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J Antimicrob Chemother. 2016 Sep;71(9):2386-96. doi: 10.1093/jac/dkw156. Epub 2016 May 12.

ECIL guidelines for the diagnosis of Pneumocystis jirovecii pneumonia in patients with haematological malignancies and stem cell transplant recipients.

Author information

1
Parasitology-Mycology Laboratory, Groupe Hospitalier Lariboisière Saint-Louis Fernand Widal, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris-Diderot, Sorbonne Paris Cité, and Institut Pasteur, Unité de Mycologie Moléculaire, CNRS URA3012, Centre National de Référence Mycoses Invasives et Antifongiques, Paris, France.
2
Institute of Microbiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
3
Department of Microbiology and Immunology, Catholic University Leuven, Leuven, Belgium and National Reference Center for Mycosis, Department of Laboratory Medicine, University Hospitals Leuven, Leuven, Belgium.
4
Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, The Netherlands.
5
Department of Infectious Diseases, Rigshospitalet-Copenhagen University Hospital, Copenhagen, Denmark.
6
Medical Parasitology Unit, Group of Opportunistic Protozoa/HIV and Other Protozoa, Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Portugal Universidade Nova de Lisboa, Lisboa, Portugal.
7
Hematology Department, Oncoematologia Pediatrica, Policlinico G. B. Rossi, Verona, Italy.
8
Department of Hematology, Oncology and Palliative Care, Ernst-von-Bergmann Klinikum, Potsdam, Germany.
9
Medizinische Klinik und Poliklinik II, Julius Maximilians Universitaet, Würzburg, Germany.
10
Department of Hematology, Radboud University Medical Center, Nijmegen, The Netherlands.
11
Hematology Department, Henri Mondor Hospital, APHP and Université Paris-Est-Créteil, Créteil, France catherine.cordonnier@aphp.fr.
12
Hematology Department, University Hospital Leuven, Campus Gasthuisberg, Leuven, Belgium.

Abstract

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.

PMID:
27550991
DOI:
10.1093/jac/dkw156
[Indexed for MEDLINE]

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