Faculty of Medicine, McGill University, Montreal, Canada.
Research Institute of the McGill University Health Centre, Montreal, Canada.
Clin Microbiol Infect. 2022 Jan;28(1):23-30. doi: 10.1016/j.cmi.2021.08.017. Epub 2021 Aug 28.
Pneumocystis jirovecii pneumonia (PCP) is an opportunistic infection commonly affecting immunocompromised people. Diagnosis usually requires invasive techniques to obtain respiratory specimens. Minimally invasive detection tests have been proposed, but their operating characteristics are poorly described.
To systematically review and meta-analyse the performance of minimally invasive PCP detection tests to inform diagnostic algorithms.
Medline, Embase, Cochrane Library (inception to 15 October 2020).
Studies of minimally invasive PCP detection tests were included if they contained a minimum of ten PCP cases.
Adults at risk of PCP.
Non-invasive PCP detection tests.
Diagnosis using the combination of clinical and radiographical features with invasive sampling.
Using the QUADAS-2 tool.
We used bivariate and, when necessary, univariate analysis models to estimate diagnostic test sensitivity and specificity.
Fifty-two studies were included; most studies (40) comprised exclusively human immunodeficiency virus (HIV) -infected individuals; nine were mixed (HIV and non-HIV), two were non-HIV and one study did not report HIV status. Sampling sites included induced sputum, nasopharyngeal aspirate, oral wash and blood. The four testing modalities evaluated were cytological staining, fluorescent antibody, PCR and lactate dehydrogenase. Induced sputum had the most data available; this modality was both highly sensitive at 99% (95% CI 51%-100%) and specific at 96% (95% CI 88%-99%). Induced sputum cytological staining had moderate sensitivity at 50% (95% CI 39%-61%) and high specificity at 100% (95% CI 100%-100%), as did fluorescent antibody testing with sensitivity 74% (95% CI 62%-87%) and specificity 100% (95% CI 91%-100%).
There are several promising minimally invasive PCP diagnostic tests available, some of which may reduce the need for invasive respiratory sampling. Understanding the operating characteristics of these tests can augment current diagnostic strategies and help establish a more confident clinical diagnosis of PCP. Further studies in non-HIV infected populations are needed.
卡氏肺孢子虫肺炎（PCP）是一种机会性感染，通常影响免疫功能低下的人群。诊断通常需要使用侵入性技术获取呼吸道标本。已经提出了微创检测试验，但它们的操作特性描述得很差。
系统综述和荟萃分析微创 PCP 检测试验的性能，为诊断算法提供信息。
Medline、Embase、Cochrane 图书馆（从建库至 2020 年 10 月 15 日）。
如果包含至少 10 例 PCP 病例，则纳入微创 PCP 检测试验研究。
有 PCP 风险的成年人。
非侵入性 PCP 检测。
使用临床和影像学特征与侵入性采样相结合的方法进行诊断。
使用 QUADAS-2 工具。
我们使用双变量和必要时的单变量分析模型来估计诊断试验的敏感性和特异性。
共纳入 52 项研究；大多数研究（40 项）仅包括人类免疫缺陷病毒（HIV）感染个体；9 项为混合（HIV 和非 HIV），2 项为非 HIV，1 项研究未报告 HIV 状态。采样部位包括诱导痰、鼻咽抽吸物、口腔冲洗和血液。评估的四种检测方法为细胞学染色、荧光抗体、PCR 和乳酸脱氢酶。诱导痰的研究数据最多；这种方法具有很高的敏感性，为 99%（95%CI 51%-100%），特异性为 96%（95%CI 88%-99%）。诱导痰细胞学染色的敏感性为 50%（95%CI 39%-61%），特异性为 100%（95%CI 100%-100%），荧光抗体检测的敏感性为 74%（95%CI 62%-87%），特异性为 100%（95%CI 91%-100%）。
有几种有前途的微创 PCP 诊断检测方法，其中一些方法可能减少对侵入性呼吸道采样的需求。了解这些检测方法的操作特性可以增强当前的诊断策略，并有助于更有信心地做出 PCP 的临床诊断。需要在非 HIV 感染人群中开展进一步的研究。
