β-d-Glucan and S-adenosylmethionine serum levels for the diagnosis of Pneumocystis pneumonia in HIV-negative Patients: A prospective study - 02/08/11
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 numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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