Abstract
Background: Blood or tissue culture or histology prove invasive Candida infection, but long time to result, limited feasibility and sensitivity call for new approaches. In this pilot project, we describe the diagnostic potential of quantitating Candida-reactive, CD4/CD69/CD154 positive lymphocytes in blood of patients with invasive Candida infection.Methods: We used flow cytometry quantitating Candida-reactive, CD4/CD69/CD154 positive lymphocytes from peripheral blood of patients with invasive Candida infection, from patients at risk and healthy volunteers as controls.Results: Elevated levels of Candida-reactive lymphocytes were measured in 13 patients with proven invasive Candida infection and in one patient with probable hepatosplenic candidiasis. Results of three candidemia patients were uninterpretable due to autofluorescence of samples. Twelve of 13 patients had Candida identified to species level by conventional methods, and T cell reactivity correctly identified Candida species in 10 of 12 patients. Nine hematological high-risk patients and 14 healthy donors had no elevated Candida-reactive T cell counts.Conclusions: This Candida-reactive lymphocyte assay correctly identified the majority of patients with invasive Candida infection and the respective species. Our assay has the potential to support diagnosis of invasive Candida infection to species level and to facilitate tailored treatment even when biopsies are contraindicated or cultures remain negative.
Highlights
Invasive Candida Infection (ICI) is among the most common bloodstream infections and represents the most common invasive fungal infection (Wisplinghoff et al, 2004; Kullberg and Arendrup, 2015)
Patients were excluded from analysis due to autofluorescence of cells leading to elevated background expression of CD69+/CD154+ T cells
To examine the mean frequency of C. albicansreactive T cells in healthy individuals we included an additional cohort of 96 healthy blood donors
Summary
Invasive Candida Infection (ICI) is among the most common bloodstream infections and represents the most common invasive fungal infection (Wisplinghoff et al, 2004; Kullberg and Arendrup, 2015). Underlying medical conditions often prevent biopsies (Clancy and Nguyen, 2013) Indirect tests, such as Candida mannan antigen, anti-mannan antibodies, Candida albicans germ tube gem tube antibodies (CAGTA) and β-1,3-D-glucan (BDG) are not species specific (Ponton et al, 1994; Laín et al, 2007; Mikulska et al, 2010; Lamoth et al, 2012). Blood or tissue culture or histology prove invasive Candida infection, but long time to result, limited feasibility and sensitivity call for new approaches. In this pilot project, we describe the diagnostic potential of quantitating Candida-reactive, CD4/CD69/CD154 positive lymphocytes in blood of patients with invasive Candida infection
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