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Use of β-D-glucan in diagnosis of suspected Pneumocystis jirovecii pneumonia in adults with HIV infection

Research output: Contribution to journalArticlepeer-review

Thomas Juniper, Chris P. Eades, Eliza Gil, Harriet Fodder, Killian Quinn, Stephen Morris-Jones, Rebecca L. Gorton, Emmanuel Q. Wey, Frank A. Post, Robert F. Miller

Original languageEnglish
Pages (from-to)1074-1077
Number of pages4
JournalInternational Journal of STD and AIDS
Volume32
Issue number11
Early online date9 Jun 2021
DOIs
Accepted/In press2021
E-pub ahead of print9 Jun 2021
PublishedOct 2021

Bibliographical note

Funding Information: The author(s) received no financial support for the research, authorship and/or publication of this article. Publisher Copyright: © The Author(s) 2021.

King's Authors

Abstract

Objectives: An elevated serum (1-3)-β-D-glucan (BDG) concentration has high sensitivity for a diagnosis of Pneumocystis pneumonia (PCP) in people with HIV (PWH). At the current manufacturer-recommended positive threshold of 80 pg/mL (Fungitell), specificity for PCP is variable and other diagnostic tests are required. We evaluated the utility of serum BDG for diagnosis of suspected PCP in PWH at three inner-London hospitals to determine BDG concentrations for diagnosis and exclusion of PCP. Methods: From clinical case records, we abstracted demographic and clinical information and categorised patients as having confirmed or probable PCP, or an alternative diagnosis. We calculated sensitivity, specificity and positive predictive value (PPV) of serum BDG concentrations >400 pg/mL and negative predictive value (NPV) of BDG <80 pg/mL. Results: 76 patients were included; 29 had laboratory-confirmed PCP, 17 had probable PCP and 30 had an alternative diagnosis. Serum BDG >400 pg/mL had a sensitivity of 83%, specificity of 97% and PPV 97% for diagnosis of PCP; BDG <80 pg/mL had 100% NPV for exclusion of PCP. Conclusions: In PWH with suspected PCP, BDG <80 pg/mL excludes a diagnosis of PCP, whereas BDG concentrations >400 pg/mL effectively confirm the diagnosis. Values 80–400 pg/mL should prompt additional diagnostic tests.

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