall, Erik Ottander, David Björkhem, Karl Oldberg, Lisa I Påhlman\",\"doi\":\"10.1111/myc.70120\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Pneumocystis jirovecii pneumonia (PCP) is a severe opportunistic infection affecting immunocompromised patients. Quantitative polymerase chain reaction (qPCR) is widely used for the detection of P. jirovecii in respiratory samples. However, the diagnosis of PCP remains challenging and the high prevalence of P. jirovecii airway colonisation complicates the interpretation of positive results. The aim of this study was to assess the utility of P. jirovecii PCR Quantification Cycle (Cq) values in differentiating between PCP and colonisation in PCR-positive respiratory samples from immunocompromised patients.</p><p><strong>Methods: </strong>Adult patients with P. jirovecii detected by qPCR in respiratory samples (bronchoalveolar lavage (BAL), sputum and oral wash) collected between 2017 and 2023 were retrospectively enrolled in the study. Patients were classified as having PCP or P. jirovecii colonisation and Cq values were compared between the groups. Receiver-operating characteristics (ROC) curve analyses were used to assess the performance of Cq values to distinguish between PCP and colonisation, and to establish Cq cut-off values for the different sample types.</p><p><strong>Result: </strong>Of 520 included participants, 247 patients (47.5%) were classified as PCP and 273 (52.5%) as colonised. The median Cq value was significantly lower in the PCP group compared to colonised patients in BAL (33.0 vs. 36.6, p < 0.001) and sputum (33.4 vs. 36.0, p < 0.0001), yielding a ROC area under the curve of 0.75 and 0.73, respectively. Cq levels for oral wash did not differ between PCP and colonisation and lacked discriminatory power with a ROC AUC of 0.45. A Cq cut-off level at 31 for BAL and sputum could predict PCP with a positive predictive value of > 85% while Cq < 38 provided a negative predictive value of 89% for BAL and 73% for sputum.</p><p><strong>Conclusion: </strong>Different Cq cut-off values in BAL and sputum may support discrimination between PCP and colonisation and assist physicians in their clinical management of PCP.</p>\",\"PeriodicalId\":18797,\"journal\":{\"name\":\"Mycoses\",\"volume\":\"68 10\",\"pages\":\"e70120\"},\"PeriodicalIF\":3.4000,\"publicationDate\":\"2025-10-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12530012/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Mycoses\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1111/myc.70120\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"DERMATOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Mycoses","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1111/myc.70120","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"DERMATOLOGY","Score":null,"Total":0}
引用次数: 0
摘要
背景：基罗氏肺囊虫肺炎（PCP）是一种影响免疫功能低下患者的严重机会性感染。定量聚合酶链反应（Quantitative polymerase chain reaction, qPCR）被广泛应用于呼吸道样本中耶氏弓形虫的检测。然而，PCP的诊断仍然具有挑战性，并且耶氏假单胞杆菌气道定植的高患病率使阳性结果的解释复杂化。本研究的目的是评估在免疫功能低下患者的PCR阳性呼吸道样本中，利用PCR定量循环（Cq）值来区分PCP和定植的效用。方法：回顾性纳入2017 - 2023年呼吸道样本（支气管肺泡灌洗液（BAL）、痰液和口腔洗液）中qPCR检测到的成年患者。将患者分为PCP或耶氏单胞杆菌定植，并比较两组间的Cq值。使用受试者工作特征（ROC）曲线分析来评估Cq值的性能，以区分PCP和菌落，并建立不同样本类型的Cq截止值。结果：在520名纳入的参与者中，247名患者（47.5%）被归类为PCP， 273名患者（52.5%）被定植。PCP组的中位Cq值明显低于BAL患者（33.0 vs 36.6, p 85%）。结论：BAL和痰中不同的Cq临界值可能支持PCP和菌落的区分，并有助于医生对PCP的临床管理。
Performance of Quantitative PCR to Distinguish Pneumocystis jirovecii Pneumonia From Colonisation in Immunocompromised Patients.
Background: Pneumocystis jirovecii pneumonia (PCP) is a severe opportunistic infection affecting immunocompromised patients. Quantitative polymerase chain reaction (qPCR) is widely used for the detection of P. jirovecii in respiratory samples. However, the diagnosis of PCP remains challenging and the high prevalence of P. jirovecii airway colonisation complicates the interpretation of positive results. The aim of this study was to assess the utility of P. jirovecii PCR Quantification Cycle (Cq) values in differentiating between PCP and colonisation in PCR-positive respiratory samples from immunocompromised patients.
Methods: Adult patients with P. jirovecii detected by qPCR in respiratory samples (bronchoalveolar lavage (BAL), sputum and oral wash) collected between 2017 and 2023 were retrospectively enrolled in the study. Patients were classified as having PCP or P. jirovecii colonisation and Cq values were compared between the groups. Receiver-operating characteristics (ROC) curve analyses were used to assess the performance of Cq values to distinguish between PCP and colonisation, and to establish Cq cut-off values for the different sample types.
Result: Of 520 included participants, 247 patients (47.5%) were classified as PCP and 273 (52.5%) as colonised. The median Cq value was significantly lower in the PCP group compared to colonised patients in BAL (33.0 vs. 36.6, p < 0.001) and sputum (33.4 vs. 36.0, p < 0.0001), yielding a ROC area under the curve of 0.75 and 0.73, respectively. Cq levels for oral wash did not differ between PCP and colonisation and lacked discriminatory power with a ROC AUC of 0.45. A Cq cut-off level at 31 for BAL and sputum could predict PCP with a positive predictive value of > 85% while Cq < 38 provided a negative predictive value of 89% for BAL and 73% for sputum.
Conclusion: Different Cq cut-off values in BAL and sputum may support discrimination between PCP and colonisation and assist physicians in their clinical management of PCP.
期刊介绍：
The journal Mycoses provides an international forum for original papers in English on the pathogenesis, diagnosis, therapy, prophylaxis, and epidemiology of fungal infectious diseases in humans as well as on the biology of pathogenic fungi.
Medical mycology as part of medical microbiology is advancing rapidly. Effective therapeutic strategies are already available in chemotherapy and are being further developed. Their application requires reliable laboratory diagnostic techniques, which, in turn, result from mycological basic research. Opportunistic mycoses vary greatly in their clinical and pathological symptoms, because the underlying disease of a patient at risk decisively determines their symptomatology and progress. The journal Mycoses is therefore of interest to scientists in fundamental mycological research, mycological laboratory diagnosticians and clinicians interested in fungal infections.
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