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

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 ß-d-glucan in serum can contribute to the diagnosis but not the follow-up of PCP ( A-II ). A negative serum ß-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.