Usefulness of (1,3) ß- d -glucan detection in bronchoalveolar lavage samples in Pneumocystis pneumonia and Pneumocystis pulmonary colonization

Damiani, Céline; Gal, Solène Le; Goin, N.; Pizio, Pierre Di; Costa, Cécilia Da; Virmaux, Michèle; Bach, Véronique; Stéphan-Blanchard, Erwan; Nevez, Gilles; Totet, Anne

doi:10.1016/j.mycmed.2014.11.001

Cited by 20 publications

(7 citation statements)

References 13 publications

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“…We had postulated that quantifying BALF BDG when values were found to be ≥500 pg/mL would show clear differences between patients with Pneumocystis pneumonia, especially those with proven and probable infection, and control patients. However, we did not find that to be the case, contrasting with results from another study in which BALF BDG levels were significantly higher in patients with Pneumocystis pneumonia when compared with colonized and uninfected patients [13].…”

Section: Discussioncontrasting

confidence: 99%

“…We found that the BALF BDG assay was moderately sensitive for the detection of infection with Pneumocystis, but specificity was poor. Our results are consistent with several prior reports with smaller numbers of patients that found BALF BDG to have moderate to high sensitivity, but low specificity for the diagnosis of Pneumocystis pneumonia [11][12][13]. In contrast, another study noted both high sensitivity and high specificity when BDG was tested using BALF that was obtained from patients with HIV, who presumably might have had a larger burden of organisms [2].…”

Section: Discussionsupporting

confidence: 91%

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

Zhou

Linder

Kauffman

et al. 2020

JoF

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We evaluated the performance of the (1,3)-β-d-glucan (BDG) assay on bronchoalveolar lavage fluid (BALF) as a possible aid to the diagnosis of Pneumocystis jirovecii pneumonia. BALF samples from 18 patients with well-characterized proven, probable, and possible Pneumocystis pneumonia and 18 well-matched controls were tested. We found that the best test performance was observed with a cut-off value of 128 pg/mL; receiver operating characteristic/area under the curve (ROC/AUC) was 0.70 (95% CI 0.52–0.87). Sensitivity and specificity were 78% and 56%, respectively; positive predictive value was 64%, and negative predictive value was 71%. The low specificity that we noted limits the utility of BALF BDG as a diagnostic tool for Pneumocystis pneumonia.

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Section: Discussioncontrasting

confidence: 99%

Section: Discussionsupporting

confidence: 91%

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

Zhou

Linder

Kauffman

et al. 2020

JoF

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“…Moreover, recent data demonstrated that the (1,3) ß-D-glucan (BDG) level in bronchoalveolar lavage (BAL) sample from the PCP patients was significantly higher than the colonized patients [ 38 ]. For ambiguous PCR results, BDG could be used as a preliminary test for patients with suspected PCP, especially in patients with slightly positive PCR results [ 39 ]. Last, most of the studies presented only unadjusted estimates, it was not possible to stratify or adjust for potential confounders in this meta-analysis, which restricted us to obtain more comprehensive results and do further detailed analysis.…”

Section: Discussionmentioning

confidence: 99%

Risk factors for mortality from pneumocystis carinii pneumonia (PCP) in non-HIV patients: a meta-analysis

et al. 2017

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The number of patients with non-human immunodeficiency virus (HIV) related pneumocystis carinii pneumonia (PCP) is increasing with widespread immunosuppressive treatment. We performed a meta-analysis to describe the clinical characteristics and factors associated with outcomes of PCP in HIV-negative patients. A total of 13 studies including 867 patients with non-HIV related PCP was included. The overall mortality for non-HIV patients with PCP was 30.6%. The most common underlying disorder for the development of PCP is hematological malignancies (29.1%), followed by autoimmune disease (20.1%), organ or bone marrow transplantation (14.0%), and solid tumors (6.0%). Risk factors associated with increased mortality rate including old age, female sex, longer time from onset of symptoms to diagnosis, respiratory failure, solid tumors, high lactate dehydrogenase, low serum albumin, bacterial, and aspergillus co-infection, etc (P < 0.05). Adjunctive corticosteroid and PCP prophylaxis was not shown to improve the outcome of PCP in non-HIV patients (P > 0.05). Our findings indicate that mortality in non-HIV patients with PCP is high. Improved knowledge about the prognostic factors may guide the early treatment.

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“…The (1!3) β-D-glucan (BDG) assay carries a high sensitivity (> 90%) with lower specificity (less than 80%) and poor tracking with disease resolution. [132][133][134][135][136] Biomarkers for the diagnosis of PJP is an important area of investigation. 137,138 Studies of PJP biomarkers including serum BDG, Krebs von den Lungen-6 antigen (KL-6), lactate dehydrogenase (LDH), and S-adenosyl methionine (SAM) demonstrated that BDG was most reliable, followed by KL-6, LDH and SAM.…”

Section: Laboratory Evaluationmentioning

confidence: 99%

Pneumocystis jiroveci

Fishman

2020

Semin Respir Crit Care Med

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Pneumocystis jiroveci remains an important fungal pathogen in a broad range of immunocompromised hosts. The natural reservoir of infection remains unknown. Pneumocystis jiroveci Pneumonia (PJP) develops via airborne transmission or reactivation of inadequately treated infection. Nosocomial clusters of infection have been described among immunocompromised hosts. Subclinical infection or colonization may occur. Pneumocystis pneumonia occurs most often within 6 months of organ transplantation and with intensified or prolonged immunosuppression, notably with corticosteroids. Infection is also common during neutropenia and low-lymphocyte counts, with hypogammaglobulinemia, and following cytomegalovirus (CMV) infection. The clinical presentation generally includes fever, dyspnea with hypoxemia, and nonproductive cough. Chest radiographic patterns are best visualized by computed tomography (CT) scan with diffuse interstitial processes. Laboratory examination reveals hypoxemia, elevated serum lactic dehydrogenase levels, and elevated serum (1→3) β-D-glucan assays. Specific diagnosis is achieved using respiratory specimens with direct immunofluorescent staining; invasive procedures may be required and are important to avoid unnecessary therapies. Quantitative nucleic acid amplification is a useful adjunct to diagnosis but may be overly sensitive. Trimethoprim-sulfamethoxazole (TMP-SMX) remains the drug of choice for therapy; drug allergy should be documented before resorting to alternative therapies. Adjunctive corticosteroids may be useful early in the clinical course; aggressive reductions in immunosuppression may provoke immune reconstitution syndromes. Pneumocystis pneumonia (PJP) prophylaxis is recommended and effective for immunocompromised individuals in the most commonly affected risk groups.

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Usefulness of (1,3) ß- d -glucan detection in bronchoalveolar lavage samples in Pneumocystis pneumonia and Pneumocystis pulmonary colonization

Cited by 20 publications

References 13 publications

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

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

Risk factors for mortality from pneumocystis carinii pneumonia (PCP) in non-HIV patients: a meta-analysis

Pneumocystis jiroveci

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