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Pneumocystis jirovecii colonization and its association with pulmonary diseases: a multicenter study based on a modified loop-mediated isothermal amplification assay

Authors
  • Xue, Ting1, 2
  • Ma, Zhuang3
  • Liu, Fan4
  • Du, Weiqin5
  • He, Li1
  • Wang, Jinyan6
  • An, Chunli1
  • 1 China Medical University, 77 Puhe Road, Shenyang, People’s Republic of China , Shenyang (China)
  • 2 Department of Respiratory and Critical Care Medicine, First Hospital of Shanxi Medical University, Taiyuan, People’s Republic of China , Taiyuan (China)
  • 3 Department of Respiratory Medicine, General Hospital of Shenyang Military Command, Shenyang, People’s Republic of China , Shenyang (China)
  • 4 Department of Respiratory Internal Medicine, the First Affiliated Hospital of China Medical University, Shenyang, People’s Republic of China , Shenyang (China)
  • 5 Department of Medical Laboratory, the Eleventh Affiliated Hospital of Shanxi Medical University, Lvliang, People’s Republic of China , Lvliang (China)
  • 6 China Medical University, Shenyang, People’s Republic of China , Shenyang (China)
Type
Published Article
Journal
BMC pulmonary medicine
Publication Date
Mar 20, 2020
Volume
20
Issue
1
Identifiers
DOI: 10.1186/s12890-020-1111-4
Source
Springer Nature
Keywords
License
Green

Abstract

BackgroundPneumocystis jirovecii (P. jirovecii) is an opportunistic fungal pathogen and the role of its colonization in pulmonary diseases has become a popular focus in recent years. The aim of this study was to develop a modified loop-mediated isothermal amplification (LAMP) assay for detection of Pneumocystis jirovecii (P. jirovecii) DNA amongst non-HIV patients with various pulmonary diseases and use it to examine the prevalence and assess the association of P. jirovecii colonization with clinical characteristics of these diseases.MethodsWe modified the previously reported LAMP assay for P. jirovecii by adding real-time detection. This method was used to detect P. jirovecii colonization in pulmonary samples collected from 403 non-HIV patients with various pulmonary diseases enrolled from 5 hospitals in China. We determined the prevalence of P. jirovecii colonization in 7 types of pulmonary diseases and assessed the association of P. jirovecii colonization with clinical characteristics of these diseases.ResultsThe modified LAMP assay showed no cross-reactivity with other common pulmonary microbes and was 1000 times more sensitive than that of conventional PCR. Using the modified LAMP assay, we detected P. jirovecii colonization in 281 (69.7%) of the 403 patients enrolled. P. jirovecii colonization was more common in interstitial lung diseases than in chronic obstructive pulmonary disease (COPD) (84.6% vs 64.5%, P < 0.05). Patients with acute exacerbation of COPD had a higher prevalence of P. jirovecii colonization compared to patients with stabilized COPD (67.4% vs 43.3%, P < 0.05). P. jirovecii colonization was associated with decreased pulmonary function, increased levels of 1,3-β-D-glucan and C-reactive protein, and decreased levels of CD4+ T-cell counts (P < 0.05 for each). Approximately 70% of P. jirovecii colonized patients had confections with other fungi or bacteria.ConclusionsWe developed a modified LAMP assay for detecting P. jirovecii. Our multi-center study of 403 patients supports that P. jirovecii colonization is a risk factor for the development of pulmonary diseases and highlights the need to further study the pathogenesis and transmission of P. jirovecii colonization in pulmonary diseases.

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