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.
Highlights
Treatment of patients with hematological malignancies, those with acute myeloblastic leukemia, has evolved toward the use of increasingly aggressive antineoplastic regimens and autologous or allogeneic bone marrow or peripheral blood stem cell transplantation [26]
Our data 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
Retrospective studies based on the analysis of more than 500 serum samples from 130 patients with candidemia treated in different hospital wards and 150 control serum samples from patients without candidemia showed that the combined use of these tests had a 93% specificity and an 80% sensitivity in the diagnosis of infections caused by the most pathogenic Candida species
Summary
Treatment of patients with hematological malignancies, those with acute myeloblastic leukemia, has evolved toward the use of increasingly aggressive antineoplastic regimens and autologous or allogeneic bone marrow or peripheral blood stem cell transplantation [26]. In order to overcome these difficulties, several groups have focused on the development of biological tests based on the detection of either antibodies to Candida proteins or polysaccharides or Candida components such as mannan [32, 48], glucan [28], arabinitol [41], or nucleic acids [15, 21] in body fluids under the assumption that these molecules would prove to be early specific markers of disseminated infection. Among these putative markers, mannan is a major component of the. The availability of serial serum samples together with complete clinical and biological records gave us the opportunity to assess the Platelia tests for the detection of infections caused by C. tropicalis, a species emerging as one of the main causative agents of candidemia in patients with malignancies [3, 20]
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