Evaluation and Clinical Impact of the Combination of Wako® (1,3)-β-D-Glucan in Serum and RT-PCR in Oral Wash for Pneumocystis jirovecii Infection Diagnosis: A Retrospective Cohort Study.
Alfredo Maldonado-Barrueco, Claudia Sanz-González, Eduardo Rubio-Mora, Inmaculada Quiles-Melero, Julio García-Rodríguez
{"title":"Evaluation and Clinical Impact of the Combination of Wako® (1,3)-β-D-Glucan in Serum and RT-PCR in Oral Wash for Pneumocystis jirovecii Infection Diagnosis: A Retrospective Cohort Study.","authors":"Alfredo Maldonado-Barrueco, Claudia Sanz-González, Eduardo Rubio-Mora, Inmaculada Quiles-Melero, Julio García-Rodríguez","doi":"10.1093/mmy/myaf085","DOIUrl":null,"url":null,"abstract":"<p><p>Pneumocystis jirovecii pneumonia (PCP) is an opportunistic infection in immunocompromised patients, with a complex diagnosis due to its colonizing role. Current guidelines recommend microbiological confirmation through direct microscopy of lower respiratory tract samples, 1,3-β-D-glucan (BDG) serum testing, or RT-PCR detection in lower respiratory samples. However, non-invasive diagnostic alternatives, such as oral wash RT-PCR combined with BDG serum levels, could be an option for non-intubated and non-candidates to bronchoscopy patients in a real clinical setting. A retrospective study analysed 49 patients with suspected PCP at Hospital Universitario La Paz (Madrid, Spain) between January 2020-March 2025. Patients underwent to serum BDG (Wako®, ≥7 pg/mL) and P. jirovecii RT-PCR in oral wash tests. The study assessed the impact of time of symptoms and treatment on microbiological findings, and the clinical utility of combining test for PCP diagnosis. Among the 49 patients, 12 (24.5%) had a positive P. jirovecii RT-PCR in oral wash, and 12 of them (85.7%) also a positive BDG. Median BDG was 27.1 (IQR: 14.4-100.7) pg/mL for positive patients (p < 0.05). Patients with (+)BDG/RT-PCR showed a longer symptom duration compared to negative (p > 0.05). Previous PCP prophylaxis/treatment showed a reduce on P. jirovecii RT-PCR results (p > 0.05). Combining tests could be useful in patients who are not candidates for bronchoscopy (p < 0.05) and influenced treatment decisions, reducing unneeded PCP treatments in (-)RT-PCR/BDG in immunosuppressed patients with high pretest value. P. jirovecii RT-PCR in oral wash showed to be good screening assay in patients without PCP treatment/prophylaxis and BDG as appears to serve as a complementary diagnostic tool for confirming PCP infection, primarily in prolonged infectious conditions. This strategy could help optimize treatment decisions reducing the need for invasive procedures. Further multicentric studies are needed to validate the combination test results and assess cost-effectiveness in clinical practice.</p>","PeriodicalId":18586,"journal":{"name":"Medical mycology","volume":" ","pages":""},"PeriodicalIF":2.3000,"publicationDate":"2025-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Medical mycology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1093/mmy/myaf085","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"INFECTIOUS DISEASES","Score":null,"Total":0}
引用次数: 0
Abstract
Pneumocystis jirovecii pneumonia (PCP) is an opportunistic infection in immunocompromised patients, with a complex diagnosis due to its colonizing role. Current guidelines recommend microbiological confirmation through direct microscopy of lower respiratory tract samples, 1,3-β-D-glucan (BDG) serum testing, or RT-PCR detection in lower respiratory samples. However, non-invasive diagnostic alternatives, such as oral wash RT-PCR combined with BDG serum levels, could be an option for non-intubated and non-candidates to bronchoscopy patients in a real clinical setting. A retrospective study analysed 49 patients with suspected PCP at Hospital Universitario La Paz (Madrid, Spain) between January 2020-March 2025. Patients underwent to serum BDG (Wako®, ≥7 pg/mL) and P. jirovecii RT-PCR in oral wash tests. The study assessed the impact of time of symptoms and treatment on microbiological findings, and the clinical utility of combining test for PCP diagnosis. Among the 49 patients, 12 (24.5%) had a positive P. jirovecii RT-PCR in oral wash, and 12 of them (85.7%) also a positive BDG. Median BDG was 27.1 (IQR: 14.4-100.7) pg/mL for positive patients (p < 0.05). Patients with (+)BDG/RT-PCR showed a longer symptom duration compared to negative (p > 0.05). Previous PCP prophylaxis/treatment showed a reduce on P. jirovecii RT-PCR results (p > 0.05). Combining tests could be useful in patients who are not candidates for bronchoscopy (p < 0.05) and influenced treatment decisions, reducing unneeded PCP treatments in (-)RT-PCR/BDG in immunosuppressed patients with high pretest value. P. jirovecii RT-PCR in oral wash showed to be good screening assay in patients without PCP treatment/prophylaxis and BDG as appears to serve as a complementary diagnostic tool for confirming PCP infection, primarily in prolonged infectious conditions. This strategy could help optimize treatment decisions reducing the need for invasive procedures. Further multicentric studies are needed to validate the combination test results and assess cost-effectiveness in clinical practice.
期刊介绍:
Medical Mycology is a peer-reviewed international journal that focuses on original and innovative basic and applied studies, as well as learned reviews on all aspects of medical, veterinary and environmental mycology as related to disease. The objective is to present the highest quality scientific reports from throughout the world on divergent topics. These topics include the phylogeny of fungal pathogens, epidemiology and public health mycology themes, new approaches in the diagnosis and treatment of mycoses including clinical trials and guidelines, pharmacology and antifungal susceptibilities, changes in taxonomy, description of new or unusual fungi associated with human or animal disease, immunology of fungal infections, vaccinology for prevention of fungal infections, pathogenesis and virulence, and the molecular biology of pathogenic fungi in vitro and in vivo, including genomics, transcriptomics, metabolomics, and proteomics. Case reports are no longer accepted. In addition, studies of natural products showing inhibitory activity against pathogenic fungi are not accepted without chemical characterization and identification of the compounds responsible for the inhibitory activity.