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

• Published in: MICROBIOLOGY and IMMUNOLOGY 1993, Vol.37(3), pp.207-212
• Main Authors: Kohno, Shigeru, Mitsutake, Kotaro, Maesaki, Shigefumi, Yasuoka, Akira, Miyazaki, Takashige, Kaku, Mitsuo, Koga, Hironobu, Hara, Kohei
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Agglutination Tests; Antigens, Fungal - blood; Beta-glucan; Biological and medical sciences; Candida; Candida - immunology; Candida - isolation & purification; Candidiasis - diagnosis; Candidiasis - immunology; D-Arabinitol; Evaluation Studies as Topic; Female; Fungemia - diagnosis; Fungemia - immunology; Glucans - immunology; Human mycoses; Humans; Infectious diseases; Limulus; Male; Mannan; Mannans - immunology; Medical sciences; Middle Aged; Mycoses; Mycotic sepsis; Sensitivity and Specificity; Serologic Tests; Sugar Alcohols - immunology
• ISSN: 0385-5600; 1348-0421
• DOI: 10.1111/j.1348-0421.1993.tb03201.x

The serodiagnostic tests, beta-glucan, mannan, candida antigen by Cand-Tec, and D-arabinitol were evaluated in 10 patients with candidemia, 14 patients with suspected fungemia, and 10 healthy persons. By blood culture or lysis centrifugation, C. albicans was isolated from 5 patients, C. parapsilosis from 4, and C. tropicalis from 1 patient; no organisms were isolated from the 14 patients with suspected fungemia or the 10 healthy subjects. Beta-glucan was measured by the difference between two chromogenic limulus tests (Endotoxin test-D® and Endospecy®), which was more than 60pg/ml in 7 of 9 (78%) candidemic patients and 1 of 12 (8%) patients with suspected fungemia. Mannan was positive in 6 of 10 (60%) candidemic patients and 1 of 13 (8%) patients with suspected fungemia. Both antigens were very sensitive and highly specific for candidemia. However, the Cand-Tec assay was less specific, because titers of more than 4 were observed in 5 of 14 (34%) patients with suspected fungemia. D-Arabinitol was the least sensitive, because a D-arabinitol/creatinine ratio greater than 2.0μmol/mg was observed in only 2 of 7 (29%) candidemic patients. The titers of serodiagnostic tests decreased after successful treatment with an anti-fungal agent. Our results show that the combined use of the assays in necessary for accurate serological diagnosis of candidemia.