Serum (1,3)-Beta-d-Glucan has suboptimal performance for the diagnosis of Pneumocystis jirovecii pneumonia in cancer patients and correlates poorly with respiratory burden as measured by quantitative PCR - 06/08/20
, Alexandre E. Malek a, Ying Jiang a, Micah M. Bhatti b, Sebastian Wurster a, Dimitrios P. Kontoyiannis a, ⁎ Highlights |
• | Serum BDG and qPCR levels correlate poorly in non-HIV cancer patients with PCP. |
• | BDG test performance improves at high pulmonary fungal load. |
• | BDG diagnostic performance in non-HIV cancer patients with PCP is suboptimal. |
• | Similar to patients with AIDS, serum BDG test NPV is very high. |
• | A negative BDG can be used to rule out PCP in non-HIV cancer patients. |
Abstract |
Objective |
Non-HIV immunocompromised patients with Pneumocystis jirovecii pneumonia (PCP) have lower fungal load than those with AIDS, potentially affecting the accuracy of diagnostic biomarkers. Therefore, we investigated the performance of serum (1,3)-Beta-d-Glucan (BDG) in conjunction with quantitative Pneumocystis jirovecii PCR (qPCR) in non-HIV cancer patients.
Methods |
We reviewed records of non-HIV cancer patients and classified them as definite, probable, or possible PCP cases, according to clinicoradiological features, microscopy findings, and qPCR results in bronchoscopy specimens. We evaluated the diagnostic performance of serum BDG and its correlation with qPCR results.
Results |
We identified 101 PCP patients (73 definite/probable, 28 possible) and 74 controls. Correlation of BDG and qPCR was low among all 101 qPCR-positive patients (Spearman's = 0.38) and in definite/probable PCP cases (Spearman's = 0.18). Considering all qPCR-positive patients, BDG showed consistently low sensitivity at different cutoffs. Among definite/probable cases, the diagnostic accuracy of BDG remained poor, yet slightly improved with high qPCR thresholds (AUC = 0.86 at ≥2000 DNA copies/mL). BDG had a low PPV but excellent NPV across different qPCR and BDG cutoffs.
Conclusions |
BDG and qPCR levels correlate poorly in non-HIV cancer patients with PCP. BDG diagnostic performance is suboptimal but a negative test may be useful to rule out PCP in this population.
Le texte complet de cet article est disponible en PDF.Keywords : Beta-d-glucan, Pcp, Pjp pcr, Pneumocystis jirovecii, Pneumocystosis
Plan
| This work was presented in part as an abstract at the 28th European Congress of Clinical Microbiology and Infectious Diseases, Madrid, Spain, April 2018. |
Vol 81 - N° 3
P. 443-451 - septembre 2020 Retour au numéro
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