Variable Correlation between Bronchoalveolar Lavage Fluid Fungal Load and Serum-(1,3)-β-d-Glucan in Patients with Pneumocystosis—A Multicenter ECMM Excellence Center Study

Toine Mercier,Stéphane Bretagne,Blandine Denis,Jörg Steinmann,Alexandre Alanio,Sanja Pleško,Ulrike Scharmann,Ivana Mareković,Samia Hamane,Nesrine Aissaoui,Harald H Kessler,Juergen Prattes,Johan Maertens,Katrien Lagrou,Maud Gits-Muselli

doi:10.3390/jof6040327

Abstract

Pneumocystis jirovecii pneumonia is a difficult invasive infection to diagnose. Apart from microscopy of respiratory specimens, two diagnostic tests are increasingly used including real-time quantitative PCR (qPCR) of respiratory specimens, mainly in bronchoalveolar lavage fluids (BAL), and serum β-1,3-d-glucan (BDG). It is still unclear how these two biomarkers can be used and interpreted in various patient populations. Here we analyzed retrospectively and multicentrically the correlation between BAL qPCR and serum BDG in various patient population, including mainly non-HIV patients. It appeared that a good correlation can be obtained in HIV patients and solid organ transplant recipients but no correlation can be observed in patients with hematologic malignancies, solid cancer, and systemic diseases. This observation reinforces recent data suggesting that BDG is not the best marker of PCP in non-HIV patients, with potential false positives due to other IFI or bacterial infections and false-negatives due to low fungal load and low BDG release.

Highlights

Pneumocystis jirovecii pneumonia (PCP) is one of the most prevalent invasive fungal infections [1].It is still one of the main infections revealing AIDS in western countries [2]
The aim of this study was to investigate the potential correlation between bronchoalveolar lavage fluids (BAL) quantitative PCR (qPCR) fungal load and serum BDG in various populations of patients based on their underlying diseases
A total of 147 patients were enrolled in this study, including 117 cases of Pneumocystis pneumonia (PCP) and 30 cases of Pneumocystis carriage (PCC)

Summary

Introduction

Pneumocystis jirovecii pneumonia (PCP) is one of the most prevalent invasive fungal infections [1]. It is still one of the main infections revealing AIDS in western countries [2]. In parallel, it is mainly diagnosed in non-HIV patients, such as patients treated for hematological malignancies, solid organ transplant recipients, or patients treated with immunosuppressive therapies [3]. The diagnosis of PCP has relied on microscopy with immunofluorescence as the most sensitive test to visualize the trophic forms and asci containing ascospores in respiratory specimens since the. PCR for the sensitive detection of P. jirovecii DNA in respiratory specimens [6]

Objectives

Methods

Results

Conclusion