Respiratory multiplex polymerase chain reaction: An important diagnostic tool in immunocompromised patients

JOURNAL TITLE: Indian Journal of Critical Care Medicine

Author
1. Amarjeet Kaur
2. Sharmila Sengupta
3. Navin Kumar
ISSN
0972-5229
DOI
10.4103/ijccm.IJCCM_2_17
Volume
21
Issue
4
Publishing Year
2017
Pages
7
Author Affiliations
    1. BLK Superspecialty Hospital, New Delhi, India
    1. Department of Microbiology, Medanta - The Medicity, Gurgaon, Haryana
  • Article keywords
    Cytomegalovirus, immunocompromised patients, multiplex polymerase chain reaction, Pneumocystis jirovecii

    Abstract

    Background: Viruses and atypical pathogens can cause significant respiratory illness in immunocompromised patients. Multiplex polymerase chain reaction (MPCR) has improved the diagnostic yield of pathogens, and it is easier to identify the co-infections also. The present study was done to evaluate the performance of MPCR on bronchoalveolar lavage (BAL) samples in immunocompromised patients. Methods: Atotal of 177 BAL specimens collected over a 19 months period from immunocompromised patients with respiratory illness were analyzed with the MPCR and aerobic culture. Patients were divided into four according to the pathogens. Category V (only viral), Category NV (nonviral, i.e., bacteria and atypical), Category M (mixed, i.e., both viral and nonviral pathogen), and Category UK (unknown etiology). Results: MPCR identified the causative pathogen in 59.3% of patients while culture could identify only in 37.8% of patients. Most frequent etiological agent was Klebsiella pneumoniae (32%), followed by cytomegalovirus (21%), and Pneumocystis jirovecii (10%). Numbers of patients in each category were Category V (9.6%), Category NV (43.5%), Category M (19.8%), and Category UK (27.1%). Mortality was significantly higher in patients of Category M having mixed infections. Conclusion: MPCR is highly sensitive and rapid tool which can be considered in the routine diagnostic algorithm of respiratory illness in immunocompromised patients.

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