You are here

Article Text

Article menu
Download PDFPDF
PostScript
letter
Pneumocystis jirovecii in pleural infection: a nucleic acid amplification study
  1. John M Wrightson1,
  2. Najib M Rahman1,
  3. Tanya Novak2,
  4. Jim F Huggett2,
  5. Nicholas A Maskell3,
  6. Alimuddin Zumla2,
  7. Robert F Miller4,
  8. Robert J O Davies1
  1. 1Oxford Pleural Unit, Oxford Centre for Respiratory Medicine, Churchill Hospital, Oxford, UK
  2. 2Centre for Infectious Diseases and International Health, Windeyer Institute for Medical Sciences, University College London, London, UK
  3. 3North Bristol Lung Centre, Southmead Hospital, Bristol, UK
  4. 4Centre for Sexual Health and HIV Research, Department of Primary Care and Population Sciences, University College London, London, UK
  1. Correspondence to Dr John M Wrightson, Oxford Pleural Unit, Oxford Centre for Respiratory Medicine, Churchill Hospital, Oxford Radcliffe Hospitals NHS Trust, Headington, Oxford OX3 7LJ, UK; johnwrightson{at}thorax.org.uk

https://doi.org/10.1136/thx.2009.129940

Statistics from Altmetric.com

    Request Permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

    Pleural infection is associated with 20% mortality in the 80 000 new cases per year in the UK and USA. Streptococcus species cause ∼50% of community-acquired bacterial pleural infection.1 Staphylococcus aureus and anaerobes are isolated in 8% and 20% of cases, respectively, and 12% of pleural infections yield polymicrobial cultures. However, even using culture and nucleic acid amplification techniques (NAATs), 26% of cases remain microbiologically obscure.

    The negative microbiology may be due to previous antibiotic treatment, varying pathogen prevalence in different pleural fluid locules (already known to vary biochemically2) or the presence of organisms that are difficult to detect using conventional techniques. One such possible organism is Pneumocystis jirovecii, which requires specialist diagnostic techniques (eg, Grocott–Gomori methenamine silver staining or NAATs).

    P jirovecii has been identified in sputum and bronchoalveolar lavage (BAL) fluid from both immunocompromised and immunocompetent individuals—it has been isolated from BAL fluid using NAATs …

    View Full Text

    Footnotes

    • Funding This study was funded by the NIHR Oxford Biomedical Research Centre. RJOD has received drug and matched placebo for clinical trials in pleural infection, from which the samples for this study were gathered, from Aventis UK and Roche UK. None of these funding sources had a role or influence on the study execution.

    • Competing interests None.

    • Ethics approval This study was conducted with the approval of the Anglia and Oxford Multicentre Research Ethics Committee (MREC) (ref: 98/5/61), the Oxfordshire Research Ethics Committee (05/Q1605) and the Cambridgeshire Research Ethics Committee (04/MRE05/53).

    • Provenance and peer review Not commissioned; externally peer reviewed.