- Autores: Alanio A, Alanio A, Bretagne S, Bretagne S, Cesaro S, Cesaro S, Cordonnier C, Cordonnier C, Donnelly J P, Einsele H, Einsele H, Hauser P M, Hauser PM, Helweg-Larsen J, Helweg-Larsen J, Johan Maertens J, Lagrou K, Lagrou K, Maschmeyer G, Maschmeyer G, Matos O, Melchers W J G
- Ano de Publicação: 2016
- Journal: Journal of Antimicrobial Chemotherapy
- Link: https://www.ncbi.nlm.nih.gov/pubmed/27550991
The Fifth European Conference on Infections in Leukaemia (ECIL-5) convened a meeting to establish evidence-based recommendations for using tests to diagnose Pneumocystis jirovecii pneumonia (PCP) in adult patients with haematological malignancies. Immunofluorescence assays are recommended as the most sensitive microscopic method (recommendation A-II: ). Real-time PCR is recommended for the routine diagnosis of PCP ( A-II: ). Bronchoalveolar lavage (BAL) fluid is recommended as the best specimen as it yields good negative predictive value ( A-II: ). Non-invasive specimens can be suitable alternatives ( B-II: ), acknowledging that PCP cannot be ruled out in case of a negative PCR result ( A-II: ). Detecting β-d-glucan in serum can contribute to the diagnosis but not the follow-up of PCP ( A-II: ). A negative serum β-d-glucan result can exclude PCP in a patient at risk ( A-II: ), whereas a positive test result may indicate other fungal infections. Genotyping using multilocus sequence markers can be used to investigate suspected outbreaks ( A-II: ). The routine detection of dihydropteroate synthase mutations in cases of treatment failure is not recommended ( B-II: ) since these mutations do not affect response to high-dose co-trimoxazole. The clinical utility of these diagnostic tests for the early management of PCP should be further assessed in prospective, randomized interventional studies.