Comparison of Blood (1->3)-β-D-Glucan Levels in AIDS-Related Pneumocystis jirovecii Pneumonia and AIDS-Related Progressive Disseminated Histoplasmosis

2021 ◽  
Author(s):  
Michael Saccente ◽  
Gayathri Krishnan
Keyword(s):  
Retrospective Study ◽  
Respiratory Symptoms ◽  
Pneumocystis Jirovecii ◽  
Pneumocystis Jirovecii Pneumonia ◽  
Disseminated Histoplasmosis ◽  
Progressive Disseminated Histoplasmosis ◽  
Glucan B

Abstract In this retrospective study, (1->3)-β-D-glucan (B-glucan) was an unreliable marker for AIDS-related Pneumocystis jirovecii pneumonia (PCP) because a high percentage of participants with progressive disseminated histoplasmosis and respiratory symptoms had a positive B-glucan result. Where histoplasmosis is common attributing B-glucan positivity to PCP without further testing risks misdiagnosis.

scholarly journals 837. Performance of Blood (1- >3)-β-D-Glucan in People with AIDS Presenting with Respiratory Symptoms

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S510-S511
Author(s):  
Lana Hasan ◽  
Gayathri Krishnan ◽  
Michael Saccente
Keyword(s):  
Bronchoalveolar Lavage ◽  
Diagnostic Test ◽  
Test Performance ◽  
Respiratory Symptoms ◽  
Fungal Infections ◽  
Pneumocystis Jirovecii ◽  
Cape Cod ◽  
Pneumocystis Jirovecii Pneumonia ◽  
Non Invasive ◽  
Progressive Disseminated Histoplasmosis

Abstract Background The gold standard for diagnosis of Pneumocystis jirovecii pneumonia (PCP) is direct visualization of the microorganism in respiratory samples, usually obtained via bronchoalveolar lavage (BAL). Blood β-D-glucan (BDG) is used as a non-invasive adjunctive diagnostic test for PCP, but specificity is only modest, in part because other opportunistic fungal infections cause high BDG. We previously showed BDG-positivity in 94% of people with AIDS (PWA), progressive disseminated histoplasmosis (PDH), and respiratory symptoms in our hospital. In this study, we aim to assess the performance of BDG as a diagnostic test for PCP in PWA who have respiratory symptoms. Methods We retrospectively identified PWA who had a BDG result between 2014 and 2019. AIDS was defined as past or current absolute CD4 count < 200 cells/µL, or a past or current AIDS-defining condition. Positive cytological or histological evidence of P. jirovecii in bronchoalveolar lavage (BAL) fluid or lung biopsy, or positive Pneumocystis PCR on sputum or BAL confirmed PCP. The Fungitell Assay (Associates of Cape Cod, East Falmouth, MA) determined BDG levels as follows: negative, < 60 pg/mL; indeterminate, 60-79 pg/mL, and positive, ≥ 80 pg/mL. Values < 31 pg/mL and those >500 pg/mL were censored at 30 pg/mL and 500 pg/mL, respectively. Respiratory symptoms were defined as cough, dyspnea, chest pain, or hypoxia. We compared BDG results for participants with proven PCP and participants without proven PCP. Results We identified 260 PWA with a BDG result, of whom 183 had at least one respiratory symptom. 84 (45.9%) of these participants had a positive BDG. BDG results among participants with and without PCP are shown in Table 1. Of the 44 participants with a positive BDG who did not have PCP, 29 (65.9%) had PDH. Other diagnoses included cryptococcosis and candidemia. The test performance of BDG for the diagnosis of PCP is shown in Table 2. Exclusion of participants with PDH increased the specificity of BDG for PCP to 86.4%. Table 1. Results of (1->3)-β-D-glucan Testing by Pneumocystis jirovecii Pneumonia Diagnosis Among Participants with AIDS and Respiratory Symptoms Table 2. Test Performance of (1->3)-β-D-glucan for the Diagnosis of Pneumocystis jirovecii Pneumonia* Conclusion At our center where histoplasmosis is endemic, a positive BDG should not be attributed to PCP among PWA with respiratory symptoms because of low specificity and low positive predictive value. However, a negative BDG can exclude PCP in this population. Disclosures All Authors: No reported disclosures

scholarly journals Test performance of blood beta-glucan for Pneumocystis jirovecii pneumonia in patients with AIDS and respiratory symptoms

AIDS ◽  
2013 ◽  
Vol 27 (6) ◽  
pp. 967-972 ◽  
Author(s):  
Brian R. Wood ◽  
Lauren Komarow ◽  
Andrew R. Zolopa ◽  
Malcolm A. Finkelman ◽  
William G. Powderly ◽  
...  
Keyword(s):  
Test Performance ◽  
Respiratory Symptoms ◽  
Pneumocystis Jirovecii ◽  
Pneumocystis Jirovecii Pneumonia ◽  
Beta Glucan

scholarly journals Diagnostic accuracy of (1→3)-β-D-glucan to predict Pneumocystis jirovecii pneumonia in non-HIV-infected patients

2020 ◽  
Vol 54 (2) ◽  
pp. 221-226
Author(s):  
Petra Rogina ◽  
Miha Skvarc
Keyword(s):  
Retrospective Study ◽  
Confidence Interval ◽  
Odds Ratio ◽  
Lower Respiratory Tract ◽  
Pneumocystis Jirovecii ◽  
Cape Cod ◽  
Direct Immunofluorescence ◽  
Pneumocystis Jirovecii Pneumonia ◽  
Radiological Findings ◽  
Serum Samples

AbstractBackgroundPneumocystis jirovecii pneumonia (PCP) is a common and potentially fatal opportunistic infection in immunocompromised non-HIV individuals. There are problems with clinical and diagnostic protocols for PCP that lack sensitivity and specificity. We designed a retrospective study to compared several methods that were used in diagnostics of PCP.Patients and methodsOne hundred and eight immunocompromised individuals with typical clinical picture for PCP and suspicious radiological findings were included in the study. Serum samples were taken to measure the values of (1→3)-β-D-glucan (Fungitell, Associates of Cape Cod, USA). Lower respiratory tract samples were obtained to perform direct immunofluorescence (DIF, MERIFLUOR® Pneumocystis, Meridian, USA) stain and real-time PCR (qPCR).ResultsFifty-four (50%) of the 108 patients in our study had (1→3)-β-D-glucan > 500 pg/ml. Patients that had (1→3)-β-D-glucan concentrations < 400 pg/ml in serum, had mean threshold cycles (Ct) 35.43 ± 3.32 versus those that had (1→3)-β-D-glucan concentrations >400 pg/mL and mean Ct of 28.97 ± 5.27 (P < 0.001). If we detected P. jirovecii with DIF and qPCR than PCP was proven. If the concentration of (1→3)-β-D-glucan was higher than 400 pg/ml and Ct of qPCR was below 28.97 ± 5.27 than we have been able be certain that P. jirovecii caused pneumonia (odds ratio [OR] 2.31, 95% confidence interval [CI] 1.62–3.27, P < 0.001).ConclusionsMeasurement of (1→3)-β-D-glucan or qPCR alone could not be used to diagnose PCP. Diagnostic cut-off value for (1→3)-β-D-glucan > 400pg/ml and qPCR below 30 Ct, allow us to conclude that patient has PCP. If the values of (1→3)-β-D-glucan are < 400 pg/ml and qPCR is above 35 Ct than colonization with P. jirovecii is more possible than PCP.

Pneumocystis jirovecii pneumonia in children. A retrospective study in a single center over three decades

2020 ◽  
Vol 38 (3) ◽  
pp. 111-118
Author(s):  
Jorge García-Moreno ◽  
Susana Melendo-Pérez ◽  
María Teresa Martín-Gómez ◽  
Marie Antoinette Frick ◽  
Joan Balcells-Ramírez ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Pneumocystis Jirovecii ◽  
Pneumocystis Jirovecii Pneumonia ◽  
Single Center

scholarly journals 934. Diagnostic Utility of Blood (1- >3)-β-D-Glucan Testing in Patients with HIV in Arkansas

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S500-S500
Author(s):  
Gayathri Krishnan ◽  
Lana Hasan ◽  
Michael Saccente
Keyword(s):  
Respiratory Symptoms ◽  
Histoplasma Capsulatum ◽  
Fungal Infections ◽  
Pneumocystis Jirovecii Pneumonia ◽  
Antigen Assay ◽  
Common Diagnosis ◽  
Sterile Site ◽  
Progressive Disseminated Histoplasmosis ◽  
Reliable Marker ◽  
Respiratory Complaints

Abstract Background Blood (1- &gt; 3)-β-D-Glucan (BDG) is a sensitive marker for Pneumocystis jirovecii pneumonia (PJP) in patients with AIDS (PWA). However, other fungal infections, including progressive disseminated histoplasmosis (PDH), cause high levels of BDG. At our hospital, PDH is a common diagnosis in PWA with fever and respiratory complaints, making it difficult to differentiate PJP from PDH based on clinical features alone. The objective of this study was to assess BDG as a diagnostic test for PJP in Arkansas where histoplasmosis is endemic. Methods We performed a retrospective review of patients with confirmed PJP and confirmed PDH who had BDG testing between 2014-2020. Positive cytological or histological evidence of P. jirovecii in bronchoalveolar lavage (BAL) or lung biopsy, or positive PCR on sputum or BAL confirmed PJP. Identification of Histoplasma capsulatum in culture of blood or other normally sterile site, histology showing typical yeast forms, or a positive urine H. capsulatum antigen assay (MiraVista Diagnostics) confirmed PDH. The Fungitell Assay determined BDG levels as follows: negative, &lt; 60 pg/mL; indeterminate, 60-79 pg/mL, and positive &gt; 80 pg/mL. Values below 31 pg/mL and those above 500 pg/mL were censored at 30 and 500, respectively. Respiratory symptoms were defined as the presence of cough, shortness of breath, or dyspnea on exertion. Results 53 episodes of PDH occurred in 46 patients. 42 were accompanied by a BDG result. Of these, 38 (90%) were positive; 3 (7%) were negative; and 1 (2%) was indeterminate. 44 (83%) of the PDH episodes were associated with respiratory symptoms. 36 of these had a BDG result. 34 (94%) were positive; 1 (3%) was negative; and 1 (3%) was indeterminate. 44 episodes of PJP occurred in 40 patients. All had a BDG result. 43 (98%) were positive.10 (23%) episodes of PJP were accompanied by a concomitant infection. The mean BDG level was significantly higher in the PJP group compared to those with PDH and respiratory symptoms (P=.002). However, values overlapped substantially, and BDG positivity was not significantly more frequent in the PJP group (P=.586). Box-and-Whisker Display of (1-&gt;3)-β-D-Glucan Results Conclusion In Arkansas, BDG positivity is not a reliable marker of PJP because it cannot distinguish between PJP and PDH. Attributing an elevated BDG to PJP without additional evaluation risks misdiagnosis. Disclosures All Authors: No reported disclosures

Pneumocystis jirovecii pneumonia in children. A retrospective study in a single center over three decades

2020 ◽  
Vol 38 (3) ◽  
pp. 111-118 ◽  
Author(s):  
Jorge García-Moreno ◽  
Susana Melendo-Pérez ◽  
María Teresa Martín-Gómez ◽  
Marie Antoinette Frick ◽  
Joan Balcells-Ramírez ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Pneumocystis Jirovecii ◽  
Pneumocystis Jirovecii Pneumonia ◽  
Single Center
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