LOW CD4 LYMPHOCYTE COUNT RELATED RISK TO Pneumocystis jiroveci PNEUMONIA IN HIV/AIDS PATIENTS FROM BRONCHOALVEOLAR LAVAGE SPECIMENS USING REAL TIME PCR DETECTION

Alicia Margaretta Widya, Ni Made Mertaniasih, Arthur Pohan Kawilarang, Isnin Anang Marhana

= http://dx.doi.org/10.20473/ijtid.v6i6.6309
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Abstract


HIV and opportunistic infections remain a big problem especially in developing country. Pneumocystis jiroveci pneumonia is a prevalent infection  in HIV infected patient with high mortality rate. Diagnosis of Pneumocystis jiroveci pneumonia is mainly based on clinical evidence. Microbiological diagnosis is quite challenging since this microorganism cannot be cultured and is mainly based on microscopic examination. Microscopic examination with special staining is still a gold standard diagnosis for P. jiroveci infection.The objectives of this study was to describe CD4 lymphocyte profile and establish microbiological diagnosis with recent molecular method in PJP suspected HIV positive patients. Fiberoptic bronchoscopy of HIV infected patients with lower respiratory tract infection in Dr. Soetomo general hospital Surabaya were performed to collect bronchoalveolar lavage specimens  from December 2016 to April 2017 for identification of Pneumocystis jiroveci using real time PCR assay. Positive samples were then evaluated for  microscopic examination with Gommori Methenamine Silver staining for comparison. Patient’s CD4 lymphocyte count were gathered prior of admission. CD4 lymphocyte count from this study were very low with 61% of the patients were below 50 cells/ µL. There were five of  total thirteen patients (38,5%) with positive real time PCR assay (MSG gene)  and one patient was also positive with GMS staining showing characteristic cysts shape with dark centered area of P. jiroveci. Patient with positive microscopic examination showed no history of prophylactic therapy. Low CD4 lymphocyte count remains a strong risk factor of P. jiroveci pneumonia in HIV/AIDS patients. Real time PCR assay shows high value in detection of P. jiroveci regarding patient’s prophylactic status.


Keywords


HIV/AIDS; Pneumocystis jiroveci; pneumonia; low CD4 count; Dr. Soetomo hospital Surabaya

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References


Infodatin. Situasi penyakit HIV/AIDS di Indonesia. Kementrian Kesehatan RI. Jakarta Selatan; 2016.

Moges NA. Prevalence of Opportunistic Infections and Associated Factors among HIV Positive Patients taking Anti-Retroviral Therapy in DebreMarkos Referral Hospital, Northwest Ethiopia. J AIDS Clin Res. 2014;5(5).

GBD 2015 HIV Collaborators. Estimates of global, regional, and national incidence, prevalence, and mortality of HIV, 1980-2015: the Global Burden of Disease Study 2015. lancet HIV. 2016 Aug;3(8):e361–87.

Bhaumik P, Debnath K, Sinha B. Spectrum of opportunistic infections among HIV / AIDS patients of Tripura. Journal, Indian Acad Clin Med. 2013;14:218–21.

Gobel FA. Stigma dan Diskriminasi Terhadap ODHA, Tugas dan Tanggungjawab Siapa? [Internet]. 2014. Available from: http://www.kebijakanaidsindonesia.net/id/artikel/artikel-kontribusi/1005-stigma-dan-diskriminasi-terhadap-odha-tugas-dan-tanggungjawab-siapa

Mussini C, Manzardo C, Johnson M, Monforte A d’Arminio, Uberti-Foppa C, Antinori A, et al. Patients presenting with AIDS in the HAART era: a collaborative cohort analysis. AIDS. 2008 Nov 30;22(18):2461–9.

Phair J, Muñoz A, Detels R, Kaslow R, Rinaldo C, Saah A. The risk of Pneumocystis carinii pneumonia among men infected with human immunodeficiency virus type 1. Multicenter AIDS Cohort Study Group. N Engl J Med. 1990 Jan 18;322(3):161–5.

Kim YJ, Woo JH, Kim MJ, Park DW, Song J-Y, Kim SW, et al. Opportunistic diseases among HIV-infected patients: a multicenter-nationwide Korean HIV/AIDS cohort study, 2006 to 2013. Korean J Intern Med. 2016 Sep;31(5):953–60.

Bennett JE, Dolin R, Blaser MJ. Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases. 8th ed. Philadelphia: Elsevier Saunders; 2015.

Morris A, Lundgren JD, Masur H, Walzer PD, Hanson DL, Frederick T, et al. Current epidemiology of Pneumocystis pneumonia. Emerg Infect Dis. 2004 Oct;10(10):1713–20.

K Y, Y N. HIV and Pneumocystis Pneumonia (PCP): An Upto date. J Infect Dis Ther. 2015;3(6).

Meyer KC. The role of bronchoalveolar lavage in interstitial lung disease. Clin Chest Med. 2004 Dec;25(4):637–49.

Alvarez-Martínez MJ, Miró JM, Valls ME, Moreno A, Rivas P V, Solé M, et al. Sensitivity and specificity of nested and real-time PCR for the detection of Pneumocystis jiroveci in clinical specimens. Diagn Microbiol Infect Dis. 2006 Oct;56(2):153–60.

Fillaux J, Malvy S, Alvarez M, Fabre R, Cassaing S, Marchou B, et al. Accuracy of a routine real-time PCR assay for the diagnosis of Pneumocystis jirovecii pneumonia. J Microbiol Methods. 2008 Oct;75(2):258–61.

Huang L, Crothers K, Morris A, Groner G, Fox M, Turner JR, et al. Pneumocystis colonization in HIV-infected patients. J Eukaryot Microbiol. 2003;50 Suppl:616–7.

Unnewehr M, Friederichs H, Bartsch P, Schaaf B. High Diagnostic Value of a New Real-Time Pneumocystis PCR from Bronchoalveolar Lavage in a Real-Life Clinical Setting. Respiration. 2016;92(3):144–9.

Fauchier T, Hasseine L, Gari-Toussaint M, Casanova V, Marty PM, Pomares C. Detection of Pneumocystis jirovecii by Quantitative PCR To Differentiate Colonization and Pneumonia in Immunocompromised HIV-Positive and HIV-Negative Patients. J Clin Microbiol. 2016;54(6):1487–95.

Masur H, Ognibene FP, Yarchoan R, Shelhamer JH, Baird BF, Travis W, et al. CD4 counts as predictors of opportunistic pneumonias in human immunodeficiency virus (HIV) infection. Ann Intern Med. 1989 Aug 1;111(3):223–31.

Crowe SM, Carlin JB, Stewart KI, Lucas CR, Hoy JF. Predictive value of CD4 lymphocyte numbers for the development of opportunistic infections and malignancies in HIV-infected persons. J Acquir Immune Defic Syndr. 1991;4(8):770–6.

Robert-Gangneux F, Belaz S, Revest M, Tattevin P, Jouneau S, Decaux O, et al. Diagnosis of Pneumocystis jirovecii pneumonia in immunocompromised patients by real-time PCR: a 4-year prospective study. J Clin Microbiol. 2014 Sep;52(9):3370–6.

Caliendo AM, Hewitt PL, Allega JM, Keen A, Ruoff KL, Ferraro MJ. Performance of a PCR assay for detection of Pneumocystis carinii from respiratory specimens. J Clin Microbiol. 1998;36(4):979–82.

Pinlaor S, Mootsikapun P, Pinlaor P, Phunmanee A, Pipitgool V, Sithithaworn P, et al. PCR diagnosis of Pneumocystis carinii on sputum and bronchoalveolar lavage samples in immuno-compromised patients. Parasitol Res. 2004 Oct;94(3):213–8.

Maskell NA, Waine DJ, Lindley A, Pepperell JCT, Wakefield AE, Miller RF, et al. Asymptomatic carriage of Pneumocystis jiroveci in subjects undergoing bronchoscopy: a prospective study. Thorax. 2003 Jul;58(7):594–7.


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