Etiology of Pulmonary Infections in Human Immunodeficiency Virus–infected Inpatients Using Sputum Multiplex Real-time Polymerase Chain Reaction. (26th April 2019)

• Record Type: Journal Article
• Authors: Maartens, Gary; Griesel, Rulan; Dube, Felix; Nicol, Mark; Mendelson, Marc
• Is Part Of: Clinical infectious diseases. Volume 70:Number 6(2020)
• Page Start: 1147
• Page End: 1152
• Publication Date: 2019-04-26
• Subjects: HIV -- bacterial pneumonia -- Pneumocystis jirovecii pneumonia -- tuberculosis -- respiratory viral infections; Communicable diseases -- Periodicals; 616.905
• DOI: 10.1093/cid/ciz332
• Languages: English
• ISSNs: 1058-4838

Abstract

Abstract: Background: There are limited data on the etiology of respiratory infections in human immunodeficiency virus (HIV)–infected patients in resource-limited settings. Methods: We performed quantitative multiplex real-time polymerase chain reaction (PCR) for Pneumocystis jirovecii and common bacterial and viral respiratory pathogens on sputum samples (spontaneous or induced) from a prospective cohort study of HIV-infected inpatients with World Health Organization danger signs and cough. Mycobacterial culture was done on 2 sputum samples, blood cultures, and relevant extrapulmonary samples. Results: We enrolled 284 participants from 2 secondary-level hospitals in Cape Town, South Africa: median CD4 count was 97 cells/μL, 64% were women, and 38% were on antiretroviral therapy. One hundred forty-eight had culture-positive tuberculosis, 100 had community-acquired pneumonia (CAP), 26 had P. jirovecii pneumonia (PJP), and 64 had other diagnoses. Probable bacterial infection (>10 5 copies/mL) was detected in 133 participants; the prevalence was highest in those with CAP (52%). Haemophilus influenzae and Streptococcus pneumoniae were the commonest bacterial pathogens detected; atypical bacteria were uncommon. Viruses were detected in 203 participants; the prevalence was highest in those with PJP (85%). Human metapneumovirus was the commonest virus detected. Multiple coinfections were commonly detected. Conclusions: Sputum multiplex PCR could become a useful diagnostic tool for bacterial respiratory infections in HIV-infected inpatients, but its value is limited as quantitative cutoffs have only been established for a few bacterial pathogens and validation has not been done in this patient population. We found a high prevalence of respiratory viruses, but it is unclear whether these viruses were causing infection as there are no accepted quantitative PCR cutoffs for diagnosing respiratory viral infections. Abstract : Sputum multiplex polymerase chain reaction showed a high prevalence of probable bacterial infections in human immunodeficiency virus-infected inpatients with World Health Organization danger signs and cough. Coinfections with tuberculosis, Pneumocystis jirovecii, and viruses were common, but there are no accepted cutoffs for diagnosing respiratory viral infections.