Nocardia polymerase chain reaction (PCR)-based assay performed on bronchoalveolar lavage fluid after lung transplantation: A prospective pilot study.
Adult
Aged
Belgium
Bronchoalveolar Lavage Fluid
/ microbiology
Female
Humans
Lung Transplantation
/ adverse effects
Middle Aged
Nocardia
/ genetics
Nocardia Infections
/ diagnosis
Opportunistic Infections
/ microbiology
Pilot Projects
Polymerase Chain Reaction
Prospective Studies
RNA, Ribosomal, 16S
/ genetics
RNA, Viral
/ genetics
Sensitivity and Specificity
Journal
PloS one
ISSN: 1932-6203
Titre abrégé: PLoS One
Pays: United States
ID NLM: 101285081
Informations de publication
Date de publication:
2019
2019
Historique:
received:
26
11
2018
accepted:
23
01
2019
entrez:
26
2
2019
pubmed:
26
2
2019
medline:
9
11
2019
Statut:
epublish
Résumé
Transplant recipients are at risk of pulmonary nocardiosis, a life-threatening opportunistic infection caused by Nocardia species. Given the limitations of conventional diagnostic techniques (i.e., microscopy and culture), a polymerase chain reaction (PCR)-based assay was developed to detect Nocardia spp. on clinical samples. While this test is increasingly being used by transplant physicians, its performance characteristics are not well documented. We evaluated the performance characteristics of this test on bronchoalveolar lavage (BAL) fluid samples from lung transplant recipients (LTRs). We prospectively included all BAL samples from LTRs undergoing bronchoscopy at our institution between December 2016 and June 2017 (either surveillance or clinically-indicated bronchoscopies). Presence of microbial pathogens was assessed using techniques available locally (including microscopy and 10-day culture for Nocardia). BAL samples were also sent to the French Nocardiosis Observatory (Lyon, France) for the Nocardia PCR-based assay. Transplant physicians and patients were blinded to the Nocardia PCR results. We included 29 BAL samples from 21 patients (18 surveillance and 11 clinically-indicated bronchoscopies). Nocardiosis was not diagnosed in any of these patients by conventional techniques. However, Nocardia PCR was positive in five BAL samples from five of the patients (24%, 95% confidence interval: 11-45%); four were asymptomatic and undergoing surveillance bronchoscopy, and one was symptomatic and was later diagnosed with influenza virus infection. None of the five PCR-positive patients died or were diagnosed with nocardiosis during the median follow-up of 21 months after the index bronchoscopy (range: 20-23 months). In this prospective study, Nocardia PCR was positive on BAL fluid from one fourth of the LTRs. Nocardia PCR-based assays should be used with caution on respiratory samples from LTRs because of the possible detection of airway colonization using this technique. Larger studies are required to determine the usefulness of the Nocardia PCR-based assay in transplant recipients.
Sections du résumé
BACKGROUND
Transplant recipients are at risk of pulmonary nocardiosis, a life-threatening opportunistic infection caused by Nocardia species. Given the limitations of conventional diagnostic techniques (i.e., microscopy and culture), a polymerase chain reaction (PCR)-based assay was developed to detect Nocardia spp. on clinical samples. While this test is increasingly being used by transplant physicians, its performance characteristics are not well documented. We evaluated the performance characteristics of this test on bronchoalveolar lavage (BAL) fluid samples from lung transplant recipients (LTRs).
METHODS
We prospectively included all BAL samples from LTRs undergoing bronchoscopy at our institution between December 2016 and June 2017 (either surveillance or clinically-indicated bronchoscopies). Presence of microbial pathogens was assessed using techniques available locally (including microscopy and 10-day culture for Nocardia). BAL samples were also sent to the French Nocardiosis Observatory (Lyon, France) for the Nocardia PCR-based assay. Transplant physicians and patients were blinded to the Nocardia PCR results.
RESULTS
We included 29 BAL samples from 21 patients (18 surveillance and 11 clinically-indicated bronchoscopies). Nocardiosis was not diagnosed in any of these patients by conventional techniques. However, Nocardia PCR was positive in five BAL samples from five of the patients (24%, 95% confidence interval: 11-45%); four were asymptomatic and undergoing surveillance bronchoscopy, and one was symptomatic and was later diagnosed with influenza virus infection. None of the five PCR-positive patients died or were diagnosed with nocardiosis during the median follow-up of 21 months after the index bronchoscopy (range: 20-23 months).
CONCLUSIONS
In this prospective study, Nocardia PCR was positive on BAL fluid from one fourth of the LTRs. Nocardia PCR-based assays should be used with caution on respiratory samples from LTRs because of the possible detection of airway colonization using this technique. Larger studies are required to determine the usefulness of the Nocardia PCR-based assay in transplant recipients.
Identifiants
pubmed: 30802260
doi: 10.1371/journal.pone.0211989
pii: PONE-D-18-33836
pmc: PMC6388935
doi:
Substances chimiques
RNA, Ribosomal, 16S
0
RNA, Viral
0
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
e0211989Déclaration de conflit d'intérêts
The authors have declared that no competing interests exist.
Références
J Clin Microbiol. 2005 Apr;43(4):1921-4
pubmed: 15815019
Infection. 2010 Apr;38(2):89-97
pubmed: 20306281
Jundishapur J Microbiol. 2014 Dec 01;7(12):e12495
pubmed: 25741428
Eur J Clin Microbiol Infect Dis. 2002 Mar;21(3):230-3
pubmed: 11957029
Curr Opin Infect Dis. 2017 Dec;30(6):545-551
pubmed: 28922286
Enferm Infecc Microbiol Clin. 2005 Feb;23(2):62-6
pubmed: 15743575
BMC Infect Dis. 2016 Jul 22;16:338
pubmed: 27448413
Med Microbiol Immunol. 2015 Aug;204(4):493-504
pubmed: 25344657
Clin Microbiol Rev. 2006 Apr;19(2):259-82
pubmed: 16614249
J Clin Microbiol. 2006 Feb;44(2):536-46
pubmed: 16455910
Clin Infect Dis. 2007 May 15;44(10):1307-14
pubmed: 17443467
J Clin Virol. 2015 Nov;72:36-41
pubmed: 26364158
J Clin Microbiol. 1993 Feb;31(2):175-8
pubmed: 8381805
Am J Transplant. 2013 Mar;13 Suppl 4:272-9
pubmed: 23465020
Am J Transplant. 2013 Mar;13 Suppl 4:83-92
pubmed: 23465002
Semin Respir Crit Care Med. 2013 Jun;34(3):371-9
pubmed: 23821511
Clin Infect Dis. 2016 Aug 1;63(3):338-45
pubmed: 27090987
Medicine (Baltimore). 2009 Jul;88(4):250-61
pubmed: 19593231
Clin Infect Dis. 1997 Jun;24(6):1154-60
pubmed: 9195074
J Clin Microbiol. 2003 Oct;41(10):4497-501
pubmed: 14532173