Contribution of Serological Tests and Blood Culture to the Early Diagnosis of Systemic Candidiasis

Abstract

The isolation of Candida species from a single blood culture is considered sufficient evidence for the initiation of systemic antifungal therapy. However, blood cultures still lack sensitivity. Previous reports have suggested that the combined serological detection of mannanemia and anti-mannan antibodies may be useful for the diagnosis of systemic candidiasis caused by Candida albicans (specificity and sensitivity 93% and 80%, respectively). In this study, serological tests to detect Candida albicans mannan and Candida albicans antibodies (Platelia Candida Antigen and Antibody tests; Bio-Rad, France) were applied retrospectively to a series of patients with at least one Candida-positive blood culture and from whom at least one serum sample, taken before or on the day of blood culture, was available. Forty-five patients were selected, including 23 infected by Candida albicans, 4 by Candida glabrata, 9 by Candida tropicalis, 5 by Candida parapsilosis, and 4 by Candida krusei. Serological tests were positive in 73% of patients at least 2 days, and in some patients, up to 15 days before blood cultures became positive. These data suggest that serological surveillance of at-risk patients using the Platelia Candida tests could result in earlier initiation of antifungal therapy, especially when used in conjunction with blood cultures. In this way, more efficient management of nosocomial infections caused by Candida species can be achieved.

ECIL recommendations for the use of biological markers for the diagnosis of invasive fungal diseases in leukemic patients and hematopoietic SCT recipients

“…An advantage in early diagnosis using Mn/A-Mn detection was reported in five studies, both in hematological and ICU patients. 46,48,52,53,55 Mn-and A-Mn-positive results preceded blood cultures in 73% of 45 patients with candidemia by a mean of 6 and 7 days, respectively. 55 In 21 patients with hepatosplenic IC, 18 (86%) were Mn-and/or A-Mnpositive at a median of 16 days before radiological detection of liver or spleen lesions.…”

“…46,48,52,53,55 Mn-and A-Mn-positive results preceded blood cultures in 73% of 45 patients with candidemia by a mean of 6 and 7 days, respectively. 55 In 21 patients with hepatosplenic IC, 18 (86%) were Mn-and/or A-Mnpositive at a median of 16 days before radiological detection of liver or spleen lesions. 48 Based on the literature review, Mn and A-Mn offer a diagnostic aid in patients with suspected IC.…”

“…[42][43][44][45][46][47][48][49][50][51][52][53][54][55] The number of IC cases per study varied from 7 to 105, with a median of 25. A control group was included in 11 of 14 studies, and most frequently consisted of patients with similar risk factors but without IC, and sometimes with other documented infections.…”

Immunoglobulin G Responses to a Panel of Candida albicans Antigens as Accurate and Early Markers for the Presence of Systemic Candidiasis

“…There has been less enthusiasm for antibody detection as a diagnostic strategy because of concerns regarding false-negative tests in immunocompromised patients (26). Nevertheless, recent studies detecting antibodies against SAP (19,20), ENO1 (13,16), mannan (30,33,36), a 52-kDa metalloprotein (6), hyphal wall protein 1 (HWP1) (14), and a Candida albicans germ tube antigen (CGTA) (26) reported sensitivities and specificities that are consistent with those of other diagnostic markers, even among highly immunocompromised hosts like stem cell transplant and liver transplant recipients (11,12,21,31,34). Moreover, various combinations of an antibody test with an antigen test have been shown to be superior to either test alone in diagnosing systemic candidiasis (23,28,29).…”

Increased Sensitivity of Mannanemia Detection Tests by Joint Detection of α- and β-Linked Oligomannosides during Experimental and Human Systemic Candidiasis

“…For all of them, sensitivity is impaired by the rapid clearance by host catabolism of epitopes from the bloodstream (14, 21, 33). We have developed an enzyme immunoassay (EIA) for the detection of mannan and shown that its combination with detection of antimannan antibodies was useful for the early diagnosis of systemic candidiasis (32,33,44); these tests have been recently marketed as the Platelia Candida Ag and Platelia Candida Ab tests, respectively. The Platelia Candida Ag test detects an ␣-linked oligomannose residue (␣-Man) epitope whose circulation was transient.…”