title: Activated platelet-derived microparticle numbers are elevated in patients with severe fungal (Candida albicans) sepsis.
abstract: BACKGROUND
  The treatment of severe sepsis highly depends on the identification of bacteria or fungi from blood and/or other body materials. Although widely available blood culturing and risk assessment scores are not completely reliable, current guidelines do not recommend the wide empirical use of antifungal medications based on questionable benefit or possible side-effects. We aimed to test whether platelet-derived microparticle (MP) measurements can improve the early detection of the infective agent behind sepsis.
  
  
  METHODS
  Thirty-three consecutive severe septic patients from our university intensive care unit were included in our prospective study. MP number and surface antigen characteristics were followed by flow cytometry on days 1 (admission), 3 and 5. For microbiological identification, various specimens were collected on admission and in case of overall status deterioration.
  
  
  RESULTS
  On admission, septic patients showed elevated annexin V and constitutive platelet marker (CD41)-positive MP numbers compared with volunteers. Mixed fungal septic patients showed significantly elevated annexin V and CD41-positive particle numbers on day 1 (P < 0.05) compared with the non-fungal septic group. Adhesive platelet marker (CD42a) harbouring vesicles were negligible in the non-fungal group, while fungal septic patients showed significantly elevated numbers in all measurements (P < 0.01). Particles from activated platelets (PAC1) had elevated numbers in the first and fifth study days compared with non-fungal septic patients (P < 0.05).
  
  
  CONCLUSIONS
  The measurement of CD42a- and PAC1-positive microparticles may provide important additional information which can help to improve the early instalment of antifungal therapy of severe septic patients.
authors.affiliation: Division of Intensive Care, Department of Anaesthesia and Intensive Therapy, University of Pécs, Ifjúság str. 13, 7624 Pécs, Hungary.
authors.forename: Gábor
authors.initials: G
authors.lastname: Woth
authors.forename: Margit
authors.initials: M
authors.lastname: Tőkés-Füzesi
authors.forename: Tamás
authors.initials: T
authors.lastname: Magyarlaki
authors.forename: Gábor L
authors.initials: GL
authors.lastname: Kovács
authors.forename: István
authors.initials: I
authors.lastname: Vermes
authors.forename: Diana
authors.initials: D
authors.lastname: Mühl
mesh_terms: D000368:Aged; D017304:Annexin A5 / Q000378:metabolism; D001792:Blood Platelets / Q000166:cytology / Q000473:pathology*; D002176:Candida albicans / Q000502:physiology*; D002177:Candidiasis / Q000097:blood / Q000473:pathology*; D055252:Cell-Derived Microparticles / Q000737:chemistry* / Q000473:pathology*; D019411:Clinical Laboratory Techniques / Q000379:methods / Q000592:standards; D005260:Female; D005434:Flow Cytometry; D006801:Humans; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000473:pathology; D040201:Platelet Membrane Glycoprotein IIb / Q000378:metabolism; D011446:Prospective Studies; D018805:Sepsis / Q000097:blood / Q000473:pathology*
chemical_list: D017304:Annexin A5; D040201:Platelet Membrane Glycoprotein IIb