D-Arabinitol, a major candidal metabolite, is reported to be a useful parameter to diagnose disseminated candidiasis. Conventional determination of serum D-arabinitol levels using gas-liquid chromatography is complicated and time-consuming compared with the enzymatic fluorometric assay, newly available in kits. D-Arabinitol concentrations were determined by both enzymatic fluorometric assay kits and gas-liquid chromatography, and a significant correlation (r = 0.943, p < 0.01) was found between the two methods in 25 sera from 15 patients with candiduria. D-Arabinitol/creatinine ratios were determined using the enzymatic fluorometric assay in 39 candiduria patients (21 febrile and 18 afebrile) and 22 patients without candiduria as the control. The ratios in the febrile patients were significantly greater than those in the afebrile and the nondocumented candidiasis groups. These results suggest that knowledge of the serum D-arabinitol concentration may help to promptly diagnose invasive candidiasis, particularly Candida pyelonephritis. In addition, enzymatic fluorometric assay kits are considered to be advantageous in that they require little time and are simple to use, as compared with gas-liquid chromatography.
To investigate the pathogenicity of the hyphal form of Candida in pyelonephritis a Candida albicans strain, assuming only the yeast form but not the hyphal form when induced by ultraviolet mutagenesis, and a revertant strain from this mutant strain showing bimorphism were compared in a rat experimental model with regard to the incidence of ascending Candida pyelonephritis and the grade of inflammation. To increase the frequency of pyelonephritis unilateral incomplete ureteral stenosis was created. The revertant strain assuming the hyphal form showed a significantly (p < 0.01) higher frequency of pyelonephritis as compared with the mutant strain not assuming this form, and the grade of inflammation was also higher in the revertant strain group. Also, higher renal tissue and serum levels of both lipid peroxide and superoxide dismutase, which are related to marked renal oxidant injury, tended to be correlated with the degree of neutrophil infiltration in the acute phase. These findings suggest that the hyphal form plays an important role in the development of C. albicans pyelonephritis and also that the oxygen radicals from neutrophils appearing at the sites of inflammation play a major part in the further extension of inflammatory lesions.
To evaluate serum markers for the diagnosis of Candida pyelonephritis, levels of D-arabinitol, candidal mannan antigen and candidal protein antigen were measured using an enzymatic fluorometric assay, an enzyme immunoassay and a latex agglutination assay, respectively. The study group comprised 36 patients with candiduria (11 disseminated candidiasis, 9 Candida pyelonephritis and 16 colonization) and 27 without candiduria. The D-arabinitol/creatinine ratio was the only marker that differentiated between Candida pyelonephritis and colonization (p < 0.01). Using the cut-off values (1.4 mumol/mg of D-arabinitol/creatinine ratio, 0.28 of mannan/creatinine ratio (x 10(4)) and 1:4 of protein antigen titer) D-arabinitol/creatinine ratio showed the highest sensitivity in Candida pyelonephritis (77.8%) as compared to mannan/creatinine ratio (55.6%) and protein antigen titer (11.1%) although there were no differences in specificity, positive predictive value or negative predictive value. These results suggest that D-arabinitol/creatinine ratio is the most useful marker of Candida pyelonephritis.
The diagnostic value of determination of serum mannan levels was studied in 41 patients with candiduria and 20 control patients without candiduria. The patients with candiduria comprised 18 asymptomatic afebrile patients (group 1) and 23 febrile patients with suspected Candida pyelonephritis (group 2). Mannan antigenemia (> or equal to 0.5 ng/ml) was detected in 14 patients in group 2, this rate being significantly higher than the rate of four patients in group 1 (p < 0.05) and none in the control group (p < 0.01). Serum mannan levels decreased gradually and became undetectable in six patients in whom therapy with an anticandidal agent was effective. Determination of serum mannan levels may be a useful parameter in diagnosing Candida pyelonephritis and deciding on effective treatment.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.