Bigot Jeanne, Vellaissamy Sandra, Senghor Yaye, Hennequin Christophe, Guitard Juliette
Centre de Recherche Saint-Antoine, CRSA, AP-HP, Inserm, Hôpital Saint-Antoine, Service de Parasitologie-Mycologie, Sorbonne Université, F-75012 Paris, France.
Hôpital Saint-Antoine, Service de Parasitologie-Mycologie, Sorbonne Université, F-75012 Paris, France.
J Fungi (Basel). 2022 Jun 24;8(7):663. doi: 10.3390/jof8070663.
According to the immunodepression status, the diagnosis of pneumonia (PjP) may be difficult. Molecular methods appear very sensitive, but they lack specificity because Pj DNA can be detected in Pneumocystis-colonized patients. The aim of this study was to evaluate the value of a serum ß-d-Glucan (BDG) assay for the diagnosis of PjP in a large cohort of HIV-negative and HIV-positive patients, either as a first-line diagnostic test for PjP or as a tool to distinguish between colonization and PjP in cases of low fungal load. Data of Pj qPCR performed on bronchopulmonary specimens over a 3-year period were retrieved retrospectively. For each result, we searched for a BDG serum assay performed within ±5 days. Among the 69 episodes that occurred in HIV-positive patients and the 609 episodes that occurred in immunocompromised HIV-negative patients, we find an equivalent sensitivity of BDG assays compared with molecular methods to diagnose probable/proven PjP, in a first-line strategy. Furthermore, BDG assay can be used confidently to distinguish between infected and colonized patients using a 80 pg/mL cut-off. Finally, it is necessary to search for causes of false positivity to increase BDG assay performance. BDG assay represents a valuable adjunctive tool to distinguish between colonization and infection.
根据免疫抑制状态，肺孢子菌肺炎（PjP）的诊断可能存在困难。分子方法似乎非常敏感，但缺乏特异性，因为在肺孢子菌定植患者中可检测到Pj DNA。本研究的目的是评估血清β -d-葡聚糖（BDG）检测在一大群HIV阴性和HIV阳性患者中对PjP诊断的价值，作为PjP的一线诊断试验或作为在真菌载量低的情况下区分定植和PjP的工具。回顾性检索了3年期间对支气管肺标本进行的Pj定量聚合酶链反应（qPCR）数据。对于每个结果，我们查找了在±5天内进行的BDG血清检测。在HIV阳性患者发生的69例病例和免疫功能低下的HIV阴性患者发生的609例病例中，我们发现在一线策略中，BDG检测与分子方法诊断可能/确诊PjP的敏感性相当。此外，使用80 pg/mL的临界值，BDG检测可可靠地用于区分感染患者和定植患者。最后，有必要寻找假阳性的原因以提高BDG检测的性能。BDG检测是区分定植和感染的有价值的辅助工具。
