Contribution of the PlateliaCandida-Specific Antibody and Antigen Tests to Early Diagnosis of SystemicCandida tropicalisInfection in Neutropenic Adults

Abstract

The Platelia Candida-specific antigen and antibody assays (Bio-Rad Laboratories) were used to test serial serum samples from seven neutropenic adult patients with hematological malignancies who had developed systemic Candida tropicalis infections. The diagnosis of candidiasis was based on a positive blood culture (all seven patients) and the isolation of C. tropicalis from a normally sterile site (six patients). All patients received early antifungal therapy with amphotericin B and/or an azole derivative and had successful outcomes. When the combined assays were applied to sera collected at different time points before and after the first positive blood culture, all patients tested positive. In six patients, at least one positive test was obtained with sera collected, on average, 5 days (range, 2 to 10 days) prior to the first positive blood culture, while blood cultures were constantly negative. High and persistent mannanemias were detected in all patients during the neutropenic period. In five patients, an increased antibody response was detected when the patients recovered from aplasia. Controls consisted of 48 serum samples from 12 febrile neutropenic patients with aspergillosis (n ‫؍‬ 4), bacteremia (n ‫؍‬ 4), or no evidence of infection (n ‫؍‬ 4). A low level of mannanemia was detected in only one serum sample, and none showed significant Candida antibody titers. Our data thus confirm the value of the combined detection of mannanemia and antimannan antibodies in individuals at risk of candidemia and suggest that in neutropenic patients, an approach based on the regular monitoring of both markers could contribute to the earlier diagnosis of C. tropicalis systemic infection.

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

“…48 The sensitivity of both Mn and A-Mn varied for different Candida species, and was the highest for C. albicans, followed by C. glabrata and C. tropicalis. 45,49 The temporal relationship between Mn/A-Mn detection in serum compared with conventional methods was also analyzed. An advantage in early diagnosis using Mn/A-Mn detection was reported in five studies, both in hematological and ICU patients.…”

“…[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.…”

A prospective study of real-time panfungal PCR for the early diagnosis of invasive fungal infection in haemato-oncology patients

“…Among the techniques based on antigen detection, the commercially available sandwich enzyme-linked immunosorbent assays (ELISA) for the detection of circulating aspergillus galactomannan (GM) 12 and candida mannan (M) (fungal cell wall components) (Platelia s Aspergillus and Platelia s Candida) are currently the most promising. [13][14][15][16] In particular, the GM ELISA has been shown to be sensitive and specific for the early diagnosis of invasive aspergillosis (IA), [17][18][19][20][21] and antigen detection is now included in the European Organisation for Research and Treatment of Cancer/Mycosis Study Group (EORTC/MSG) guidelines as one of the criteria for diagnosis of IA 22 and has been approved by the United States Food and Drug Administration (FDA).…”

Principales infecciones en el paciente oncológico: manejo práctico

“…Sin embargo, en los últimos años han resurgido otras especies como C. krusei, C. lusitaniae, C. utilis, C. dublinensis y C. guillermondii. La introducción de fluconazol y otros azoles ha condicionado la selección de Candidas no albicans con resistencia a azoles en estos pacientes como C. krusei y C. glabrata, aunque también se han propuesto otros factores [11][12][13][14][15] .…”