Usefulness of Serum (1, 3) Beta D Glucan in Diagnosis of Pneumocystis Jirovecii Pneumonia in Immunocompromised Patients

Abstract

Background and study aim: This study aims to figure out the use of the serological 1, 3 Beta-D-Glucan (BDG) test for early detection of Pneumocystis jirovecii Pneumonia (PcP) among immunocompromised patients with acute respiratory distress syndrome (ARDS).Patients and methods: This is a cross-sectional study. It was done at Ain Shams University Hospitals. The study included 44 clinically relevant patients with ARDS, based on their clinical and radiological findings. The group included 26 males and 18 females. Their ages ranged from 1 to 74 years.Results: Out of 44 immunocompromised Patients with ARDS caused by Invasive Fungal Infections (IFI) suspected PcP according to clinical, radiological findings and Galactomannan, they included patients in ICU, with hematological malignancies, on immunosuppressive drugs and HIV positive Patients. 72.7 % were positive for BDG, while 27.3 % were negative for BDG. Positive predictive value of BDG was 75 % while BDG’s negative predictive value 91.7 %. Sensitivity of the test was 96% while Specificity was 57.9%. There was a statistically significant relation between results of BDG and Galactomannan , lymphocytic count and LDH level.Conclusions: PcP is a significant problem for immunocompromised patients in the ICU and those suffering from hematological malignancies. The disease is associated with increased incidence of ICU admission due to respiratory failure and death. BDG can be a non-invasive diagnostic method with high negative predictive value that can rule out IFI. However, its serum levels doesn't reflect the severity of the disease, nor is it suitable for monitoring response to treatment.