Clinical Significance of Measurement of Serum D-Arabinitol Levels in Candiduria Patients

Abstract

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.

Candida Infections of the Genitourinary Tract

“…Data from experiments in rabbits suggests that detection of renal Candida casts may be a useful diagnostic marker in distinguishing upper versus lower urinary tract candidiasis (178), but the frequency of this finding is unknown (16,106). One study suggests that the D-arabinitol/ creatinine ratio could be used to differentiate between Candida pyelonephritis and colonization (261). However, in that study the clinical distinction between pyelonephritis and colonization was poorly documented.…”

Current Status of Nonculture Methods for Diagnosis of Invasive Fungal Infections

“…Table 8 summarizes the results of several clinical studies that have evaluated D-arabinitol as a diagnostic marker for candidiasis. The early studies in which serum arabinitol concentrations were determined by GC and GC-MS (105,180), a study in which serum arabinitol/creatinine ratios were determined by GC (74), studies that used enzymatic assays to determine serum D-arabinitol/creatinine ratios (67,204,205,219) and studies that used GC-MS to determine the serum or urine D-/Larabinitol ratios (41,117,179) all support the usefulness of D-arabinitol, both as an initial diagnostic marker and for mon- (51,52,58,136). Some of these results can be explained by analytical artifacts (235), others could not be reproduced when they were examined in greater detail (232,237), and some unfavorable results remain unexplained.…”

CandidaAntigen Detection by a Latex Agglutination Test in Candiduria Patients

“…a major candidal metabolite, is a useful parameter in the prompt diagnosis of Candida pyelonephritis in candiduria patients [16], However, the measurement kit is only limitedly available in Japan and, in addition, some other methods such as enzyme-linked immunosorbent, gas-liquid chromato graphic or spectrofluorometric assays are complicated, time-consuming and, in part, expensive. On the other hand, since the CAND-TEC assay has the advantages described above, its usefulness in patients with various Candida infections has been investigated [1][2][3][4][5][6][7][8], This assay which detects candidal protein antigen, not mannans [1], is apparently specific for the fungal antigen which circulates in the sera of patients with infections caused by C. albicans, C. tropicalis or C. parapsilosis [2], This test was recently reported to be unreliable [5][6][7] because the antigen detected by this assay has not been identified [ 1,3], while the positive threshold has not been decided [3].…”