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Pneumocystis pneumonia associated with human immunodeficiency virus infection without elevated (1 → 3)-β-D glucan: A

Takahiro Kamada1, Kenjiro Furuta1, Hiromi Tomioka1

  • 1Department of Respiratory Medicine, Kobe City Medical Center West Hospital, Japan.

Respiratory Medicine Case Reports
|June 23, 2016
PubMed

Insights

Pneumocystis pneumonia (PCP) in HIV patients can occur even with normal serum (1→3)-β-D-glucan levels. This finding emphasizes that a negative test does not rule out this opportunistic infection.

Area of Science:

  • Medical Mycology
  • Infectious Diseases
  • Immunocompromised Host Infections

Background:

  • Pneumocystis pneumonia (PCP) is a significant opportunistic infection in immunosuppressed individuals, especially those with acquired immunodeficiency syndrome (AIDS).
  • Serum (1→3)-β-D-glucan is a biomarker derived from the cell wall of Pneumocystis jirovecii, a fungus responsible for PCP.
  • Elevated serum (1→3)-β-D-glucan is generally considered a sensitive indicator for human immunodeficiency virus-associated PCP (HIV-PCP).

Observation:

  • This report details a specific case of HIV-PCP.
  • In this particular case, serum (1→3)-β-D-glucan levels were not elevated despite the presence of PCP.

Findings:

  • The case demonstrates that a negative serum (1→3)-β-D-glucan assay does not exclude the diagnosis of HIV-PCP.
  • This challenges the assumption of high sensitivity in all HIV-PCP cases.

Implications:

  • Clinicians should maintain a high index of suspicion for PCP in at-risk patients, even with negative biomarker results.
  • Diagnostic strategies for PCP in immunocompromised patients may require a multi-faceted approach beyond single biomarker testing.
  • Further research is warranted to understand the reasons for negative biomarker results in confirmed PCP cases.
Keywords:
(1 → 3)-β-D-glucanAcquired immunodeficiency syndromeHuman immunodeficiency virusPneumocystis pneumonia

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