Serum markers in interstitial pneumonia with and without Pneumocystis jiroveciicolonization: a prospective study

Shimizu, Yasuo; Sunaga, Noriaki; Dobashi, Kunio; Fueki, Makoto; Fueki, Naoto; Makino, Sohei; Mori, Masataka

doi:10.1186/1471-2334-9-47

Cited by 39 publications

(32 citation statements)

References 34 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The remaining two patients presented positive BG results but with values (82.7 and 84 pg/ml) close to the threshold (24). Similarly, Shimizu et al showed that serum BG levels determined using the Wako test kit (Wako Pure Chemical Industries, Tokyo, Japan; manufacturer's threshold, Ն11 pg/ml) were negative for 7 of 7 colonized patients (25). Using the same assay with a threshold adjusted to 15.6 pg/ml, Matsumura et al determined a specificity of 80% and a sensitivity of 100% for PCP diagnosis with the serum BG assay (26).…”

mentioning

confidence: 99%

Combined Quantification of Pulmonary Pneumocystis jirovecii DNA and Serum (1→3)-β- d -Glucan for Differential Diagnosis of Pneumocystis Pneumonia and Pneumocystis Colonization

et al. 2013

View full text Add to dashboard Cite

This study assessed a quantitative PCR (qPCR) assay for Pneumocystis jirovecii quantification in bronchoalveolar lavage (BAL) fluid samples combined with serum (1¡3)-␤-D-glucan (BG) level detection to distinguish Pneumocystis pneumonia (PCP) from pulmonary colonization with P. jirovecii. Forty-six patients for whom P. jirovecii was initially detected in BAL fluid samples were retrospectively enrolled. Based on clinical data and results of P. jirovecii detection, 17 and 29 patients were diagnosed with PCP and colonization, respectively. BAL fluid samples were reassayed using a qPCR assay targeting the mitochondrial large subunit rRNA gene. qPCR results and serum BG levels (from a Fungitell kit) were analyzed conjointly. P. jirovecii DNA copy numbers were significantly higher in the PCP group than in the colonization group (1.3 ؋ 10 7 versus 3.4 ؋ 10 3 copies/l, P < 0.05). A lower cutoff value (1.6 ؋ 10 3 copies/l) achieving 100% sensitivity for PCP diagnosis and an upper cutoff value (2 ؋ 10 4 copies/ l) achieving 100% specificity were determined. Applying these two values, 13/17 PCP patients and 19/29 colonized patients were correctly assigned to their patient groups. For the remaining 14 patients with P. jirovecii DNA copy numbers between the cutoff values, PCP and colonization could not be distinguished on the basis of qPCR results. Four of these patients who were initially assigned to the PCP group presented BG levels of >100 pg/ml. The other 10 patients, who were initially assigned to the colonization group, presented BG levels of <100 pg/ml. These results suggest that the combination of the qPCR assay, applying cutoff values of 1.6 ؋ 10 3 and 2 ؋ 10 4 copies/l, and serum BG detection, applying a 100 pg/ml threshold, can differentiate PCP and colonization diagnoses.

show abstract

mentioning

confidence: 99%

Combined Quantification of Pulmonary Pneumocystis jirovecii DNA and Serum (1→3)-β- d -Glucan for Differential Diagnosis of Pneumocystis Pneumonia and Pneumocystis Colonization

et al. 2013

View full text Add to dashboard Cite

show abstract

“…Its clinical usefulness had been demonstrated with hematologic patients when used either alone (13) or in combination with serum galactomannan (9). BG is also a component of the P. jiroveci cell wall, but no method for detecting BG in serum has so far been validated for diagnostic purposes in PCP, despite some encouraging reports (3,10,14).The aim of this study was to evaluate the role of a serum BG test in the presumptive diagnosis of PCP in immunocompromised patients unable to undergo invasive diagnostic procedures.From May 2008 to January 2009, 31 serum samples from immunocompromised patients with pneumonia were collected and stored. All patients admitted to our clinical unit and for whom invasive diagnostic procedures were unfeasible had clear risk factors (see below) for PCP.…”

mentioning

confidence: 99%

mentioning

confidence: 99%

Clinical Evaluation of a (1,3)-β- d -Glucan Assay for Presumptive Diagnosis of Pneumocystis jiroveci Pneumonia in Immunocompromised Patients

Bono

Mularoni

Furfaro

et al. 2009

Clin Vaccine Immunol

View full text Add to dashboard Cite

The diagnosis of pneumocystis pneumonia (PCP) due to Pneumocystis jiroveci is usually based on the microscopic detection of cysts in respiratory specimens, such as bronchoalveolar lavage specimens made by fiber-optic bronchoscopy, which has a good sensitivity although it is sometimes very difficult to perform due to the frequent severe respiratory failure of affected patients. In addition, when an appropriate specimen is obtained, the microscopic identification of P. jiroveci is strongly related to the observer's skills and experience.Other diagnostic procedures, such as PCR, have been reported to be both sensitive and specific, although none of these procedures turned out to be a reliable method in the analysis of biological samples-sputum and pharyngeal swabs-taken using noninvasive techniques (12).(1,3)-␤-D-Glucan (BG) is a component of the cell wall of many fungal organisms, and its presence in serum had been shown to be a reliable marker of invasive fungal infection in both clinical (7,8,10,11) and autoptic (6) studies. Its clinical usefulness had been demonstrated with hematologic patients when used either alone (13) or in combination with serum galactomannan (9). BG is also a component of the P. jiroveci cell wall, but no method for detecting BG in serum has so far been validated for diagnostic purposes in PCP, despite some encouraging reports (3,10,14).The aim of this study was to evaluate the role of a serum BG test in the presumptive diagnosis of PCP in immunocompromised patients unable to undergo invasive diagnostic procedures.From May 2008 to January 2009, 31 serum samples from immunocompromised patients with pneumonia were collected and stored. All patients admitted to our clinical unit and for whom invasive diagnostic procedures were unfeasible had clear risk factors (see below) for PCP. Clinical presentations of patients were either consistent or not consistent with PCP. Each patient gave informed consent. In the same period of time, 11 control sera from healthy volunteers (the investigators involved in the study and laboratory personnel) were also collected.A case of presumptive PCP was based on the presence of a baseline clinical condition compatible with the risk of PCP (human immunodeficiency virus [HIV] disease with fewer than 200 CD4 cells/l, administration of high-dose steroids for more than 8 weeks, or hematological malignancies treated with immunosuppressive therapy) plus, according to the modified 1993 definition of PCP as an AIDS-defining condition (1), all the following factors: (i) a history of dyspnea on exertion or nonproductive cough of recent onset (less than 3 months); (ii) arterial PO 2 of less than 70 mm Hg; (iii) chest X-ray finding of bilateral interstitial infiltrate; and (iv) no evidence of bacterial pneumonia.PCP therapy was administered according to the clinical judgment of attending physicians.After all data collection and before the final analysis, each case was evaluated by an independent expert, who was unaware of BG test results, and classified as presumptive PCP or ...

show abstract

“…Furthermore, 36% of IPF patients grow bacteria in BAL fluid in the absence of clear signs of infection, even before immunosuppression [55]. A specific role for co-trimoxazole is also suggested by a high prevalence of P. jiroveci colonization (23.3%) among patients with IPF associated with collagen vascular disease [56]. The importance of infection is outlined by the findings of the TIPAC study; 11/35 deaths were a result of pneumonia during the study [57].…”

Section: Management Strategiesmentioning

confidence: 99%

Acute Exacerbations of Idiopathic Pulmonary Fibrosis

Αντωνίου

Wells²

2013

Respiration

View full text Add to dashboard Cite

Idiopathic pulmonary fibrosis (IPF) is a chronic, progressive and ultimately fatal disease, with a highly variable course in individual patients. Episodes of rapid deterioration are not uncommon, often following a period of stability. In cases of uncertain etiology, with typical clinical and high-resolution computed tomography (HRCT) features, the term ‘acute exacerbation of IPF' (AE-IPF) has been coined to describe a combination of diffuse alveolar damage and preexisting usual interstitial pneumonia. In 2007, a consensus definition and diagnostic criteria were proposed. Although the presence of overt infection is currently an exclusion criterion, it appears likely that occult infection, reflux and thoracic surgical procedures are all trigger factors for AE-IPF. The development of new, usually bilateral infiltrates (ground-glass attenuation with variable admixed consolidation) is a defining HRCT feature. The outcome is poor with a short-term mortality in excess of 50% despite therapy. A number of pathophysiologic pathways are activated, with immunologic dysregulation, epithelial damage and circulating fibrocytes all believed to play a pathogenetic role. Acute exacerbations are less prevalent in other fibrotic lung diseases than in IPF and may have a better outcome, with the exception of acute exacerbations of rheumatoid lung. In AE-IPF, the exclusion of alternative causes of rapid deterioration, including heart failure and infection, is the main goal of investigation. Empirical high-dose corticosteroid steroid therapy is generally used in AE-IPF, without proven benefit.

show abstract

Serum markers in interstitial pneumonia with and without Pneumocystis jiroveciicolonization: a prospective study

Cited by 39 publications

References 34 publications

Combined Quantification of Pulmonary Pneumocystis jirovecii DNA and Serum (1→3)-β- d -Glucan for Differential Diagnosis of Pneumocystis Pneumonia and Pneumocystis Colonization

Combined Quantification of Pulmonary Pneumocystis jirovecii DNA and Serum (1→3)-β- d -Glucan for Differential Diagnosis of Pneumocystis Pneumonia and Pneumocystis Colonization

Clinical Evaluation of a (1,3)-β- d -Glucan Assay for Presumptive Diagnosis of Pneumocystis jiroveci Pneumonia in Immunocompromised Patients

Acute Exacerbations of Idiopathic Pulmonary Fibrosis

Contact Info

Product

Resources

About