Oral Wash PCR Improves the Diagnosis of Pneumocystis Pneumonia in Immunocompromised Patients Without HIV: A Prospective Multicenter Study
Abstract
Background: Pneumocystis pneumonia (PCP) is increasingly common in human immunodeficiency virus (HIV)-negative immunocompromised patients, who generally have low fungal burdens. Bronchoalveolar lavage (BAL) may be poorly tolerated in fragile patients and oral wash (OW) could be an interesting alternative, but its effectiveness remains underexplored in these patients.
Methods: A prospective multicenter cohort study was conducted to assess polymerase chain reaction (PCR) on OW in HIV-negative patients undergoing BAL to document respiratory symptoms. Beta-1-3-D-glucan (BDG) was also measured on blood samples. Patients were classified by a multidisciplinary committee as having definite PCP, colonization, possible PCP, or without Pneumocystis. Positive predictive value (PPV), negative predictive value (NPV), and receiver operating characteristic (ROC) analysis were determined for each test. Agreement between BAL PCR, OW PCR, and BDG was assessed.
Results: Statistical analyses were performed on 369 patients: 76 with PCP, 55 colonized, 214 without Pneumocystis, and 24 possible PCP. PCR in OW was positive in 81.6%, 30.9%, 0%, and 45.8% of patients with PCP, colonization, no PCP, and possible PCP, respectively. Mean fungal loads in OW were 4251 ± 15 501 and 3 ± 8.5 copies/mL in patients with PCP and colonized patients, respectively (P < .0001). The PPV and NPV of OW PCR were 78.5% and 73.1%, respectively. The ROC analysis identified a threshold of 7 copies/mL for OW to achieve a PPV of 90%, with a sensitivity of 73.5%. Agreement between OW PCR and BDG was poor (κ < 0.4), but the combination of BDG+/OW PCR+ yielded a PPV of 92%.
Conclusions: PCR on OW is a useful noninvasive tool for diagnosing PCP in HIV-negative patients.
Clinical Trials Registration: PNEUMOQUANT, clinical trial no. NCT 02648256.
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BibTeX
@article{robertgangneux2026oral,
title = {{Oral Wash PCR Improves the Diagnosis of Pneumocystis Pneumonia in Immunocompromised Patients Without HIV: A Prospective Multicenter Study}},
author = {Florence Robert-Gangneux and Gilles Nevez and Céline Damiani and Yannick Le Guen and Christophe Gut-Gobert and Amélie Bazire and Anne Totet and Vincent Jounieaux and Rozenn Le Berre and Fanny Thepault and Pierre Tattevin and Aude Barnier and Stéphane Jouneau and Florian Reizine and Mallorie Kerjouan and Pierre Chauvin and Chloé Rousseau and Ronan Garlantézec and Jean-Pierre Gangneux and Christophe Camus and Solène Le Gal},
journal = {Clinical Infectious Diseases},
year = {2026},
month = jun,
doi = {10.1093/cid/ciag356},
url = {https://u-picardie.hal.science/hal-05653718v1},
note = {CC BY-NC-ND 4.0},
}
RIS
TY - JOUR
TI - Oral Wash PCR Improves the Diagnosis of Pneumocystis Pneumonia in Immunocompromised Patients Without HIV: A Prospective Multicenter Study
AU - Florence Robert-Gangneux
AU - Gilles Nevez
AU - Céline Damiani
AU - Yannick Le Guen
AU - Christophe Gut-Gobert
AU - Amélie Bazire
AU - Anne Totet
AU - Vincent Jounieaux
AU - Rozenn Le Berre
AU - Fanny Thepault
AU - Pierre Tattevin
AU - Aude Barnier
AU - Stéphane Jouneau
AU - Florian Reizine
AU - Mallorie Kerjouan
AU - Pierre Chauvin
AU - Chloé Rousseau
AU - Ronan Garlantézec
AU - Jean-Pierre Gangneux
AU - Christophe Camus
AU - Solène Le Gal
PY - 2026
DA - 2026/06/11
JO - Clinical Infectious Diseases
DO - 10.1093/cid/ciag356
UR - https://u-picardie.hal.science/hal-05653718v1
AB - Background: Pneumocystis pneumonia (PCP) is increasingly common in human immunodeficiency virus (HIV)-negative immunocompromised patients, who generally have low fungal burdens. Bronchoalveolar lavage (BAL) may be poorly tolerated in fragile patients and oral wash (OW) could be an interesting alternative, but its effectiveness remains underexplored in these patients. Methods: A prospective multicenter cohort study was conducted to assess polymerase chain reaction (PCR) on OW in HIV-negative patients undergoing BAL to document respiratory symptoms. Beta-1-3-D-glucan (BDG) was also measured on blood samples. Patients were classified by a multidisciplinary committee as having definite PCP, colonization, possible PCP, or without Pneumocystis. Positive predictive value (PPV), negative predictive value (NPV), and receiver operating characteristic (ROC) analysis were determined for each test. Agreement between BAL PCR, OW PCR, and BDG was assessed. Results: Statistical analyses were performed on 369 patients: 76 with PCP, 55 colonized, 214 without Pneumocystis, and 24 possible PCP. PCR in OW was positive in 81.6%, 30.9%, 0%, and 45.8% of patients with PCP, colonization, no PCP, and possible PCP, respectively. Mean fungal loads in OW were 4251 ± 15 501 and 3 ± 8.5 copies/mL in patients with PCP and colonized patients, respectively (P < .0001). The PPV and NPV of OW PCR were 78.5% and 73.1%, respectively. The ROC analysis identified a threshold of 7 copies/mL for OW to achieve a PPV of 90%, with a sensitivity of 73.5%. Agreement between OW PCR and BDG was poor (κ < 0.4), but the combination of BDG+/OW PCR+ yielded a PPV of 92%. Conclusions: PCR on OW is a useful noninvasive tool for diagnosing PCP in HIV-negative patients. Clinical Trials Registration: PNEUMOQUANT, clinical trial no. NCT 02648256.
SN - 1058-4838
SN - 1537-6591
ER -