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Background   Pneumocystis jirovecii  pneumonia (PCP) is one of the most common HIV-related opportunistic infections. The diagnosis of PCP is based on analyses from respiratory tract specimens which may require the invasive procedure of a diagnostic bronchoscopy. The objective of this study was to evaluate the diagnostic potential of  Pneumocystis jirovecii  PCR in serum combined with the 1,3-β-D-glucan (betaglucan) test for the diagnosis of PCP in HIV-infected patients.    Methods  This was a retrospective case-control study including serum samples from 26 HIV-infected patients with PCP collected within 5 days prior to the start of PCP treatment, 21 HIV-infected control subjects matched by blood CD4 +  cell counts, and 18 blood donors. The serum samples were analyzed for  Pneumocystis jirovecii  PCR and betaglucan. The reference standard for PCP was based on previously described microbiological and clinical criteria.    Results  All patients with PCP had detectabe  Pneumocystis jirovecii  DNA in serum yielding a sensitivity for the  Pneumocystis jirovecii  PCR assay in serum of 100%. All blood donors had negative  Pneumocystis  PCR in serum. The specificity when testing HIV-infected patients was 71%, but with a PCR Cycle threshold (Ct) value of 34 as cut-off the specificity was 90%. At a putative pretest probaility of 20%, the negative and positive predictive value for the  Pneumocystis  PCR assay in serum was 0.99 and 0.71, respectively. Betaglucan with cut-off level 200 pg/ml combined with a positive  Pneumocystis jirovecii  PCR result had sensitivity and specificity of 92 and 90%, respectively. The concentration of  Pneumocystis jirovecii  DNA in serum samples, expressed by the PCR Ct values, correlated inversely to the betaglucan levels in serum.    Conclusion  In this case-control study including 70% of all HIV-infected patients with PCP treated at Sahlgrenska University Hospital during a time period of 13 years,  Pneumocystis  PCR analysis on serum samples had a very high sensitivity and negative predictive value for the diagnosis of PCP in HIV-infected patients. A serum-based diagnostic procedure either based on  Pneumocystis jirovecii  PCR alone or in combination with betaglucan analysis may thus be feasible and would facilitate the care of HIV-infected patients with suspected PCP.

bmc infectious diseases

Serum-based diagnosis of Pneumocystis pneumonia by detection of Pneumocystis jirovecii DNA and 1,3-β-D-glucan in HIV-infected patients: a retrospective case control study