Pneumocystosis and quantitative PCR.

OBJECTIVE: Pneumocystis pneumonia (PCP) is now predominantly observed in immunosuppressed non-HIV-infected patients. The sensitivity of the PCR is here higher than direct examination (DE) of respiratory secretions because the infection is caused by a lower inoculum of Pneumocystis jirovecii (P. jirovecii). The objective of our retrospective study was to assess the contribution of quantitative PCR (qPCR) in the diagnosis of PCP. PATIENTS AND METHODS: All patients hospitalized for PCP suspicion with a positive qPCR were included. Irrespective of the qPCR value, patients were initially classified into two groups (infection and colonization [PCP ruled out]) based on clinical, radiological, and microbiological data. Both groups were then compared based on the qPCR value. RESULTS: Between 2013 and 2016, 150 patients were included; 75% of them were not infected with HIV. The diagnosis of PCP was retained for 129 patients and rejected for 21 patients. The DE was negative in 60% of PCP cases. The median value of qPCR was 76,650copies/mL among infected patients and 3220copies/mL among colonized patients. The threshold corresponding to a specificity of 100% was 56,000copies/mL. The optimal value to distinguish an infection from a colonization was 10,100copies/mL. CONCLUSION: Our study confirms the diagnostic value of the qPCR in immunosuppressed patients, especially when the DE is negative. When the qPCR is˂56,000copies/mL, the result should be interpreted based on the clinical context and paraclinical examinations.

[Cough as the presenting feature of pulmonary AL amyloidosis: A case report]. / Amylose pulmonaire AL révélée par une toux : à propos d'une observation.

INTRODUCTION: Pulmonary lesions may be a presenting feature of AL amyloidosis. OBSERVATION: We report a 49-year-old male with AL amyloidosis secondary to a multiple myeloma with symptomatic interstitial pulmonary lesions and chronic cough as the presenting feature. CONCLUSION: Lung involvement is relatively frequent during AL amyloidosis but most of the time it remains asymptomatic. Interstitial pneumonia is the rarest condition of pulmonary amyloidosis. It is related to a large diffusion of the disease as demonstrated by the usual concurrent presence of cardiac lesions.