Clinical performance of (1,3) beta-D glucan for the diagnosis of pneumocystis pneumonia (PCP) in cancer patients tested with PCP polymerase chain reaction Journal Article


Authors: Morjaria, S.; Frame, J.; Franco-Garcia, A.; Geyer, A.; Kamboj, M.; Babady, N. E.
Article Title: Clinical performance of (1,3) beta-D glucan for the diagnosis of pneumocystis pneumonia (PCP) in cancer patients tested with PCP polymerase chain reaction
Abstract: Background. Serum (1,3)-beta-D glucan (BDG) is increasingly used to guide the management of suspected Pneumocystis pneumonia (PCP). BDG lacks specificity for PCP, and its clinical performance in high-risk cancer patients has not been fully assessed. Polymerase chain reaction (PCR) for PCP detection is highly sensitive, but cannot differentiate between colonization and infection. We evaluated the diagnostic performance of serum BDG in conjunction with PCP PCR on respiratory samples in patients with cancer and unexplained lung infiltrates. Methods. We performed a retrospective analysis of adult patients evaluated for PCP at our institution from 2012 to 2015, using serum BDG and PCP PCR. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the serum BDG at different thresholds were evaluated using PCP PCR alone or in conjunction with clinical presentation in PCP PCR-positive patients. Results. With PCP PCR alone as the reference method, BDG (>= 80 pg/mL) had a sensitivity of 69.8%, specificity of 81.2%, PPV of 34.6%, and NPV of 95.2% for PCP. At >= 200 pg/mL in patients with a positive PCR and a compatible PCP clinical syndrome, BDG had a sensitivity of 70%, specificity of 100%, PPV of 100%, and NPV of 52.0% for PCP. Conclusions. Patients negative by both BDG and PCR were unlikely to have PCP. In patients with a compatible clinical syndrome for PCP, higher BDG values (>200 pg/mL) were consistently associated with clinically-significant PCP infections among PCP PCR-positive oncology patients.
Keywords: diagnostic accuracy; accuracy; time; blood; serum; colonization; bronchoalveolar lavage; infected patients; pneumocystis jiroveci; carinii-pneumonia; lactate-dehydrogenase; cancer; polymerase chain beaction; beta-d glucans; jirovecii pneumonia
Journal Title: Clinical Infectious Diseases
Volume: 69
Issue: 8
ISSN: 1058-4838
Publisher: Oxford University Press  
Date Published: 2019-10-15
Start Page: 1303
End Page: 1309
Language: English
ACCESSION: WOS:000490004300005
DOI: 10.1093/cid/ciy1072
PROVIDER: wos
PUBMED: 30561560
PMCID: PMC6763633
Notes: Article -- Source: Wos
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MSK Authors
  1. Ngolela Esther Babady
    122 Babady
  2. Mini Kamboj
    113 Kamboj
  3. Alexander Iosif Geyer
    23 Geyer