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.

中文翻译：

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诊断耶氏肺孢子虫肺炎：现有方法和新方法的回顾。


耶氏肺孢子虫可导致免疫功能低下患者出现危及生命的肺炎。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。该方法已被证明不敏感，并且可能需要侵入性操作来获取足够的样本。为了解决这些问题，已经开发了诸如聚合酶链反应（PCR）、环介导等温扩增（LAMP）和抗体-抗原测定等分子检测方法。这些技术非常灵敏，有可能检测痰、口腔洗液、鼻咽抽吸物和血清等非侵入性样本中的肺孢子虫生命形式。本综述评估了 100 项研究，这些研究比较了患者样本中耶氏肺孢子菌肺炎 (PCP) 的各种诊断测试的使用情况。新型诊断方法已在研究环境中广泛使用，但在临床实施中面临障碍，包括：对低真菌负荷的解释、技术标准化、融入资源贫乏环境、对宿主因素的影响了解甚少、真菌负担的地理差异有机体、研究的异质性以及临床医生对 PCP 的认识有限。解决这些障碍需要识别进展为 PCP 的表型和定植的诊断界限、生成生命形式特异性标记、比较商业 PCR 检测、调查具有成本效益的护理点选择、评估宿主因素，例如可能影响诊断的艾滋病毒状况，以及可能对诊断组合有用的遗传多样性标记的识别。 进行高质量的研究和对医生进行教育对于提高 PCP 的诊断率并最终改善患者的治疗效果至关重要。