An evaluation of serodiagnostic tests in patients with candidemia: beta-glucan, mannan, candida antigen by Cand-Tec and D-arabinitol.
The serodiagnostic tests, beta-glucan, mannan, candida antigen by Cand-Tec, and D-arabinitol were evaluated in 10 patients with candidemia, 14 patients with suspected fungemia, and 10 healthy persons. By blood culture or lysis centrifugation, C. albicans was isolated from 5 patients, C. parapsilosis from 4, and C. tropicalis from 1 patient; no organisms were isolated from the 14 patients with suspected fungemia or the 10 healthy subjects. Beta-glucan was measured by the difference between two chromogenic limulus tests (Endotoxin test-D and Endospecy), which was more than 60 pg/ml in 7 of 9 (78%) candidemic patients and 1 of 12 (8%) patients with suspected fungemia. Mannan was positive in 6 of 10 (60%) candidemic patients and 1 of 13 (8%) patients with suspected fungemia. Both antigens were very sensitive and highly specific for candidemia. However, the Cand-Tec assay was less specific, because titers of more than 4 were observed in 5 of 14 (34%) patients with suspected fungemia. D-Arabinitol was the least sensitive, because a D-arabinitol/creatinine ratio greater than 2.0 mumol/mg was observed in only 2 of 7 (29%) candidemic patients. The titers of serodiagnostic tests decreased after successful treatment with an anti-fungal agent. Our results show that the combined use of the assays in necessary for accurate serological diagnosis of candidemia.
Kohno
S
S
Second Department of Internal Medicine, Nagasaki University School of Medicine, Japan.
Mitsutake
K
K
Maesaki
S
S
Yasuoka
A
A
Miyazaki
T
T
Kaku
M
M
Koga
H
H
Hara
K
K
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000372:Agglutination Tests; D000946:Antigens, Fungal / Q000097:blood*; D002175:Candida / Q000276:immunology* / Q000302:isolation & purification; D002177:Candidiasis / Q000175:diagnosis* / Q000276:immunology; D005069:Evaluation Studies as Topic; D005260:Female; D016469:Fungemia / Q000175:diagnosis* / Q000276:immunology; D005936:Glucans / Q000276:immunology*; D006801:Humans; D008297:Male; D008351:Mannans / Q000276:immunology*; D008875:Middle Aged; D012680:Sensitivity and Specificity; D012698:Serologic Tests; D013402:Sugar Alcohols / Q000276:immunology*
D000946:Antigens, Fungal; D005936:Glucans; D008351:Mannans; D013402:Sugar Alcohols; C014999:arabitol