Objective: To prospectively assess the diagnostic utility of S-adenosylmethionine (AdoMet) and (1→3)-β-d-glucan (β-d-glucan) serum markers for Pneumocystis pneumonia (PCP) in HIV-negative patients. Methods: HIV-negative, immunocompromised patients suspected of PCP based on clinical presentation and chest imaging were included. PCP was confirmed or rejected by results of direct microscopy and/or real-time PCR on broncho-alveolar lavage (BAL) fluid. Measurement of serum β-d-glucan and AdoMet was performed on serum samples collected at enrollment and during follow-up. Both serum β-d-glucan and AdoMet were assessed for diagnostic accuracy and correlation with clinical and laboratory parameters. Results: In 31 patients enrolled (21 PCP-positive, 10 PCP-negative), AdoMet levels did not discriminate between patients with and without PCP. Elevated serum β-d-glucan was a reliable indicator for PCP with a sensitivity of 0.90 and specificity of 0.89 at the 60 pg/ml cut-off. In PCP-positive patients β-d-glucan serum levels decreased during treatment and inversely correlated with Pneumocystis PCR cycle threshold values in BAL fluid. Conclusions: The level of serum β-d-glucan - but not AdoMet - was diagnostic for PCP within the clinical context and may serve as marker for pulmonary fungal load and treatment monitoring. © 2010 The British Infection Society.

Beta-d-glucan, HIV-negative, Pneumocystis jirovecii, Pneumonia, S-Adenosylmethionine, Serum marker, Solid organ transplantation, diagnosis
dx.doi.org/10.1016/j.jinf.2010.10.007, hdl.handle.net/1765/21471
Journal of Infection
Article in press - dd November 2010
Erasmus MC: University Medical Center Rotterdam

de Boer, M.G.J, Gelinck, L.B.S, van Zelst, B.D, van de Sande, W.W.J, Willems, L.N.A, van Dissel, J.T, … Kroon, F.P. (2011). β-d-Glucan and S-adenosylmethionine serum levels for the diagnosis of Pneumocystis pneumonia in HIV-negative Patients: A prospective study. Journal of Infection, 62(1), 93–100. doi:10.1016/j.jinf.2010.10.007