Increased prevalence of Pneumocystis jirovecii colonisation in acute pulmonary exacerbations of cystic fibrosis - 10/06/16

Doi : 10.1016/j.jinf.2016.05.001

Heather D. Green ^a,^b,^⁎ , Rowland J. Bright-Thomas ^a,^b, Ken J. Mutton ^b,^c, Malcolm Guiver ^c, Andrew M. Jones ^a,^b
^a Manchester Adult Cystic Fibrosis Centre, University Hospital of South Manchester NHS Foundation Trust, Southmoor Road, Manchester, M23 9LT, UK
^b University of Manchester, Institute of Inflammation and Repair, UK
^c Central Manchester University Hospitals NHS Trust, Clinical Virology Department and PHE Public Health Laboratory, Clinical Sciences Building, Manchester Royal Infirmary, Manchester, M13 9WL, UK

^∗Corresponding author. Manchester Adult Cystic Fibrosis Centre, University Hospital of South Manchester, Southmoor Road, Wythenshawe, Manchester, M23 9LT, UK. Tel.: +44 7739018723.Manchester Adult Cystic Fibrosis CentreUniversity Hospital of South ManchesterSouthmoor RoadWythenshaweManchesterM23 9LTUK

Summary

Objectives

This study examined the prevalence of Pneumocystis jirovecii in the sputum of adults with cystic fibrosis during clinical stability and acute pulmonary exacerbation.

Methods

This was a prospective, longitudinal observational study of patients attending the Manchester Adult Cystic Fibrosis Centre. Sputum samples were analysed for P. jirovecii DNA using PCR at enrolment and up to 5 follow-up visits. Patients were classified as stable or exacerbating using a modified Fuch's pulmonary exacerbation score.

Results

226 samples were tested from 111 patients. P. jirovecii was more likely to be detected in samples at acute pulmonary exacerbation (7/76 (9.2%)) compared with stable visits (3/150 (2%)), p = 0.03. P. jirovecii was detected less frequently if patients had received co-trimoxazole within 3 months of sample collection (0% versus 29.7%, p = 0.03).

Conclusions

Prevalence of P. jirovecii in stable patients is low, but P. jirovecii is detected in approximately 1 in 10 patients experiencing an acute pulmonary exacerbation.

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Highlights

•	Prevalence of P. jirovecii in stable patients with cystic fibrosis is low at 2%.
•	Prevalence of P. jirovecii in exacerbating patients with cystic fibrosis is 9.2%.
•	Recent co-trimoxazole use is associated with lower detection of P. jirovecii.

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Keywords : Pneumocystis jirovecii, Cystic fibrosis, Pulmonary exacerbation

Abbreviations : BAL, CF, COPD, CRP, FEV₁, HIV, MACFC, PCR, PEx, REC

Plan

Background

Materials and methods

Participants and study design

Detection of Pneumocystis jirovecii

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Vol 73 - N° 1

P. 1-7 - juillet 2016 Retour au numéro

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Increased prevalence of Pneumocystis jirovecii colonisation in acute pulmonary exacerbations of cystic fibrosis - 10/06/16

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