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

Alanio, Alexandre
Hauser, Philippe M.
Lagrou, Katrien
Melchers, Willem J. G.
Helweg-Larsen, Jannik
Matos, Olga
Cesaro, Simone
Maschmeyer, Georg
Einsele, Hermann
Donnelly, J. Peter
Cordonnier, Catherine
Maertens, Johan
Bretagne, Stéphane
Agrawal, Samir
Akova, Murat
Alanio, Alexandre
Aljurf, Mahmoud
Averbuch, Dina
Berg, Thomas
Blennow, Ola
Bretagne, Stéphane
Brüggemann, Roger
Calandra, Thierry
Castagnola, Elio
Cesaro, Simone
Cordonnier, Catherine
Cornely, Oliver
De La Camara, Rafael
Donnelly, Peter
Drgona, Lubos
Duarte, Rafael
Einsele, Hermann
Engelhard, Dan
Girmenia, Corrado
Hargreaves, Ruth
Hauser, Philippe
Helweg-Larsen, Jannick
Herbrecht, Raoul
Hirsch, Hans
Hubacek, Petr
Kibbler, Christopher
Klyasova, Galina
Kouba, Michal
Kullberg, Bart-Jan
Lagrou, Katrien
Ljungman, Per
Maertens, Johan
Mallet, Vincent
Marchetti, Oscar
Maschmeyer, Georg
Matos, Olga
Melchers, Willem
Mikulska, Malgorzata
Munoz, Patricia
Orasch, Christina
Pagano, Livio
Pagliuca, Antonio
Penack, Olaf
Pettrikos, George
Racil, Zdenek
Ribaud, Patricia
Rizzi-Puechal, Valérie
Roilides, Emmanuel
Sinko, Janos
Skiada, Anna
Slavin, Monica
Styczynski, Jan
Tissot, Frederic
Tweddle, Lorraine
van Boemmel, Florian
von Lilienfeld-Toal, Marie
Viscoli, Claudio
Ward, Katherine
Wood, Craig

¹Parasitology-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
²Institute of Microbiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
³Department of Microbiology and Immunology, Catholic University Leuven, Leuven, Belgium and National Reference Center for Mycosis, Department of Laboratory Medicine, University Hospitals Leuven, Leuven, Belgium
⁴Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, The Netherlands
⁵Department of Infectious Diseases, Rigshospitalet-Copenhagen University Hospital, Copenhagen, Denmark
⁶Medical 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
⁷Hematology Department, Oncoematologia Pediatrica, Policlinico G. B. Rossi, Verona, Italy
⁸Department of Hematology, Oncology and Palliative Care, Ernst-von-Bergmann Klinikum, Potsdam, Germany
⁹Medizinische Klinik und Poliklinik II, Julius Maximilians Universitaet, Würzburg, Germany
¹⁰Department of Hematology, Radboud University Medical Center, Nijmegen, The Netherlands
¹¹Hematology Department, Henri Mondor Hospital, APHP and Université Paris-Est-Créteil, Créteil, France
¹²Hematology Department, University Hospital Leuven, Campus Gasthuisberg, Leuven, Belgium

Corresponding author. Haematology Department, Henri Mondor University Hospital, 51 Avenue du Maréchal de Lattre de Tassigny, 94000 Créteil, France. Tel: +33 1 49 81 20 59; Fax: +33 1 49 81 20 67; E-mail: [email protected]

† ECIL-5 participants are listed in the Acknowledgements section.

Journal of Antimicrobial Chemotherapy 71(9):p 2386-2396, September 2016. | DOI: 10.1093/jac/dkw156

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.