Diagnosis of invasive candidiasis in neutropenic children with cancer by determination of D-arabinitol/L-arabinitol ratios in urine.
Determination of D-arabinitol/L-arabinitol ratios (referred to as D/L-arabinitol ratios) in urine as a tool for the diagnosis of invasive candidiasis was investigated in a prospective study comprising 100 children with cancer. The analyses were made by gas chromatography. Positive D/L-arabinitol ratios were found for 10 of 10 children with confirmed invasive candidiasis, 12 of 23 patients undergoing empiric antifungal chemotherapy, and 4 of 67 children not receiving antifungal treatment. D/L-Arabinitol ratios were positive 3 to 31 days (median, 12 days) before the first culture-positive blood sample was drawn or empiric therapy was initiated. The regular monitoring of D/L-arabinitol ratios in urine holds great promise as a sensitive method for diagnosing invasive candidiasis in immunocompromised children with cancer. Moreover, it may be possible to use an early rise in D/L-arabinitol ratios as a basis for the institution of antifungal chemotherapy and as a means of avoiding unnecessary treatment with potentially toxic antifungal agents.
Christensson
B
B
Department of Infectious Diseases, Lund University Hospital, Sweden.
Wiebe
T
T
Pehrson
C
C
Larsson
L
L
D000293:Adolescent; D000935:Antifungal Agents / Q000627:therapeutic use; D002177:Candidiasis / Q000150:complications* / Q000175:diagnosis* / Q000652:urine; D002648:Child; D002675:Child, Preschool; D006801:Humans; D016867:Immunocompromised Host; D007223:Infant; D007938:Leukemia / Q000150:complications; D008223:Lymphoma / Q000150:complications; D009369:Neoplasms / Q000150:complications* / Q000276:immunology; D009894:Opportunistic Infections / Q000150:complications* / Q000175:diagnosis* / Q000652:urine; D011446:Prospective Studies; D013237:Stereoisomerism; D013402:Sugar Alcohols / Q000737:chemistry / Q000652:urine*; D013997:Time Factors
D000935:Antifungal Agents; D013402:Sugar Alcohols; C014999:arabitol