Flea Bytes: Fungitell (B,D Glucans) for Diagnosis of Pneumocystis Pneumonia

The gold standard for diagnosing pneumocystis jirovecii pneumonia is by isolating the bug itself either by DFA or culture. This task is much harder in non-HIV patients as the organism load is much lower. This meta-analysis examined 14 studies, most were retrospective. 2 only included patients with HIV, 8 with both HIV and non-HIV patients with other types of immunosuppression, and 2 with non-HIV immunosuppressed patients.

Using this pool of studies, the authors found that Fungitell had excellent sensitivity 95%, very good specificity  86%, and AUC of 97%.

+ LR 6.9 (5.1–9.3)
–  LR 0.06 (0.03–0.11)
The p-value for heterogeneity was 0.31. Two studies lie clearly out of the 95% ellipse.

In cases where obtaining microbiologic samples is impossible, dangerous, or even too difficult – BD glucans may be a way to empirically treat patients with some confidence.

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Flea Bytes: BNP Test Characteristic in ED Patients with Dyspnea

BNPNejm

The BNP test alone was more accurate than any history or physical exam finding in predicting CHF as the cause of dyspnea. One must remember that BNP has a range of NPV and PPV depending on the value and you shouldn’t use a single cut point in making clinical decisions.

Reference:
Breathing Not Properly Study: N Engl J Med 2002; 347:161-167 http://www.nejm.org/doi/full/10.1056/NEJMoa020233#t=abstract