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. 2019 Sep 27;69(8):1303-1309.
doi: 10.1093/cid/ciy1072.

Clinical Performance of (1,3) Beta-D Glucan for the Diagnosis of Pneumocystis Pneumonia (PCP) in Cancer Patients Tested With PCP Polymerase Chain Reaction

Sejal Morjaria  1   2 , John Frame  3 , Alexandra Franco-Garcia  1 , Alexander Geyer  2   4 , Mini Kamboj  1   2 , N Esther Babady  1   5
Affiliations

Clinical Performance of (1,3) Beta-D Glucan for the Diagnosis of Pneumocystis Pneumonia (PCP) in Cancer Patients Tested With PCP Polymerase Chain Reaction

Sejal Morjaria et al. Clin Infect Dis. .

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: Pneumocystis jiroveci; beta-D glucans; cancer; diagnostic accuracy; polymerase chain beaction.

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Figures

Figure 1.
Figure 1.
Diagram of inclusion and exclusion criteria for the study population. Abbreviations: BAL, bronchoalveolar lavage; BDG, beta-D glucan; BW, bronchial washings; MSKCC, Memorial Sloan Kettering Cancer Center; PCP, Pneumocystis pneumonia; PCR, polymerase chain reaction.
Figure 2.
Figure 2.
Receiver operating characteristic curve for serum BDG performance, using PCR as the reference method. BDG shown at thresholds of 80 pg/ml, 200 pg/ml, and 500 pg/ml. Abbreviations: AUC, area under the curve; BDG, beta-D glucan; PCR, polymerase chain reaction.
Figure 3.
Figure 3.
PCP patients and BDG value heat map. This figure illustrates the proportion of patients in each PCP diagnostic category and the corresponding BDG value. The intensity of the red color increases with of a greater proportion of patients falling within the corresponding BDG range and diagnostic category. Abbreviations: BDG, beta-D glucan; PCR, polymerase chain reaction.
See this image and copyright information in PMC

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