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Abstract：
Pneumocystis jirovecii can cause life-threatening pneumonia in immunocompromised patients. Traditional diagnostic testing has relied on staining and direct visualization of the life-forms in bronchoalveolar lavage fluid. This method has proven insensitive, and invasive procedures may be needed to obtain adequate samples. Molecular methods of detection such as polymerase chain reaction (PCR), loop-mediated isothermal amplification (LAMP), and antibody-antigen assays have been developed in an effort to solve these problems. These techniques are very sensitive and have the potential to detect Pneumocystis life-forms in noninvasive samples such as sputum, oral washes, nasopharyngeal aspirates, and serum. This review evaluates 100 studies that compare use of various diagnostic tests for Pneumocystis jirovecii pneumonia (PCP) in patient samples. Novel diagnostic methods have been widely used in the research setting but have faced barriers to clinical implementation including: interpretation of low fungal burdens, standardization of techniques, integration into resource-poor settings, poor understanding of the impact of host factors, geographic variations in the organism, heterogeneity of studies, and limited clinician recognition of PCP. Addressing these barriers will require identification of phenotypes that progress to PCP and diagnostic cut-offs for colonization, generation of life-form specific markers, comparison of commercial PCR assays, investigation of cost-effective point of care options, evaluation of host factors such as HIV status that may impact diagnosis, and identification of markers of genetic diversity that may be useful in diagnostic panels. Performing high-quality studies and educating physicians will be crucial to improve the rates of diagnosis of PCP and ultimately to improve patient outcomes.
摘要：
肺孢子虫可在免疫功能低下的患者中引起危及生命的肺炎。传统的诊断测试依赖于支气管肺泡灌洗液中生命形式的染色和直接可视化。这种方法被证明是不敏感的，和侵入性程序可能需要获得足够的样本。分子检测方法，如聚合酶链反应（PCR），环介导等温扩增(LAMP),为了解决这些问题，已经开发了抗体-抗原测定法。这些技术非常灵敏，有可能在非侵入性样本如痰中检测肺孢子虫的生命形式，口腔洗液，鼻咽抽吸物,和血清。这篇综述评估了100项研究，这些研究比较了在患者样本中使用各种诊断性肺孢子虫肺炎（PCP）的方法。新的诊断方法已广泛用于研究环境，但面临着临床实施的障碍，包括：低真菌负担的解释，技术标准化，整合到资源贫乏的环境中，对宿主因素的影响了解不足，生物体的地理变化，研究的异质性，和有限的临床医生识别PCP。解决这些障碍需要鉴定进展为PCP的表型和定殖的诊断截止值，生命形式特异性标记的产生，商业PCR检测的比较，调查具有成本效益的护理点选择，评估可能影响诊断的宿主因素，如艾滋病毒状况，并鉴定可能在诊断面板中有用的遗传多样性标记。进行高质量的研究和教育医生对于提高PCP的诊断率并最终改善患者预后至关重要。
