<abstract xmlns="http://www.w3.org/1999/xhtml"><sec id="j_raon-2020-0028_s_005_w2aab3b7c45b1b6b1aab1c16b1Aa"><h3>Background</h3><p><italic>Pneumocystis jirovecii</italic> pneumonia (PCP) is a common and potentially fatal opportunistic infection in immunocompromised non-HIV individuals. There are problems with clinical and diagnostic protocols for PCP that lack sensitivity and specificity. We designed a retrospective study to compared several methods that were used in diagnostics of PCP.</p></sec><sec id="j_raon-2020-0028_s_006_w2aab3b7c45b1b6b1aab1c16b2Aa"><h3>Patients and methods</h3><p>One hundred and eight immunocompromised individuals with typical clinical picture for PCP and suspicious radiological findings were included in the study. Serum samples were taken to measure the values of (1→3)-β-D-glucan (Fungitell, Associates of Cape Cod, USA). Lower respiratory tract samples were obtained to perform direct immunofluorescence (DIF, MERIFLUOR® Pneumocystis, Meridian, USA) stain and real-time PCR (qPCR).</p></sec><sec id="j_raon-2020-0028_s_007_w2aab3b7c45b1b6b1aab1c16b3Aa"><h3>Results</h3><p>Fifty-four (50%) of the 108 patients in our study had (1→3)-β-D-glucan > 500 pg/ml. Patients that had (1→3)-β-D-glucan concentrations &lt; 400 pg/ml in serum, had mean threshold cycles (Ct) 35.43 ± 3.32 <italic>versus</italic> those that had (1→3)-β-D-glucan concentrations >400 pg/mL and mean Ct of 28.97 ± 5.27 (P &lt; 0.001). If we detected <italic>P. jirovecii</italic> with DIF and qPCR than PCP was proven. If the concentration of (1→3)-β-D-glucan was higher than 400 pg/ml and Ct of qPCR was below 28.97 ± 5.27 than we have been able be certain that <italic>P. jirovecii</italic> caused pneumonia (odds ratio [OR] 2.31, 95% confidence interval [CI] 1.62–3.27, P &lt; 0.001).</p></sec><sec id="j_raon-2020-0028_s_008_w2aab3b7c45b1b6b1aab1c16b4Aa"><h3>Conclusions</h3><p>Measurement of (1→3)-β-D-glucan or qPCR alone could not be used to diagnose PCP. Diagnostic cut-off value for (1→3)-β-D-glucan > 400pg/ml and qPCR below 30 Ct, allow us to conclude that patient has PCP. If the values of (1→3)-β-D-glucan are &lt; 400 pg/ml and qPCR is above 35 Ct than colonization with <italic>P. jirovecii</italic> is more possible than PCP.</p></sec></abstract>

BackgroundPneumocystis jirovecii pneumonia (PCP) is a common and potentially fatal opportunistic infection in immunocompromised non-HIV individuals. There are problems with clinical and diagnostic protocols for PCP that lack sensitivity and specificity. We designed a retrospective study to compared several methods that were used in diagnostics of PCP.Patients and methodsOne hundred and eight immunocompromised individuals with typical clinical picture for PCP and suspicious radiological findings were included in the study. Serum samples were taken to measure the values of (1→3)-β-D-glucan (Fungitell, Associates of Cape Cod, USA). Lower respiratory tract samples were obtained to perform direct immunofluorescence (DIF, MERIFLUOR® Pneumocystis, Meridian, USA) stain and real-time PCR (qPCR).ResultsFifty-four (50%) of the 108 patients in our study had (1→3)-β-D-glucan > 500 pg/ml. Patients that had (1→3)-β-D-glucan concentrations < 400 pg/ml in serum, had mean threshold cycles (Ct) 35.43 ± 3.32 versus those that had (1→3)-β-D-glucan concentrations >400 pg/mL and mean Ct of 28.97 ± 5.27 (P < 0.001). If we detected P. jirovecii with DIF and qPCR than PCP was proven. If the concentration of (1→3)-β-D-glucan was higher than 400 pg/ml and Ct of qPCR was below 28.97 ± 5.27 than we have been able be certain that P. jirovecii caused pneumonia (odds ratio [OR] 2.31, 95% confidence interval [CI] 1.62–3.27, P < 0.001).ConclusionsMeasurement of (1→3)-β-D-glucan or qPCR alone could not be used to diagnose PCP. Diagnostic cut-off value for (1→3)-β-D-glucan > 400pg/ml and qPCR below 30 Ct, allow us to conclude that patient has PCP. If the values of (1→3)-β-D-glucan are < 400 pg/ml and qPCR is above 35 Ct than colonization with P. jirovecii is more possible than PCP.

Diagnostic accuracy of (1→3)-β-D-glucan to predict Pneumocystis jirovecii pneumonia in non-HIV-infected patients

Radiology and Oncology

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

BackgroundPneumocystis jirovecii pneumonia (PCP) is a common and potentially fatal opportunistic infection in immunocompromised non-HIV individuals. There are problems with clinical and diagnostic protocols for PCP that lack sensitivity and specificity. We designed a retrospective study to compared several methods that were used in diagnostics of PCP.Patients and methodsOne hundred and eight immunocompromised individuals with typical clinical picture for PCP and suspicious radiological findings were included in the study. Serum samples were taken to measure the values of (1→3)-β-D-glucan (Fungitell, Associates of Cape Cod, USA). Lower respiratory tract samples were obtained to perform direct immunofluorescence (DIF, MERIFLUOR® Pneumocystis, Meridian, USA) stain and real-time PCR (qPCR).ResultsFifty-four (50%) of the 108 patients in our study had (1→3)-β-D-glucan > 500 pg/ml. Patients that had (1→3)-β-D-glucan concentrations 400 pg/mL and mean Ct of 28.97 ± 5.27 (P  400pg/ml and qPCR below 30 Ct, allow us to conclude that patient has PCP. If the values of (1→3)-β-D-glucan are < 400 pg/ml and qPCR is above 35 Ct than colonization with P. jirovecii is more possible than PCP.

BackgroundPneumocystis jirovecii pneumonia (PCP) is a common and potentially fatal opportunistic infection in immunocompromised non-HIV individuals. There are...

(1→3)-β-D-glucan group	N = 108 patients	Mean Ct ± SD
Group 1 < 100 pg/mL	24	35.43 ± 3.51
Group 2 100–200 pg/mL	11	34.82 ± 3.65
Group 3 200–300 pg/mL	4	37.33 ± 2.36
Group 4 300–400 pg/mL	7	35.27 ± 2.75
Group 5 400–500 pg/mL	8	29.41 ± 6.25*
Group 6 > 500 pg/mL	54	28.90 ± 5.18*

(1→3)-β-D-glucan group	N = 108 patients	(1→3)-β-D-glucan (pg/mL) ± SD
< 100 pg/mL	24	81.14 ± 3.41
100–200 pg/mL	11	124.4 ± 22.37
200–300 pg/mL	4	238,75 ± 16,55
300–400 pg/mL	7	336.75 ± 20.18
400–500 pg/mL	8	454.13 ± 31.3
> 500 pg/mL*	54	> 500 pg/mL

Diagnosis	N = 108 patients	(1→3)-β-D-glucan (pg/mL) ± SD
Malignant disease	20 (18%)	240.34 ± 162.45
Transplantation	53 (49%)	330.01 ± 191.26
Autoimmune disease	35 (33%)	427.73 ± 152.23

PCP	108 patients	(1→3)-β-D-glucan (pg/mL) ± SD	qPCR Ct ± SD
Possible PCP	66 (61%)	256.06 ± 183.48	35.01 ± 3.8
Microbiologically confirmed PCP (DIF and qPCR positive)	42 (39%)	467.5 ± 95.5	27.2 ± 4.6
Subgroup definite PCP (DIF positive and qPCR Ct < 30 and response to treatment)	26 (24%)	494.81 ± 17.73*
P value		< 0.001	< 0.001

Diagnostic accuracy of (1→3)-β-D-glucan to predict Pneumocystis jirovecii pneumonia in non-HIV-infected patients

Article Category: Research Article

Data publikacji: 28 maj 2020

Zakres stron: 221 - 226

Otrzymano: 31 gru 2019

Przyjęty: 14 kwi 2020

DOI: https://doi.org/10.2478/raon-2020-0028

© 2020 Petra Rogina, Miha Skvarc, published by Sciendo

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

Average Ct values for each (1→3)-β-D-glucan range

Average (1→3)-β-D-glucan values for each (1→3)-β-D-glucan range

Average (1→3)-β-D-glucan values for each group of immunocompromised patients

(1→3)-β-D-glucan values for patients with microbiologically confirmed PCP and possible PCP