β-d-Glucan and S-adenosylmethionine serum levels for the diagnosis of Pneumocystis pneumonia in HIV-negative Patients: A prospective study - 02/08/11
, Luc B.S. Gelinck b, Bertrand D. van Zelst c, Wendy W.J. van de Sande b, Luuk N.A. Willems d, Jaap T. van Dissel a, Robert de Jonge c, Frank P. Kroon a
Corresponding author. Tel.: +31 715262613; fax: +31 75266758.Summary |
Objective |
To prospectively assess the diagnostic utility of S-adenosylmethionine (AdoMet) and (1→3)-β-d-glucan (β-d-glucan) serum markers for Pneumocystis pneumonia (PCP) in HIV-negative patients.
Methods |
HIV-negative, immunocompromised patients suspected of PCP based on clinical presentation and chest imaging were included. PCP was confirmed or rejected by results of direct microscopy and/or real-time PCR on broncho-alveolar lavage (BAL) fluid. Measurement of serum β-d-glucan and AdoMet was performed on serum samples collected at enrollment and during follow-up. Both serum β-d-glucan and AdoMet were assessed for diagnostic accuracy and correlation with clinical and laboratory parameters.
Results |
In 31 patients enrolled (21 PCP-positive, 10 PCP-negative), AdoMet levels did not discriminate between patients with and without PCP. Elevated serum β-d-glucan was a reliable indicator for PCP with a sensitivity of 0.90 and specificity of 0.89 at the 60 pg/ml cut-off. In PCP-positive patients β-d-glucan serum levels decreased during treatment and inversely correlated with Pneumocystis PCR cycle threshold values in BAL fluid.
Conclusions |
The level of serum β-d-glucan – but not AdoMet – was diagnostic for PCP within the clinical context and may serve as marker for pulmonary fungal load and treatment monitoring.
Le texte complet de cet article est disponible en PDF.Keywords : Pneumocystis jirovecii, Pneumonia, S-Adenosylmethionine, Beta-d-glucan, Serum marker, Solid organ transplantation, HIV-negative, Diagnosis
Plan
Vol 62 - N° 1
P. 93-100 - janvier 2011 Retour au numéro
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