Abstract
BackgroundDiagnosis of pneumocystis pneumonia (PCP) relies on microscopic visualization of P. jirovecii, or detection of Pneumocystis DNA in respiratory specimens, which involves invasive procedures such as bronchoalveolar lavage. The (1–3)-β-D-glucan (BG) assay has been proposed as a less invasive and less expensive diagnostic test to rule out PCP. We therefore compared blood levels of BG in patients with PCP with those of patients with candidemia, chronic disseminated candidiasis (CDC), invasive aspergillosis, mucormycosis, and tuberculosis and those of healthy volunteers.MethodsAdult patients who were diagnosed with PCP, candidemia, CDC, invasive aspergillosis, mucormycosis, and tuberculosis whose blood samples were available, and healthy volunteers were enrolled in a tertiary hospital in Seoul, South Korea, during a 21-month period. The blood samples were assayed with the Goldstream Fungus (1–3)-β-D-glucan test (Gold Mountain River Tech Development, Beijing, China).ResultsA total of 136 individuals including 50 patients P. jirovecii,15 candidemia, 6 CDC, 15 invasive aspergillosis, 10 mucormycosis, and 40 controls (20 TB and 20 healthy volunteers) were included. The mean±SD of the concentration of 1–3-β-D-glucan in the patients with PCP (290.08 pg/mL±199.98) were similar to those of patients with candidemia (314.14 pg/mL±205.60, p = 0.90 at an α = 0.005) and CDC (129.74 pg/mL±182.79, p = 0.03 at an α = 0.005), but higher than those of patients with invasive aspergillosis (131.62 pg/mL±161.67, p = 0.002 at an α = 0.005), mucormycosis (95.08 pg/mL±146.80, p<0.001 at an α = 0.005), and tuberculosis (103.31 pg/mL±140.81, p<0.001 at an α = 0.005) as well as healthy volunteers (101.18 pg/mL±197.52, p<0.001 at an α = 0.005). At a cut-off value > 31.25 pg/mL, which is highly sensitive for PCP versus tuberculosis plus healthy volunteers at the expense of specificity, the BG assay had a sensitivity of 92% (95% CI 81%-98%) and a specificity of 55% (95% CI 39%-71%).ConclusionsThe BG assay appears to be a useful adjunct test for PCP.
Highlights
Pneumocystis pneumonia (PCP) is one of the most frequent opportunistic infections in immunocompromised patients [1]
Adult patients who were diagnosed with pneumocystis pneumonia (PCP), candidemia, chronic disseminated candidiasis (CDC), invasive aspergillosis, mucormycosis, and tuberculosis whose blood samples were available, and healthy volunteers were enrolled in a tertiary hospital in Seoul, South Korea, during a 21-month period
Diagnostic performance of (1–3)-β-D-glucan assay in PCP
Summary
Pneumocystis pneumonia (PCP) is one of the most frequent opportunistic infections in immunocompromised patients [1]. The mortality of patients requiring mechanical ventilation ranges from 50%to 60% [2]. This high mortality rate results partly from difficulties in early diagnosis because of the nonspecific clinical features, concurrent use of prophylactic drugs, and possible coinfections with other microorganisms [1, 3]. Because P. jirovecii cannot be propagated in culture, the standard procedures for detecting this microorganism are microscopic visualization of cysts or trophic forms in pulmonary specimens along with cytochemical or immunofluorescence staining with monoclonal antibodies, or DNA amplification (PCR or PCR-related protocols) [4]. Diagnosis of pneumocystis pneumonia (PCP) relies on microscopic visualization of P. jirovecii, or detection of Pneumocystis DNA in respiratory specimens, which involves invasive procedures such as bronchoalveolar lavage. We compared blood levels of BG in patients with PCP with those of patients with candidemia, chronic disseminated candidiasis (CDC), invasive aspergillosis, mucormycosis, and tuberculosis and those of healthy volunteers
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