https://orcid.org/0000-0002-4305-7766
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Lu Hao, Chen He, Critical Considerations for PCR Diagnostics in Pneumocystis Pneumonia Detection, Clinical Infectious Diseases, Volume 80, Issue 4, 15 April 2025, Page 933, https://doi.org/10.1093/cid/ciae428
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To the Editor—The recent article by Brown et al provides a large-scale meta-analysis of the diagnostic performance of the polymerase chain reaction (PCR) for Pneumocystis pneumonia (PCP) in a variety of respiratory samples from human immunodeficiency virus (HIV) and non-HIV populations [1]. Although we commend the authors for their thorough methodology and valuable insights, a few points need further discussion.
A potential limitation of the study is that the clinical background information for the patients, including the comorbidity and medication status, might be incomplete. The patient's immune status may be affected by the diseases and medication treatment, such as hematologic malignancies, solid tumors, autoimmune diseases, and receiving immunosuppressants or glucocorticoids [2]. Besides that, the study does not provide information regarding whether the patients had received antifungal therapy before PCR testing of respiratory specimens. The pretreatment may influence the fungal load, thereby potentially affecting the test's specificity and sensitivity [3]. Patients could be divided into distinct groups based on their background characteristics, including age, gender, comorbidity, and medication treatment, and then employed in a stratified analysis, which would mitigate the confounding effects of background diversity.
