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Utilidade clínica do (1->3) B-D-glucano como marcador laboratorial no diagnóstico de pneumonia por Pneumocystis jirovecii
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A pneumonia por Pneumocystis jirovecii (PPc) é uma das principais causas de morte em doentes imunocomprometidos, revestindo-se assim de elevado interesse o diagnóstico precoce desta infecção, por forma a instaurar a terapêutica adequada. Actualmente, os meios laboratoriais de diagnóstico baseiam-se fundamentalmente na detecção directa deste microrganismo nas secreções pulmonares dos doentes, o que implica a realização de procedimentos invasivos. É nessa perspectiva que surge o doseamento do β-glucano no soro de doentes com presumível infecção, uma vez que, este composto é um dos principais componentes da parede dos quistos de P. jirovecii.
Neste estudo procedeu-se ao doseamento do β-glucano em amostras de soro de 66 indivíduos e verificou-se que, nos 47 indivíduos que confirmaram o diagnóstico de PPc, a mediana de β-glucano obtida foi de 314,5 pg/mL, enquanto nos restantes 19 foi de 63,7 pg/mL. Estatisticamente obteve-se uma forte correlação entre níveis elevados de β-glucano no soro de doentes e a presença de infecção por P. jirovecii. Em relação ao diagnóstico clínico, os resultados obtidos demonstraram correlação entre um diagnóstico clinico sugestivo de PPc e níveis elevados de β-glucano no soro. Constatou-se ainda que, para a infecção por P. jirovecii o cut-off que apresentou melhores resultados para o teste Fungitell® situa-se nos 100 pg/mL, obtiveram-se resultados de sensibilidade de 89% e especificidade de 74%.
Estudos preliminares apontaram para o facto de níveis elevados de β-glucano no soro corresponderem a níveis elevados de parasitémia e uma evolução clínica negativa da doença.
Pneumocystis jirovecii pneumonia (PcP) is a leading cause of death in immunocompromised patients, covering thus of great interest for early diagnosis of this infection, in order to provide appropriate therapy. Currently, diagnostic laboratory are mainly based on direct detection of this microorganism in the pulmonary secretions of patients, which involves invasive procedures. In this perspective, there is the determination of β-glucan in the serum of patients with suspected infection, since this compound is a major component of the cyst wall of P. jirovecii. In this study proceeded to the determination of β-glucan in serum samples from 66 individuals and found that in 47 individuals who confirmed the diagnosis of PCP, the median β-glucan obtained was 314.5 pg / mL, while the remaining 19 was 63.7 pg / mL. Statistically it was found a strong correlation between high levels of β-glucan in the serum and the presence of infection by P. jirovecii. In relation to clinical diagnosis, the results showed a correlation between clinical diagnosis suggestive of PcP and high levels of β-glucan in the serum. It was further observed that for infection with P. jirovecii the cut-off showed better results for the test Fungitell ® is located at 100 pg / mL with the results of sensitivity of 89% and specificity of 74%. Preliminary studies pointed to the fact that high levels of β-glucan in serum correspond to high levels of parasitemia and a negative clinical course of disease.
Pneumocystis jirovecii pneumonia (PcP) is a leading cause of death in immunocompromised patients, covering thus of great interest for early diagnosis of this infection, in order to provide appropriate therapy. Currently, diagnostic laboratory are mainly based on direct detection of this microorganism in the pulmonary secretions of patients, which involves invasive procedures. In this perspective, there is the determination of β-glucan in the serum of patients with suspected infection, since this compound is a major component of the cyst wall of P. jirovecii. In this study proceeded to the determination of β-glucan in serum samples from 66 individuals and found that in 47 individuals who confirmed the diagnosis of PCP, the median β-glucan obtained was 314.5 pg / mL, while the remaining 19 was 63.7 pg / mL. Statistically it was found a strong correlation between high levels of β-glucan in the serum and the presence of infection by P. jirovecii. In relation to clinical diagnosis, the results showed a correlation between clinical diagnosis suggestive of PcP and high levels of β-glucan in the serum. It was further observed that for infection with P. jirovecii the cut-off showed better results for the test Fungitell ® is located at 100 pg / mL with the results of sensitivity of 89% and specificity of 74%. Preliminary studies pointed to the fact that high levels of β-glucan in serum correspond to high levels of parasitemia and a negative clinical course of disease.
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Técnicas laboratoriais Análise e diagnóstico Pneumonia Pneumocysti jirovecii B-D-glucano Diagnóstico não invasivo