Characteristic and clinical relevance of Candida mannan test in the diagnosis of probable invasive candidiasis

Abstract

The gold standard laboratory tests used to diagnose invasive Candida infection (ICI) are based on the in vitro culture of blood or samples from other sterile sites. However, these tests have limited sensitivity (Se) and are generally not diagnostic until late in the infectious process. The Serion Candida mannan kit was evaluated for the diagnosis of ICI at Grenoble University Hospital (France) between 2007 and 2011. The results were then compared with worldwide data published between 1997 and 2011. This retrospective study was based on follow-up from the investigation of 162 patients of whom 91 had proven ICI; 13 had Candida colonization index (CCI) scores ≥0.42, positive mannan tests, with nonconcomitant infections; and 58 had no evidence of Candida infection. Candida albicans, C. glabrata, C. tropicalis, and C. parapsilosis were the etiologic agents in 104 patients. For patients with or without ICI, the 12-week mortality rates were 35/104 (33.7%) and 6/58 (10.3%), respectively. The mannan diagnostic specificity was 51% and Se was 77%. However, in the meta-analysis (n = 1,536), values were 86% and 62%, respectively. Positive mannan test results may appear early (median 6 days) in the development of candidemia and have moderate diagnostic value for ICI, with a negative predictive value of 83%. In patients at risk of ICI with negative candidemia, the combination of Candida mannan test data with a CCI score ≥0.42 may improve the diagnosis of probable ICI.

Contribution of Candida biomarkers and DNA detection for the diagnosis of invasive candidiasis in ICU patients with severe abdominal conditions

“…The combination of mannan-Ag and mannan-Ab has been also recommended [ 28 , 34 ] but results of clinical studies are not very encouraging, with a diagnostic specificity of 51 % and sensitivity of 77 % in a retrospective analysis of 162 patients of whom 91 had proven IC [ 35 ]. In samples from 31 patients with candidemia and 50 patients with bacteremia, the use of mannan-Ag and mannan-Ab alone showed sensitivities of 64.3 % and 61.5 %, specificities of 95.7 % and 65.8 %, and negative predictive values of 81.8 % and 71.4 %, respectively [ 32 ].…”

Specificity of mannan antigen and anti‐mannan antibody screening in patients with haematological malignancies at risk for fungal infection

“…Mannans are a main cell wall component of Candida spp. and may therefore be specific biomarkers for detection of ICIs . In particular, combination of mannan antigen and anti‐mannan antibody (Mn/A‐Mn) testing has been recommended as a highly sensitive and specific strategy for diagnosis of invasive Candida infections .…”

Components of the Calcium-Calcineurin Signaling Pathway in Fungal Cells and Their Potential as Antifungal Targets

“…Candida spp., Aspergillus spp., and Cryptococcus spp. are the most pervasive fungal pathogens isolated in invasive fungal infections (3)(4)(5)(6)(7)(8). In contrast with bacterial infections, many of which can be treated with multiple classes of antibiotics, the therapeutic options for fungal infections are exceedingly insufficient due to the limited number of antifungal drugs available and their potential toxicity (9,10).…”