Clinical characteristics and risk factors associated with Pneumocystis jirovecii infection in patients with solid tumors: study of thirteen-year medical records of a large cancer center.

BACKGROUND: Pneumocystis jirovecii pneumonia (PCP)-related risk factors among patients with solid tumors are not completely defined. Thus, we aimed to characterize PCP cases with underlying solid tumors, to highlight the factors contributing to its development besides the prolonged use of moderate-to-high dose corticosteroids. METHODS: We retrospectively reviewed the medical records of patients with solid tumors diagnosed with PCP between 2006 and 2018 at a cancer center in Tokyo, Japan. Demographic and clinical data were collected, which included malignancy types, total lymphocyte count, coexisting pulmonary disease, chemotherapy, radiation therapy, corticosteroid use, and PCP-attributable mortality. RESULTS: Twenty cases of PCP with solid tumors were documented in 151,718 patients and 788,914 patient-years. Lung cancer (n = 6, 30%) was the most common underlying tumor, followed by breast cancer (n = 3, 15%). Only six (30%) patients were taking a dosage of ≥20 mg prednisone equivalents daily for ≥4 weeks from the onset of PCP. Among the remaining 14 patients, seven (50%) had coexisting pulmonary diseases, 10 (71%) had received chemotherapy within 90 days prior to PCP diagnosis, seven (50%) had undergone chest radiation therapy before PCP diagnosis, seven (50%) had received only intermittent corticosteroids, and one (7%) received no corticosteroids. Mortality attributable to PCP was 40%. CONCLUSIONS: More than half of the patients were not taking a dosage of ≥20 mg prednisone equivalents daily for ≥4 weeks. Multiple other factors (e.g., lymphocytopenia, radiation to chest) may have potentially contributed to PCP in patients with solid tumors in a composite manner. We need to establish a method for estimating the likelihood of PCP taking multiple factors into account in this patient population.

Clinical Performance of (1,3) Beta-D Glucan for the Diagnosis of Pneumocystis Pneumonia (PCP) in Cancer Patients Tested With PCP Polymerase Chain Reaction.

BACKGROUND: Serum (1,3)-beta-D glucan (BDG) is increasingly used to guide the management of suspected Pneumocystis pneumonia (PCP). BDG lacks specificity for PCP, and its clinical performance in high-risk cancer patients has not been fully assessed. Polymerase chain reaction (PCR) for PCP detection is highly sensitive, but cannot differentiate between colonization and infection. We evaluated the diagnostic performance of serum BDG in conjunction with PCP PCR on respiratory samples in patients with cancer and unexplained lung infiltrates. METHODS: We performed a retrospective analysis of adult patients evaluated for PCP at our institution from 2012 to 2015, using serum BDG and PCP PCR. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the serum BDG at different thresholds were evaluated using PCP PCR alone or in conjunction with clinical presentation in PCP PCR-positive patients. RESULTS: With PCP PCR alone as the reference method, BDG (≥80 pg/mL) had a sensitivity of 69.8%, specificity of 81.2%, PPV of 34.6%, and NPV of 95.2% for PCP. At ≥200 pg/mL in patients with a positive PCR and a compatible PCP clinical syndrome, BDG had a sensitivity of 70%, specificity of 100%, PPV of 100%, and NPV of 52.0% for PCP. CONCLUSIONS: Patients negative by both BDG and PCR were unlikely to have PCP. In patients with a compatible clinical syndrome for PCP, higher BDG values (>200 pg/mL) were consistently associated with clinically-significant PCP infections among PCP PCR-positive oncology patients.

The Diagnostic Value of (1 → 3)-Beta-D-glucans and Galactomannan Assays in Children Suffering from Bacteremia in Pediatric Intensive Care Unit.

The value of (1 â†’ 3)-beta-D-glucans (BG) and galactomannan (GM) assays on diagnostic invasive fungal infections (IFIs) has been observed in adult ICU and in children with hematological malignancies. Only scant data evaluated non-hematological in pediatric intensive care unit (PICU). Here, we retrospectively analyzed the role of bacterial infection to the reactivity of BG and GM assays in PICU. The results showed that the overall prevalence of bacteremia was 13.8% (65/470). The most common underlying disease was pneumonia (81.8%), followed by congenital heart disease (43.2%). The median levels of GM and range for each group [A: without bacterial infection nor IFIs (n = 151); B, patients with bacterial infection (n = 36); C, patients with bacterial infection and IFIs (n = 8)] were, respectively: 0.14 (0.01-1.34), 0.21 (0.06-1.34), 0.14 (0.02-0.99). No significant difference was found among three groups (P = 0.66). The median levels of BG and range for each group (A, B, C) were, respectively: 50.00 pg/mL (16.20-548.20 pg/mL), 50.00 pg/mL (16.10-597.60 pg/mL), 268.7 pg/mL (50.9-4224.00 pg/mL). Patients with bacteremia and IFIs showed significantly higher BG levels than these who with or without bacteremia (P = 0.003), but there was no significant difference between control subjects and patients with bacteremia group. We also observed the GM and BG levels in Gram-negative and Gram-positive groups. No significant difference was found between two groups. In conclusions, the results showed that bacteremia was unlikely cause of false-positive results of the BG and GM assays in PICU.

Assessment of exposure to dust, gaseous pollutants and endotoxins in sewage treatment plants of Ahmedabad city, India.

BACKGROUND: Sewage treatment plant workers (STPs) are exposed to gaseous pollutants (H2S) and bioaerosols and their health is at risk. OBJECTIVE: The aim of the study was to evaluate exposures to dust, 1,3 Beta D Glucans, endotoxins and gaseous pollutants in different process plants and to provide suitable recommendations. METHODS: Gaseous pollutants and bioaerosols (inhalable dust, 1,3 beta D-glucans and endotoxins) were evaluated in two sewage treatment plants (STPs) of Ahmedabad city, India. The concentration of H2S, CO, CH4 and Cl2 were monitored in two process areas of STPs using real-time gas detectors. The dust, 1,3 beta D-glucans and endotoxins were evaluated as per standard methods. RESULTS: The mean concentration of H2S exceeded the permissible exposure limit of 10 ppm, whereas the concentration of other gaseous pollutants (CO, Cl2 and CH4) were below the permissible exposure limits of Indian Factories Act, 1948. The inhalable dust concentration was also within the permissible exposure limit of 10 mg/m3 as per Indian Factories Act, 1948. CONCLUSIONS: Significant exposures to gaseous and bioaerosols were found in the work environment of STPs. The paired t-test result showed a significant difference between two STPs for H2S, 1,3 beta D-Glucans and endotoxins. STPs were advised to reduce the exposure to H2S and bioaerosols as per CPCB guidelines applicable to India to prevent health effects.

The protective role of phytate in the oxidative degradation of cereal beta-glucans.

This study investigated the role of phytate in the Fenton reaction induced oxidative degradation of cereal ß-glucan. Viscosity analysis showed that the degradation rate was high in the beginning of oxidation, which fitted to the second order kinetic model. Oat ß-glucan contained significant amount of residual phytate and after the residual phytate was removed, faster degradation was shown compared to the original oat ß-glucan. Adding the same amount of phytic acid (PA) to the phytate removed ß-glucan sample also retarded the degradation but not as efficiently as the residual phytate. Considerable retardation of viscosity loss was shown when the PA to iron ratio was high. The presence of ascorbic acid weakened the retardation effect of phytic acid. Thus, phytate can significantly improve the oxidative stability of ß-glucan when the ratio of phytic acid to transition metals and the presence of ascorbic acid are taken into consideration.