Nonvalue of antigen detection immunoassays for diagnosis of candidemia

Abstract

We evaluated the Cand-Tec (Ramco Laboratories Inc., Houston, Tex.) and LA-Candida antigen detection system (Immuno-Mycologics Inc., Norman, Okla.) tests as possible rapid alternatives to blood cultures for the identification of patients with candidemia. Tests were performed on sera from (i) 33 patients with candidemia, (ii) 82 patients with fever and risk factors for invasive candidiasis, and (iii) 13 healthy controls. A total of 21 patients had no evidence of invasive candidiasis, as determined by clinical course, blood culture, and/or autopsy; results for 61 patients were indeterminate regarding the presence of invasive candidiasis, or else the patients had invasive candidiasis with organ involvement. By using a threshold positive Cand-Tec titer of '1:4, the sensitivity in candidemic patients was 49%; the specificity was 43% (patients with true-negative results had neither candidemia nor other evidence of invasive candidiasis). Coexistent disseminated candidiasis in some candidemic patients may have accounted for some positive Cand-Tec tests and possible overestimation of the sensitivity of the test for candidemia. Cand-Tec test results were negative for healthy controls. All test results obtained by the LA-Candida antigen detection system assay were negative. Our findings indicate that neither of these assays reliably identifies patients with candidemia.

Retrospective evaluation of two latex agglutination tests for detection of circulating antigens during invasive candidosis

“…For Pastorex Candida, the high specificity is in agreement with earlier findings (23). The specificity of Cand-Tec reported in other studies varied considerably (6,8,12,16,25,26,28).…”

“…The presence of Candida antigens in serum appears to be a specific indicator of invasive disease (2,9,15,22,24,28,33). However, the low and varying antigen concentrations, which often fall below the detection limits of the available methods (5,26,33), also lead to controversy about the clinical usefulness of antigen detection tests. In this study, we compared the results of culture and of antibody and antigen detection in a group of 19 patients with or without an antibody response.…”

An Evaluation of Serodiagnostic Tests in Patients with Candidemia: Beta‐Glucan, Mannan, Candida Antigen by Cand‐Tec and D‐Arabinitol

“…The sensitivity of Cand-Tec (70%) in patients with candidemia in the present study was similar to that of beta-glucan and mannan assays, but the specificity was much lower than the other assays. The sensitivity and specificity have varied among reports (6,7,15,16,20), and Phillips reported that the assay was unreliable in candidemic patients (20). D-Arabinitol is a major metabolic product of C. albicans, C. tropicalis, C. parapsilosis, C. solani, and C. guilliermondi.…”

Intraabdominelle Pilzinfektionen

“…Im Verlauf einer schweren hämorrhagisch nekrotisierenden Pankreatitis werden Systemmykosen beschrieben. 28 30 Die antimykotische Behandlung von C. albicans (C. tropicalis, C. parapsilosis) sollte initial mit Fluconazol 800 mg die )1 gefolgt von 400 mg die )1 erfolgen. Bei Differenzierung von C. krusei, C. glabrata oder weiteren non-albicans Stämmen sowie resistenten C. albicans sollte die Fluconzoldosis auf 800 mg die )1 (C. glabrata) gesteigert werden bzw.…”