Negative Serum (1,3) -β-D-glucan Has a Low Power to Exclude Pneumocystis Jirovecii Pneumonia (PJP) in HIV-uninfected Patients with Positive QPCR

Overview

Journal Ann Clin Microbiol Antimicrob

Publisher Biomed Central

Specialties Infectious Diseases
Microbiology

Date 2023 Nov 21

PMID 37986091

Authors

Yuan Huang

Jie Yi

Jing-Jing Song

Li-Jun Du

Xiao-Meng Li

Lin-Lin Cheng

Song-Xin Yan

Hao-Long Li

Yong-Mei Liu

Hao-Ting Zhan

Ya-Ling Dou

Yong-Zhe Li

Affiliations

Soon will be listed here.

Abstract

Objective: The current study evaluated the diagnostic performance of serum (1,3)-beta-D Glucan (BDG) in differentiating PJP from P. jirovecii-colonization in HIV-uninfected patients with P. jirovecii PCR-positive results.

Methods: This was a single-center retrospective study between 2019 and 2021. The diagnosis of PJP was based on the following criteria: detection of P. jirovecii in sputum or BAL specimen by qPCR or microscopy; Meet at least two of the three criteria: (1) have respiratory symptoms of cough and/or dyspnea, hypoxia; (2) typical radiological picture findings; (3) receiving a complete PJP treatment. After exclusion, the participants were divided into derivation and validation cohorts. The derivation cohort defined the cut-off value of serum BDG. Then, it was verified using the validation cohort.

Results: Two hundred and thirteen HIV-uninfected patients were enrolled, with 159 PJP and 54 P. jirovecii-colonized patients. BDG had outstanding specificity, LR, and PPV for PJP in both the derivation (90.00%, 8.900, and 96.43%) and the validation (91.67%, 9.176, and 96.30%) cohorts at ≥ 117.7 pg/mL. However, it had lower sensitivity and NPV in the derivation cohort (89.01% and 72.97%), which was even lower in the validation cohort (76.47% and 57.89%). Of note, BDG ≥ 117.7 pg/mL has insufficient diagnostic efficacy for PJP in patients with lung cancer, interstitial lung disease (ILD) and nephrotic syndrome. And although lymphocytes, B cells, and CD4 T cells in PJP patients were significantly lower than those in P. jirovecii-colonized patients, the number and proportion of peripheral blood lymphocytes did not affect the diagnostic efficacy of serum BDG.

Conclusions: Serum BDG ≥ 117.7 pg/mL could effectively distinguish P. jirovecii-colonization from infection in qPCR-positive HIV-uninfected patients with infectious diseases, solid tumors (excluding lung cancer), autoimmune or inflammatory disorders, and hematological malignancies. Of note, for patients with lung cancer, ILD, and nephrotic diseases, PJP should be cautiously excluded at BDG < 117.7 pg/mL.

Citing Articles

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Shi Y, Chen R, Sun H, Xu K, Wang M, Li Z Clin Rheumatol. 2025; .

PMID: 40047990 DOI: 10.1007/s10067-025-07392-1.

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