Diagnostic Performance of Bronchoalveolar Lavage (1,3)-β-d-Glucan Assay for Pneumocystis jirovecii Pneumonia

Zhou, Shiwei; Linder, Kathleen A.; Kauffman, Carol A.; Richards, Blair; Kleiboeker, Steve; Miceli, Marisa H.

doi:10.3390/jof6040200

Cited by 4 publications

(2 citation statements)

References 14 publications

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“… 6 1,3-β-D-glucan (BDG) is currently a common serological biomarker for auxiliary diagnosis of PJP, but it lacks specificity. 7 Polymerase chain reaction (PCR) is widely used to detect PJ because of its good sensitivity and specificity, but it has limited value in single detection of mixed infection. 8 Therefore, there is an urgent need to explore a more accurate and efficient microbial diagnostic tool for detecting PJP in non-HIV populations.…”

Section: Introductionmentioning

confidence: 99%

Study on mNGS Technique in Diagnosing Pneumocystis jirovecii Pneumonia in Non-HIV-Infected Patients

Li,

Han,

et al. 2024

IDR

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To investigate the value of metagenomic Next-Generation Sequencing (mNGS) in diagnosing Pneumocystis jirovecii pneumonia (PJP) in non-human immunodeficiency virus (HIV)-infected patients. Methods: In this retrospective study, non-HIV-infected patients with PJP and those diagnosed with non-PJP from August 2022 to December 2024 were selected as subjects. The presence of Pneumocystis jirovecii (PJ) and other co-pathogens in bronchoalveolar lavage fluid (BALF) was analyzed, and the diagnostic efficacy of NGS, polymerase chain reaction (PCR) and serum 1,3-β-D-glucan (BDG) in PJP was compared with the reference standard of clinical compound diagnosis. Results: Eighty-nine non-HIV-infected patients were recruited, with dyspnea as the primary symptom (69.66%) and solid malignant tumor as the most common underlying disease (20.22%). Taking clinical compound diagnosis as the reference standard, the sensitivity, specificity, negative predictive value and positive predictive value of mNGS were higher than those detected by PCR and serum BDG. Among 42 non-HIV-infected patients with PJP who underwent mNGS and conventional pathogen detection of BALF, 6 had simple PJ infection and 36 had combined PJ infection. The detection rate of mNGS in mixed infections was significantly higher than that of conventional pathogen detection (85.71 vs 61.70%, P = 0.012). A total of 127 pathogens were detected in BALF using mNGS, among which fungi had the highest detection rate (46.46%). The fungi, viruses and bacteria detected were mainly Pneumocystis jirovecii, human gammaherpesvirus 4 and Acinetobacter baumannii. Conclusion: mNGS is highly effective in diagnosing non-HIV-infected patients with PJP and exhibits ideal performance in the detection of co-pathogens. In addition, it has certain value for clinical diagnosis and guidance of targeted anti-infective drug treatment.

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Section: Introductionmentioning

confidence: 99%

Study on mNGS Technique in Diagnosing Pneumocystis jirovecii Pneumonia in Non-HIV-Infected Patients

Li,

Han,

et al. 2024

IDR

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“…colonization and/or infection, but also for the presence of not fungi-related interfering factors, like intravenous treatment with antibiotics, albumin, immunoglobulin, and haemodialysis. Serum BDG might help the clinician to exclude the diagnosis of invasive fungal infections (IFD), like PCP, due to its high negative predictive value (93%) [ 10 – 14 ], although several authors have pointed out that this test cannot be considered the only test to perform in order to rule out the diagnosis of both IFD and/or PCP [ 15 , 16 ]. BDG can be measured also in BAL, however, its role in clinical practice is still a matter of debate.…”

Section: Introductionmentioning

confidence: 99%

Comparison of different microbiological procedures for the diagnosis of Pneumocystis jirovecii pneumonia on bronchoalveolar-lavage fluid

et al. 2022

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Background The current diagnostic gold standard for Pneumocystis jirovecii is represented by microscopic visualization of the fungus from clinical respiratory samples, as bronchoalveolar-lavage fluid, defining “proven” P. jirovecii pneumonia, whereas qPCR allows defining “probable” diagnosis, as it is unable to discriminate infection from colonization. However, molecular methods, such as end-point PCR and qPCR, are faster, easier to perform and interpret, thus allowing the laboratory to give back the clinician useful microbiological data in a shorter time. The present study aims at comparing microscopy with molecular assays and beta-D-glucan diagnostic performance on bronchoalveolar-lavage fluids from patients with suspected Pneumocystis jirovecii pneumonia. Bronchoalveolar-lavage fluid from eighteen high-risk and four negative control subjects underwent Grocott-Gomori’s methenamine silver-staining, end-point PCR, RT-PCR, and beta-D-glucan assay. Results All the microscopically positive bronchoalveolar-lavage samples (50%) also resulted positive by end-point and real time PCR and all, but two, resulted positive also by beta-D-glucan quantification. End-point PCR and RT-PCR detected 10 (55%) and 11 (61%) out of the 18 samples, respectively, thus showing an enhanced sensitivity in comparison to microscopy. All RT-PCR with a Ct < 27 were confirmed microscopically, whereas samples with a Ct ≥ 27 were not. Conclusions Our work highlights the need of reshaping and redefining the role of molecular diagnostics in a peculiar clinical setting, like P. jirovecii infection, which is a rare but also severe and rapidly progressive clinical condition affecting immunocompromised hosts that would largely benefit from a faster diagnosis. Strictly selected patients, according to the inclusion criteria, resulting negative by molecular methods could be ruled out for P. jirovecii pneumonia.

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General Approaches for Direct and Indirect Detection and Identification of Fungi

Fida,

Wengenack,

Theel

2023

ClinMicroNow

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The frequency with which invasive fungal infections (IFIs) occur has markedly increased over the past decade. The ability to rapidly detect and identify the causative fungal agents is essential for the successful management of IFIs. The ability to detect fungi in clinical material depends on several factors, including the quality of the specimen that is received into the laboratory. Microscopic examination of specimens can be carried out with either unfixed specimens or fixed, stained specimens. The use of unfixed specimens has the advantages of being quick and relatively simple to carry out; the use of fixed, stained specimens may highlight features specific to certain fungi and also the host response in tissue, but they take longer to process and hence may delay reporting. Detection of antibodies targeting fungal pathogens may be useful in a range of IFIs, particularly when they occur in immunocompetent patients; however, these assays may have limited use in significantly immunocompromised patients.

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Diagnostic Performance of Bronchoalveolar Lavage (1,3)-β-d-Glucan Assay for Pneumocystis jirovecii Pneumonia

Cited by 4 publications

References 14 publications

Study on mNGS Technique in Diagnosing Pneumocystis jirovecii Pneumonia in Non-HIV-Infected Patients

Study on mNGS Technique in Diagnosing Pneumocystis jirovecii Pneumonia in Non-HIV-Infected Patients

Comparison of different microbiological procedures for the diagnosis of Pneumocystis jirovecii pneumonia on bronchoalveolar-lavage fluid

General Approaches for Direct and Indirect Detection and Identification of Fungi

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