The utility of serology in diagnosing candidosis in non‐neutropenic critically ill patients

Ibáñez-Nolla, Jordi; Jm, Torres-Rodríguez; Nolla, M.; León, MA; Méndez, Raúl; Soria, G; Rm, Díaz Romero; Marrugat, Jaume

doi:10.1046/j.1439-0507.2001.00616.x

Cited by 9 publications

(9 citation statements)

References 26 publications

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“…However, none of our patients showed detectable mannan levels (Ն2.5 ng/ml). The sensitivity of this test has been reported to range between 0 and 25% (6,8,17,19). In accordance with our results Gutierrez et al reported that all their patients with candidemia were negative for the Pastorex Candida test (6).…”

Section: Discussionsupporting

confidence: 91%

Circulating β (1-3) Glucan and Immunoglobulin G Subclass Antibodies toCandida albicansCell Wall Antigens in Patients with Systemic Candidiasis

Kondori

Edebo

Mattsby‐Baltzer

2004

Clin Vaccine Immunol

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Invasive candidiasis in patients who are immunocompromised or in intensive care units (ICUs) presents both diagnostic and therapeutic problems. We previously described antibodies that were directed against Candida albicans cell wall fragments (CW), periodate-treated CW (CW IO4 ), phosphopeptidomannan (PPM), and ␤(1-3) glucan. In this study, circulating fungal antigens [mannan and ␤(1-3) glucan] and immunoglobulin G (IgG) subclass antibodies to these cell wall antigens (anti-CW) were analyzed in patients with systemic candidiasis. Sera were collected from 14 patients on two or three consecutive occasions, starting on the day when candidiasis was culture proven. The sera were analyzed by enzyme-linked immunosorbent assay. The control groups consisted of lactating mothers (n ‫؍‬ 9) (group I) who had breast milk that was positive for C. albicans and also had acute inflammation of the nipples, and age-matched blood donors (n ‫؍‬ 10) (group II). Within the first 3 weeks of Candida infection all of the patients were positive for ␤(1-3) glucan by the Gluspecy test, but no patients were positive for mannan in the less-sensitive Pastorex Candida test. The controls were negative for both ␤(1-3) glucan (<20 pg/ml) and mannan (<2.5 ng/ml). IgG1 anti-CW and IgG2 anti-PPM antibodies were the most discriminatory antibodies. The ratio of IgG1 anti-CW to IgG2 anti-PPM was significantly lower in nonsurviving patients than in the other patients within the first week of candidiasis (P ‫؍‬ 0.019). The IgG2 levels of anti-CW IO4 and antiglucan antibodies correlated strongly (r ‫؍‬ 0.681; P < 0.0001), and the absence of these antibodies was associated with increased levels of ␤(1-3) glucan. Increased levels of IgG1 anti-CW or IgG2 anti-PPM antibodies (titer of >3 logs) or of a combination of the two antibodies (log sum, >5) showed 92% sensitivity, 100% specificity, and positive predictive values. In conclusion, ␤(1-3) glucan and the two subclass antibodies appear to be early specific markers for the laboratory diagnosis of candidiasis. Furthermore, the kinetics of ␤(1-3) glucan appearance in serum may assist in evaluating the therapeutic efficacy of antifungal treatments.

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Section: Discussionsupporting

confidence: 91%

Circulating β (1-3) Glucan and Immunoglobulin G Subclass Antibodies toCandida albicansCell Wall Antigens in Patients with Systemic Candidiasis

Kondori

Edebo

Mattsby‐Baltzer

2004

Clin Vaccine Immunol

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“…Both have comparable specificity (70-80%), but the ELISA shows an improved sensitivity (42-98%). 151,152 Further improvements in the sensitivity (76%) can be achieved by the combination of the sandwich ELISA with the detection of specific antibodies (Platelia-Candida). 148,149 The early increase of mannan antigen and anti-mannan antibodies was suggested as helpful for the diagnosis of hepatosplenic candidosis.…”

Section: Number Of Body Regions Colonised With Candidamentioning

confidence: 99%

“…It is commercially available as latex‐agglutination (Pastorex‐ Candida ; BioRad, BioRad Laboratories GmbH, Munich, Germany) or as a Sandwich‐ELISA (Platelia‐ Candida ; BioRad). Both have comparable specificity (70–80%), but the ELISA shows an improved sensitivity (42–98%) 151,152 . Further improvements in the sensitivity (76%) can be achieved by the combination of the sandwich ELISA with the detection of specific antibodies (Platelia‐ Candida ) 148,149 .…”

Section: Diagnosismentioning

confidence: 99%

Diagnosis and therapy of Candida infections: joint recommendations of the German Speaking Mycological Society and the Paul-Ehrlich-Society for Chemotherapy

Ruhnke

Rickerts

Cornely

et al. 2011

Mycoses

124

130

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Invasive Candida infections are important causes of morbidity and mortality in immunocompromised and hospitalised patients. This article provides the joint recommendations of the German-speaking Mycological Society (Deutschsprachige Mykologische Gesellschaft, DMyKG) and the Paul-Ehrlich-Society for Chemotherapy (PEG) for diagnosis and treatment of invasive and superficial Candida infections. The recommendations are based on published results of clinical trials, case-series and expert opinion using the evidence criteria set forth by the Infectious Diseases Society of America (IDSA). Key recommendations are summarised here: The cornerstone of diagnosis remains the detection of the organism by culture with identification of the isolate at the species level; in vitro susceptibility testing is mandatory for invasive isolates. Options for initial therapy of candidaemia and other invasive Candida infections in non-granulocytopenic patients include fluconazole or one of the three approved echinocandin compounds; liposomal amphotericin B and voriconazole are secondary alternatives because of their less favourable pharmacological properties. In granulocytopenic patients, an echinocandin or liposomal amphotericin B is recommended as initial therapy based on the fungicidal mode of action. Indwelling central venous catheters serve as a main source of infection independent of the pathogenesis of candidaemia in the individual patients and should be removed whenever feasible. Pre-existing immunosuppressive treatment, particularly by glucocorticosteroids, ought to be discontinued, if feasible, or reduced. The duration of treatment for uncomplicated candidaemia is 14 days following the first negative blood culture and resolution of all associated symptoms and findings. Ophthalmoscopy is recommended prior to the discontinuation of antifungal chemotherapy to rule out endophthalmitis or chorioretinitis. Beyond these key recommendations, this article provides detailed recommendations for specific disease entities, for antifungal treatment in paediatric patients as well as a comprehensive discussion of epidemiology, clinical presentation and emerging diagnostic options of invasive and superficial Candida infections.

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“…Sólo se identifi caron cuatro estudios para el análisis fi nal de esta revisión [9][10][11][12] . Tres de éstos evaluaban pruebas diagnósticas basadas en serología (antigenemia y anticuerpos) y uno utilizaba una prueba de diagnóstico molecular (RPC-TR ADN) (Figura 1).…”

Section: Resultsunclassified

“…Tres estudios incluidos en esta revisión sistemática evaluaban pruebas de serología para candidemia [9][10][11] . Anticuerpos.…”

Section: Pruebas Serológicasunclassified

Métodos diagnósticos en candidemia: una revisión sistemática de la literatura con meta-análisis

Cortés

et al. 2011

Rev. chil. infectol.

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Candidemia is a disease with high morbidity and mortality especially in critical care patients. Early diagnosis enables early treatment. Objectives: To conduct a systematic review of the literature in order to establish the best laboratory tests for the diagnosis of candidemia in critical patients. Materials and Methods: We conducted a systematic review of available literature in PubMed. Serological studies were subjected to meta-analysis in metadisk-Beta 1.1.1. Results: 4 studies of 1286 reviewed were included. Three were about serological tests and one about molecular testing (RT-PCR). The sensitivity and specifi city for RT-PCR, antibody testing and antigen and antibody tests were 87% and 100%, 47.5% and 82.6%, 96% and 81%, respectively. Diagnostic Odds Ratio of antigenemia was 1.51 (95% CI = 0,032-70,964, p = 0.001). Conclusions: RT-PCR has better diagnostic performance, measuring antigenemia plus antibodies improves sensitivity, specifi city, LR + and LR-¬. There is insuffi cient evidence to support this.Key words: Fungemia, candidemia, molecular diagnostic techniques, serology, systematic reviews. Palabras clave: Fungemia, candidemia, técnicas de diagnóstico molecular, serología, revisión sistemática. Universidad Nacional deColombia, Bogotá, Colombia. Departamento de MedicinaInterna (JAC, ACM, LECT). Departamento de Epidemiología (JSC).Realizado en la Universidad Introducción L a candidiasis sistémica es una patología con alta morbilidad y mortalidad 1,2 . Ésta se presenta con una alta frecuencia en la población hospitalizada, especialmente aquella sometida a servicios de cuidado crítico 2 . Esto genera no sólo un elevado impacto en los indicadores de morbilidad y mortalidad en los servicios de atención sanitaria, sino un impacto creciente en el costo asociado a esta entidad 1 . Algunos factores como las largas hospitalizaciones en unidades de cuidados intensivos (UCI), la inmunosupresión subyacente en los pacientes (Ej. enfermedades auto-inmunes, quimioterapia, administración de corticoesteroides, malignidad hematológica o tumor sólido, neutropenia y trasplante de órganos), la terapia antimicrobiana, los factores mecánicos que interfi eren las barreras naturales (Ej. quemaduras, uso de catéteres, implante de prótesis, ventilación mecánica), son factores asociados a la emergencia de esta patología 2,3 . En Colombia, datos del grupo para el control de la resistencia bacteriana (GREBO) muestran que entre 2 y 5% de los aislados del torrente sanguíneo en UCI son ocasionadas por especies de Candida 4 . En general, se ha demostrado que Candida albicans es la especie asociada con mayor frecuencia a infecciones sistémicas del torrente sanguíneo, pero que su frecuencia en las UCI ha disminuido en el tiempo 5 . Dado el impacto clínico y la frecuencia de presentación de candidemias, especialmente en pacientes gravemente comprometidos, se hace necesario disponer de herramientas diagnósticas, que permitan una rápida y adecuada determinación de la candidemia y que faciliten la tipifi cación etiológica entre las especies...

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The utility of serology in diagnosing candidosis in non‐neutropenic critically ill patients

Cited by 9 publications

References 26 publications

Circulating β (1-3) Glucan and Immunoglobulin G Subclass Antibodies toCandida albicansCell Wall Antigens in Patients with Systemic Candidiasis

Circulating β (1-3) Glucan and Immunoglobulin G Subclass Antibodies toCandida albicansCell Wall Antigens in Patients with Systemic Candidiasis

Diagnosis and therapy of Candida infections: joint recommendations of the German Speaking Mycological Society and the Paul-Ehrlich-Society for Chemotherapy

Métodos diagnósticos en candidemia: una revisión sistemática de la literatura con meta-análisis

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