Early diagnosis of invasive candidiasis with mannan antigenemia and antimannan antibodies.
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.
Prella
Maura
M
Infectious Diseases Service, Department of Internal Medicine, Centre Hospitalier Universitaire Vaudois, CH-1011 Lausanne, Switzerland.
Bille
Jacques
J
Pugnale
Mauro
M
Duvoisin
Bertrand
B
Cavassini
Matthias
M
Calandra
Thierry
T
Marchetti
Oscar
O
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
D000908:Antibodies, Fungal; D008351:Mannans