(1–3)-Beta-D-glucan in association with lactate dehydrogenase as biomarkers of Pneumocystis pneumonia (PcP) in HIV-infected patients

  • F. Esteves
  • C.-H. Lee
  • B. de Sousa
  • R. Badura
  • M. Seringa
  • C. Fernandes
  • J. F. Gaspar
  • F. Antunes
  • O. Matos


Pneumocystis pneumonia (PcP) is a major HIV-related illness caused by Pneumocystis jirovecii. Definitive diagnosis of PcP requires microscopic detection of P. jirovecii in pulmonary specimens. The objective of this study was to evaluate the usefulness of two serum markers in the diagnosis of PcP. Serum levels of (1–3)-beta-d-glucan (BG) and lactate dehydrogenase (LDH) were investigated in 100 HIV-positive adult patients and 50 healthy blood donors. PcP cases were confirmed using indirect immunofluorescence with monoclonal anti-Pneumocystis antibodies and nested-PCR to amplify the large subunit mitochondrial rRNA gene of P. jirovecii in pulmonary specimens. BG and LDH levels in serum were measured using quantitative microplate-based assays. BG and LDH positive sera were statistically associated with PcP cases (P ≤ 0.001). Sensitivity, specificity, positive/negative predictive values (PPV/NPV), and positive/negative likelihood ratios (PLR/NLR) were 91.3 %, 61.3 %, 85.1 %, 79.2 %, 2.359, and 0.142, respectively, for the BG kit assay, and 91.3 %, 35.5 %, 75.9 %, 64.7 %, 1.415 and 0.245, respectively, for the LDH test. Serologic markers levels combined with the clinical diagnostic criteria for PcP were evaluated for their usefulness in diagnosis of PcP. The most promising cutoff levels for diagnosis of PcP were determined to be 400 pg/ml of BG and 350 U/l of LDH, which combined with clinical data presented 92.8 % sensitivity, 83.9 % specificity, 92.8 % PPV, 83.9 % NPV, 5.764 PLR and 0.086 NLR (P < 0.001). This study confirmed that BG is a reliable indicator for detecting P. jirovecii infection. The combination between BG/LDH levels and clinical data is a promising alternative approach for PcP diagnosis.


Cutoff Limit Clinical Diagnostic Criterion Induce Sputum Trichosporonosis Pulmonary Specimen 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



This research was supported by the scientific projects PTDC/SAU-MII/104231/2008 and PTDC/SAU-MIC/116716/2010 financed by Fundação para a Ciência e a Tecnologia (FCT).

We thank the Associates of Cape Cod, Inc. for providing the free BG detection kit.

Competing interests

The authors declare that they have no competing interests.


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Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • F. Esteves
    • 1
  • C.-H. Lee
    • 2
  • B. de Sousa
    • 3
  • R. Badura
    • 4
  • M. Seringa
    • 1
  • C. Fernandes
    • 1
  • J. F. Gaspar
    • 5
  • F. Antunes
    • 4
  • O. Matos
    • 1
    • 6
  1. 1.Unidade de Parasitologia Médica, Grupo de Protozoários Oportunistas/VIH e Outros Protozoários, CMDT, Instituto de Higiene e Medicina TropicalUniversidade Nova de LisboaLisboaPortugal
  2. 2.Department of Pathology and Laboratory MedicineIndiana University School of MedicineIndianapolisUSA
  3. 3.Faculdade de Psicologia e Ciências da EducaçãoUniversidade de Coimbra, CMDTCoimbraPortugal
  4. 4.Centro Hospitalar Lisboa NorteHospital de Santa Maria, FM/ULLisboaPortugal
  5. 5.Departamento de Genética, CIGMH, Faculdade de Ciências MédicasUniversidade Nova de LisboaLisboaPortugal
  6. 6.Unidade de Protozoários Oportunistas/VIH e Outras Protozooses—CMDT, Instituto de Higiene e Medicina TropicalUniversidade Nova de LisboaLisboaPortugal

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