epiglucan and Acquired-Immunodeficiency-Syndrome

In this retrospective study, (1->3)-β-d-glucan (B-glucan) was an unreliable marker for AIDS-related Pneumocystis jirovecii pneumonia (PCP) because a high percentage of participants with progressive disseminated histoplasmosis and respiratory symptoms had a positive B-glucan result. Where histoplasmosis is common, attributing B-glucan positivity to PCP without further testing risks misdiagnosis.

Topics: Acquired Immunodeficiency Syndrome; beta-Glucans; Glucans; Histoplasmosis; Humans; Pneumocystis carinii; Pneumonia, Pneumocystis; Retrospective Studies

The objective of this study was to define the test characteristics of plasma beta-glucan for diagnosis of Pneumocystis jirovecii pneumonia (PCP) in AIDS patients with respiratory symptoms.. Analysis of baseline blood samples in a randomized strategy study of patients with acute opportunistic infections, limited to participants with respiratory symptoms.. Participants in the 282-person ACTG A5164 trial had baseline plasma samples assayed for beta-glucan testing. As part of A5164 trial, two study investigators independently adjudicated the diagnosis of PCP. Respiratory symptoms were identified by investigators from a list of all signs and symptoms with an onset or resolution in the 21 days prior to or 14 days following study entry. Beta-glucan was defined as positive if at least 80 pg/ml and negative if less than 80 pg/ml.. Of 252 study participants with a beta-glucan result, 159 had at least one respiratory symptom, 139 of whom had a diagnosis of PCP. The sensitivity of beta-glucan for PCP in participants with respiratory symptoms was 92.8% [95% confidence interval (CI) 87.2-96.5], and specificity 75.0% (95% CI 50.9-91.3). Among 134 individuals with positive beta-glucan and respiratory symptoms, 129 had PCP, for a positive predictive value of 96.3% (95% CI 91.5-98.8). Fifteen of 25 patients with a normal beta-glucan did not have PCP, for a negative predictive value of 60% (95% CI 38.7-78.9).. Elevated plasma beta-glucan has a high predictive value for diagnosis of PCP in AIDS patients with respiratory symptoms. We propose an algorithm for the use of beta-glucan as a diagnostic tool on the basis of the pretest probability of PCP in such patients.

Topics: Acquired Immunodeficiency Syndrome; AIDS-Related Opportunistic Infections; beta-Glucans; Biomarkers; Humans; Plasma; Pneumocystis carinii; Pneumonia, Pneumocystis; Predictive Value of Tests; Randomized Controlled Trials as Topic

Topics: Acquired Immunodeficiency Syndrome; AIDS-Related Opportunistic Infections; beta-Glucans; Biomarkers; Humans; Pneumocystis carinii; Pneumonia, Pneumocystis

Serum β-D-glucan has been demonstrated as a reliable, adjunct diagnostic marker for PCP, but its kinetics after PCP treatment are poorly understood. To evaluate the correlation between the levels of β-D-glucan and the clinical response, we investigated the individual transition of serum β-D-glucan levels after the initiation of PCP treatment.. Retrospective study. Seventeen PCP patients with AIDS who were admitted to our hospital were analyzed.. All subjects showed the serum β-D-glucan levels above the cut-off value, and the median level was 224 pg/mL [IQR: 78-597] at the time of PCP diagnosis. There were no correlations between serum β-D-glucan levels and CRP, LDH, or AaDO(2) at room air. Although there was a downward trend in serum β-D-glucan level as PCP treatment was initiated, a significant number of subjects showed a marked increase in the serum β-D-glucan levels despite their evident clinical improvement.. The serum β-D-glucan level does not reflect the severity and prognosis of PCP infection, and thus it may not be suitable for monitoring the response to treatment.

Topics: Acquired Immunodeficiency Syndrome; Adult; beta-Glucans; Biomarkers; Female; Humans; Male; Middle Aged; Pneumocystis carinii; Pneumonia, Pneumocystis; Retrospective Studies; Treatment Outcome