Comparing Polymerase Chain Reaction Testing of Nasopharyngeal Swab and Lower Respiratory Tract Specimens for the Diagnosis of Pneumocystis jirovecii Pneumonia

Rusheng Chew; Sarah Tozer; Kimberly Ulett; David L Paterson; David Whiley; Theo Sloots; David Fielding; Christopher Zappala; Farzad Bashirzadeh; Justin Hundloe; Cheryl Bletchley; Marion L Woods

doi:10.1093/ofid/ofae071

Comparing Polymerase Chain Reaction Testing of Nasopharyngeal Swab and Lower Respiratory Tract Specimens for the Diagnosis of Pneumocystis jirovecii Pneumonia

Open Forum Infect Dis. 2024 Feb 2;11(3):ofae071. doi: 10.1093/ofid/ofae071. eCollection 2024 Mar.

Authors

Rusheng Chew^{1

2

3}, Sarah Tozer⁴, Kimberly Ulett⁵, David L Paterson^{4

6

7}, David Whiley⁶, Theo Sloots³, David Fielding^{3

8}, Christopher Zappala^{3

8}, Farzad Bashirzadeh⁸, Justin Hundloe⁸, Cheryl Bletchley⁴, Marion L Woods^{3

7}

Affiliations

¹ Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom.
² Mathematical and Economic Modelling Department, Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand.
³ Faculty of Medicine, University of Queensland, Brisbane, Australia.
⁴ Central Laboratory, Pathology Queensland, Central Laboratory, Brisbane, Australia.
⁵ Department of Medicine, Gold Coast Hospital and Health Service, Gold Coast, Australia.
⁶ UQ Centre for Clinical Research, University of Queensland, Brisbane, Australia.
⁷ Infectious Diseases Unit, Royal Brisbane and Women's Hospital, Brisbane, Australia.
⁸ Department of Thoracic Medicine, Royal Brisbane and Women's Hospital, Brisbane, Australia.

Abstract

Using nasopharyngeal (NP) swab samples instead of lower respiratory tract specimens for polymerase chain reaction (PCR) to diagnose Pneumocystis jirovecii pneumonia (PJP) may be better tolerated and improve diagnostic accessibility. In this 2-year Australian retrospective cohort study of patients with clinically suspected PJP, P jirovecii PCR on NP swab samples had perfect specificity but low sensitivity (0.66).

Keywords: Pneumocystis jirovecii pneumonia; nasopharyngeal swab specimen; specimen quality; test performance.