A multiplex real-time PCR assay for identification of Pneumocystis jirovecii, Histoplasma capsulatum, and Cryptococcus neoformans/Cryptococcus gattii in samples from AIDS patients with opportunistic pneumonia

J Clin Microbiol. 2014 Apr;52(4):1168-76. doi: 10.1128/JCM.02895-13. Epub 2014 Jan 29.

Abstract

A molecular diagnostic technique based on real-time PCR was developed for the simultaneous detection of three of the most frequent causative agents of fungal opportunistic pneumonia in AIDS patients: Pneumocystis jirovecii, Histoplasma capsulatum, and Cryptococcus neoformans/Cryptococcus gattii. This technique was tested in cultured strains and in clinical samples from HIV-positive patients. The methodology used involved species-specific molecular beacon probes targeted to the internal transcribed spacer regions of the rDNA. An internal control was also included in each assay. The multiplex real-time PCR assay was tested in 24 clinical strains and 43 clinical samples from AIDS patients with proven fungal infection. The technique developed showed high reproducibility (r(2) of >0.98) and specificity (100%). For H. capsulatum and Cryptococcus spp., the detection limits of the method were 20 and 2 fg of genomic DNA/20 μl reaction mixture, respectively, while for P. jirovecii the detection limit was 2.92 log10 copies/20 μl reaction mixture. The sensitivity in vitro was 100% for clinical strains and 90.7% for clinical samples. The assay was positive for 92.5% of the patients. For one of the patients with proven histoplasmosis, P. jirovecii was also detected in a bronchoalveolar lavage sample. No PCR inhibition was detected. This multiplex real-time PCR technique is fast, sensitive, and specific and may have clinical applications.

Publication types

  • Evaluation Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • AIDS-Related Opportunistic Infections / diagnosis*
  • Bronchoalveolar Lavage Fluid / microbiology
  • Cryptococcus / isolation & purification*
  • DNA, Fungal / chemistry
  • DNA, Fungal / genetics
  • DNA, Ribosomal / genetics
  • DNA, Ribosomal Spacer / genetics
  • Histoplasma / isolation & purification*
  • Humans
  • Lung Diseases, Fungal / diagnosis*
  • Molecular Diagnostic Techniques / methods
  • Multiplex Polymerase Chain Reaction / methods*
  • Pneumocystis carinii / isolation & purification*
  • Pneumonia / microbiology
  • Real-Time Polymerase Chain Reaction / methods*
  • Reproducibility of Results
  • Sensitivity and Specificity
  • Time Factors

Substances

  • DNA, Fungal
  • DNA, Ribosomal
  • DNA, Ribosomal Spacer