Vysoký výskyt pneumónie spôsobenej Pneumocystis jirovecii u onkologických pacientov: 19-ročná štúdia

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Autoři: V. Boldiš ^1,2; F. Ondriska ^1,3; Ľ. Kováč ⁴; J. Steinhübel ¹; M. Bastlová ¹
Působiště autorů: Department of Parasitology, Medirex Ltd., Galvaniho 17/C, 82016 Bratislava, Slovakia ¹; Medirex Group Academy n. p. o., Nitra, Slovakia ²; School of Health Sciences and Social Work, University in Trnava, Trnava, Slovakia ³; Department of Virology, Serology and Molecular biology of infectious diseases, Medirex Ltd., Bratislava, Slovakia ⁴
Vyšlo v časopise: Epidemiol. Mikrobiol. Imunol. 72, 2023, č. 2, s. 93-98
Kategorie: Původní práce

Souhrn

Cieľ: Pneumocystis jirovecii patril v minulosti do skupiny prvokov, ale v súčasnosti je taxonomicky zaradený do ríše húb. P. jirovecii je oportúnny patogén, zodpovedný za pneumocystovú pneumóniu s častými komplikáciami u imunokompromitovaných pacientov. Oneskorené začatie vhodnej liečby zvyšuje riziko úmrtia u pacientov s oslabenou imunitou. Cieľom práce bolo zistiť a zhodnotiť spoľahlivosť metód laboratórnej diagnostiky pneumocystózy používaných v rutinných laboratóriách ako aj výskyt tohto ochorenia u pacientov zo Slovenska za 19 rokov.

Materiál a metódy: Diagnostika je založená na mikroskopickom dôkaze (farbenie podľa Giemsa a Gram-Weigerta) a detekcii DNA parazita klasickou alebo real-time PCR v bronchoalveolárnej laváži a spúte.

Výsledky: Pneumocysty boli zistené u 190 osôb (5,7 %) z celého súboru pacientov. Onkologickí pacienti predstavovali najrizikovejšiu skupinu z hľadiska infekcie pneumocystami, čo sme potvrdili ich najvyšším podielom (57,9 %) z jedincov s pneumocystózou. Na základe binárneho klasifikačného testu sme vyhodnotili 33,7 % citlivosť a 100 % špecifickosť mikroskopického dôkazu v porovnaní s PCR. Molekulárne metódy sú v porovnaní s mikroskopickým dôkazom citlivejšie v detekcii P. jirovecii a v súčasnosti predstavujú spoľahlivý detekčný systém v diagnostike pneumocystózy.

Záver: Vzhľadom na narastajúci počet imunokompromitovaných osôb je diagnostika P. jirovecii u pacientov s pľúcnymi komplikáciami nevyhnutná. To sa potvrdilo aj v našej štúdii, kde v priebehu rokov stúpal počet vyšetrení a záchytov tohto oportúnneho patogénu.

Klíčová slova:

Pneumocystis jirovecii – pneumocystóza – mikroskopický dôkaz – polymerázová reťazová reakcia (PCR)

Zdroje

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