Serum (1 → 3)-β-d-glucan measurement as an early indicator of Pneumocystis jirovecii pneumonia and evaluation of its prognostic value  J. Held, M.S. Koch, U. Reischl, T. Danner, A. Serr  Clinical Microbiology and Infection  Volume 17, Issue 4, Pages 595-602 (April 2011) DOI: 10.1111/j.1469-0691.2010.03318.x Copyright © 2011 European Society of Clinical Infectious Diseases Terms and Conditions

Fig. 1 (1→3)-β-D-Glucan (BG) kinetics of a patient with Pneumocystis jirovecii (carinii) pneumonia in whom timely measurement of BG could have prevented a significant delay in initiation of effective therapy. A 26-year-old female with acute lymphoblastic leukaemia underwent haematopoietic stem cell transplantation in December 2005. On 29 May 2006 (day)5), she presented with fever, dyspnoea and non-productive cough. The patient was on trimethoprim–sulphamethoxazole (SXT) prophylaxis. Chest X-ray showed bilateral infiltrates suggestive of atypical pneumonia. Serum Aspergillus galactomannan testing gave negative findings. Therapy with clarithromycin was initiated but showed no effect. The patient was re-admitted to the hospital on day)3. A computed tomography scan showed progression of the infiltrates, and therapy was changed to meropenem, voriconazole and foscavir. Bronchoscopy was performed on day 0, and P. jirovecii cysts were detected by specific immunofluorescence and PCR. Intravenous trimethoprim–sulphamethoxazole was started, with good treatment response. The subsequent clinical course was uneventful, and the patient was discharged on day 23. Retrospectively, BG levels were already highly elevated (836 pg/mL) on day)5, and a steady decrease in BG levels reflected a good clinical response. The red line indicates the cut-off (85 pg/mL). BAL, bronchoalveolar lavage; CL, clarithromycin; F, foscavir; M, meropenem; Pj, P. jirovecii; V, voriconazole. Clinical Microbiology and Infection 2011 17, 595-602DOI: (10.1111/j.1469-0691.2010.03318.x) Copyright © 2011 European Society of Clinical Infectious Diseases Terms and Conditions