Diagnosing Invasive Candidiasis

Summary Objective To assess the diagnostic value of serum Candida mannan antigen (MN) and anti‐mannan IgG and IgM antibodies for candidiasis. Methods This study was a prospective cohort study. Clinical data and venous blood samples from 23 medical centres in Beijing, China were collected between 1 January 2017 and 31 December 2018. All collected specimens were tested within one week for serum Candida MN and IgG and IgM antibodies using an ELISA kit. Results A total of 452 patients were enrolled, including 188 patients in the Candida exposure groups (56 patients with Candida bloodstream infection, 69 patients with Candida‐positive tracheal aspirate cultures and 63 patients with Candida‐positive urine cultures) and 264 patients in the control groups (212 healthy controls and 52 patients with bacteraemia). The receiver operating characteristic (ROC) curve of the 56 patients with Candida bloodstream infection and 212 healthy controls showed that serum MN and IgG had good diagnostic value. The area under the ROC curve (AUC) values were 0.812 (95% CI, 0.750‐0.873) and 0.866 (95% CI, 0.808‐0.924), respectively, wherein the MN specificity and sensitivity were 86.79% and 60.71%, and the IgG were 84.43% and 80.36%, respectively. The AUC of the combination of serum MN and IgG was 0.871(95% CI, 0.813‐0.929), and the specificity and sensitivity were 93.87% and 57.14%. Conclusions The serum levels of Candida MN and its IgG antibody have diagnostic value for Candida bloodstream infection, and combination of MN and IgG can improve diagnostic specificity and may provide a new approach for diagnosis of candidaemia.

Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 96%

Diagnostic value of Candida mannan antigen and anti‐mannan IgG and IgM antibodies for Candida infection

Wang

Luo

Zhang

et al. 2019

“…Several commercial assays are available for detection of mannan antigen or anti‐mannan antibodies in body fluids to improve the diagnosis of IC (Table 2). However, none of these assays has been approved by FDA 28 . Earlier indirect assays such as Pastorex Candida test (Sanofi Diagnostics Pasteur, Mames‐la‐Coquette, France) that used latex agglutination technique to detect mannan antigen showed poor sensitivity (0%‐25%) and limited diagnostic utility due to low serum concentration and rapid clearance of mannan from the bloodstream 28 .…”

Section: Mannan Marker For Diagnosis Of Invasive Candidiasismentioning

confidence: 99%

“…However, to date, only the Fungitell test (Associates of Cape Cod) is FDA‐approved as an adjunct for the diagnosis of invasive mycoses 39 . Fungitell and other assays evaluate BDG concentrations in body fluids by utilising indirect colorimetric or turbidimetric methods to measure the rate of activation of a horseshoe crab coagulation cascade mediated by BDG binding 28 . Fungitell test can detect BDG levels as low as 1 pg/mL in serum within days to weeks 40 prior to positive blood cultures and thus could be useful for earlier initiation of antifungal therapy and distinguishing between patients with or without IFIs 41 .…”

Section: Bdg As a Panfungal Marker For Ifis Diagnosismentioning

confidence: 99%

Cell wall polysaccharides from pathogenic fungi for diagnosis of fungal infectious disease

Osibe

Lei

Wang

et al. 2020

Invasive fungal diseases are associated with significant morbidity and mortality, particularly in immunocompromised individuals. Early and accurate diagnosis is crucial for effective treatment. Despite traditional methods such as microbiological culture, histopathology, radiology and direct microscopy are available, antigen/antibody‐based diagnostics are emerging for diagnosis of invasive fungal infections (IFI). Fungal cell wall is a unique structure composed of polysaccharides that are well correlated with fungal burden during fungal infections. Based on this feature, cell wall polysaccharides have been explored as antigens in IFIs diagnostics such as the galactomannan assay, mannan test, β‐glucan assay and cryptococcal CrAg test. Herein, we provide an overview on the cell wall polysaccharides from three opportunistic pathogens: Aspergillus fumigatus, Candida albicans and Cryptococcus neoformans, and their applications for IFIs diagnosis. The clinical outcome of newly developed cell wall polysaccharides‐based diagnostics is also discussed.

“…The Fungitell assay measures plasma concentrations of BDG using a kinetic protocol which involves the binding of BDG to a horseshoe crab coagulate. This triggers a coagulation cascade which can be used to subsequently quantify BDG concentrations using colorimetric methods similar to that of an enzyme‐linked immunosorbent assay …”

Section: (1→3)‐β‐d‐glucan As An Emerging Diagnostic Toolmentioning

confidence: 99%

Use of (1→3)‐β‐d‐glucan for diagnosis and management of invasive mycoses in HIV‐infected patients

Farhour

Mehraj

Chen

et al. 2018

SummaryPeople living with HIV (PLHIV) are highly vulnerable to invasive fungal infections (IFIs) due to their immune dysfunction. Diagnosis and treatment of IFIs remain challenging due to the requirement of deep tissue sampling to visualise and culture fungi before initiating treatment. Such techniques are less practical in resource‐limited settings due to their cost and requirement of relatively invasive procedures. Hence, identification of surrogate markers for the early diagnosis and therapeutic monitoring of IFIs is required. Recent studies have shown that (1→3)‐β‐d‐glucan (BDG), a major fungal cell wall antigen, represents a promising soluble marker for the presumptive diagnosis and therapeutic monitoring of IFIs in HIV‐infected patients. Herein, we review findings on the merits of BDG assays in the diagnosis of IFIs and monitoring of antifungal therapies for PLHIV. Conversely to other types of immunocompromised patients, HIV infection is associated with gut damage and subsequent bacterial and fungal translocation leading to elevated BDG plasma levels.