RESUMO
A commercial loop-mediated isothermal amplification (LAMP) assay is available for the detection of Pneumocytis jirovecii (Eazyplex®, Amplex diagnostics, Germany). Few centers currently use this LAMP assay in France. Recently, the commercialization of reagents used to perform the P. jirovecii immunofluorescence assay (IFA) was stopped. This study aimed to assess the position of the commercial LAMP P. jirovecii assay in the diagnostic strategy for Pneumocystis pneumonia. Over 24 months (August 1, 2021, to September 1, 2023), all bronchoalveolar lavage fluid (BALF) samples with a request for P. jirovecii detection were analyzed with the commercial Eazyplex® LAMP assay, using a Genie 2® device (Amplex, diagnostics), in parallel with the techniques used for direct examination. Specific P. jirovecii quantitative real-time PCR (qPCR) was subsequently performed. In total, 346 BALF samples were analyzed by Diff-Quik coloration, IFA, and the commercial Eazyplex® LAMP assay for initial screening. Twenty-six cases of PCP were retained based on radiological, biological and clinical criteria. Among the 26 cases of PCP, 11 BALF samples were positive using the initial screening techniques: four with the three techniques, six by IFA and Eazyplex®, and one only by IFA. The eleven BALF samples were positive with the specific P. jirovecii qPCR assay, with a mean quantification cycle (Cq) of 27 [19-32]. The commercial Eazyplex® LAMP assay is able to provide a result in 25 min and its sensitivity is similar to that of BALF direct examination techniques, such as IFA, which is a technique no longer available on the European market. The sensitivity of the commercial Eazyplex® LAMP assay is however clearly inferior to that of the specific P. jirovecii qPCR assay and, therefore, cannot replace the specific qPCR, but may have a place in the diagnostic strategy.
RESUMO
BACKGROUND: Episodes of CMV-viruria have been reported in hematopoietic stem cell transplant (HSCT) recipients, but their context of occurrence, pathophysiology, and clinical significance remain misunderstood. METHODS: Uurine samples from 517 recipients were collected. Clinical features of recipients with or without episodes of CMV-viruria were retrospectively compared. RESULTS: CMV-viruria was detected in 15.5 % of cases. Age, sex, type of transplantation, HLA-matching, conditioning regimen, and immunosuppressive therapies did not differ between patients with and without CMV-viruria. CMV-seropositive status (R + ) was more frequent among CMV-viruric recipients. Cumulated mortality did not differ between the two groups but graft-versus-host diseases occurred more frequently among CMV-viruric patients (p = 0.04). No reduction of the estimated glomerular filtration rates was observed in CMV-viruric recipients. CONCLUSIONS: CMV-viruria primarily occurs in CMV-seropositive recipients and is not related to the degree of immunosuppression. We suggest that CMV-viruria is primarily related to the inability of the graft immune system to contain CMV-replication in R + patients. CMV-viruria is not associated with increased mortality or renal dysfunction.