title: Early diagnosis of invasive candidiasis with mannan antigenemia and antimannan antibodies.
abstract: Late treatment of invasive candidiasis (IC) results in severe complications and high mortality. New tools are needed for early diagnosis. We conducted a retrospective study to assess the diagnostic utility of mannan antigenemia (Mn) and antimannan antibodies (anti-Mn) in neutropenic cancer patients at high risk for candidiasis. Twenty-eight patients with IC (based on European Organization for Research and Treatment of Cancer and Mycoses Study Group definitions) and 25 controls were studied. Mn and anti-Mn were positive (> or = 0.25 ng/mL and > or = 5 AU/mL, respectively) in 25/28 (89%) patients with candidiasis and in 4/25 (16%) controls: sensitivity, 89%; specificity, 84%; positive predictive value, 86%; negative predictive value, 88%. In patients with hepatosplenic lesions, assessing Mn/anti-Mn shortened the median time of diagnosis of candidiasis when compared with imaging (9 versus 25 days after fever onset as first sign of infection; P < 0.001). Candidiasis was diagnosed before neutrophil recovery in 78% and 11% of cases with Mn/anti-Mn and radiology, respectively (P < 0.001). Mn and anti-Mn may be useful for early noninvasive diagnosis of IC.
authors.affiliation: Infectious Diseases Service, Department of Internal Medicine, Centre Hospitalier Universitaire Vaudois, CH-1011 Lausanne, Switzerland.
authors.forename: Maura
authors.initials: M
authors.lastname: Prella
authors.forename: Jacques
authors.initials: J
authors.lastname: Bille
authors.forename: Mauro
authors.initials: M
authors.lastname: Pugnale
authors.forename: Bertrand
authors.initials: B
authors.lastname: Duvoisin
authors.forename: Matthias
authors.initials: M
authors.lastname: Cavassini
authors.forename: Thierry
authors.initials: T
authors.lastname: Calandra
authors.forename: Oscar
authors.initials: O
authors.lastname: Marchetti
mesh_terms: D000328:Adult; D000368:Aged; D000908:Antibodies, Fungal / Q000032:analysis* / Q000276:immunology; D002177:Candidiasis / Q000175:diagnosis* / Q000276:immunology; D016022:Case-Control Studies; D042241:Early Diagnosis; D005260:Female; D016469:Fungemia / Q000175:diagnosis* / Q000276:immunology; D019337:Hematologic Neoplasms / Q000175:diagnosis / Q000276:immunology*; D006801:Humans; D016867:Immunocompromised Host; D008297:Male; D008351:Mannans / Q000276:immunology; D008875:Middle Aged; D009894:Opportunistic Infections / Q000175:diagnosis*; D011379:Prognosis; D012016:Reference Values; D012189:Retrospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity
chemical_list: D000908:Antibodies, Fungal; D008351:Mannans