Abstract
A total of 911 sera from 171 patients at risk for systemic candidiasis and 24 sera from 24 non-hospitalized control subjects were analyzed for the presence of candida antigen using a commercially available latex agglutination test (Cand-Tec). Thirty-seven (22 %) patients had systemic candidasis documented by positive blood cultures, deep biopsy culture and histopathology or autopsy. Six patients had transient candidemia, 20 patients had candiduria, 53 patients had mucous membrane colonization, 21 patients were not colonized but received empiric amphotericin B, and 34 patients were not colonized and not treated with amphotericin B. The intraobserver reproducibility was 90 % for the exact titer and 100 % for a deviation of one dilution. The sensitivity and specificity of the candida antigen test in detection of systemic candidasis was 95 % and 50 % (≥ 1: 2), 73 % and 72 % (≥ 1 : 4), and 46 % and 80 % (≥ 1 : 8) respectively. Despite the poor specificity, serial antigen determinations in patients with documented systemic candidiasis demonstrated both an early diagnostic and prognostic role for the candida antigen test. Seventy-one percent of patients whose antigen titer increased during the course of amphotericin B therapy of documented infection died versus only 13 % of those whose titer decreased while on therapy (p = 0.01). The candida antigen test has a limited yet potentially useful role in the diagnosis and management of systemic candidasis in high-risk patients.
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Harvey, R. L., Myers, J. P.: Nosocomial fungemia in a large community teaching hospital. Archives of Internal Medicine 1987, 147: 2117–2120.
Horn, R., Wong, B., Kiehn, T. E., Armstrong, D.: Fungemia in a cancer hospital: changing frequency, earlier onset, and results of therapy. Reviews of Infectious Diseases 1985, 7: 646–655.
Maksymiuck, A. W., Throngprosert, S., Hopfer, R., Luna, M., Fainstein, V., Bodey, G. P.: Systemic candidasis in cancer patients. American Journal of Medicine 1984, 77: 20–27.
Wey, S. B., Mori, M., Pfaller, M. A., Woolson, R. F., Wenzel, R. P.: Hospital-acquired candidemia: attributable mortality and excess length of stay. Archives of Internal Medicine 1988, 188: 2642–2645.
Karabinis, A., Hill, C., Leclercq, B., Tancrede, C., Baume, D., Andremont, A.: Risk factors for candidemia in cancer patients: a case-control study. Journal of Clinical Microbiology 1988, 26: 429–432.
Horan, T., Culver, D., Jarvis, W., Emori, G., Banerjee, S., Martone, W., Thorsnberry, C.: Pathogens causing nosocomial infections: preliminary data from the National Nosocomial Infections Surveillance System. Antimicrobic Newsletter 1988, 5: 65–67.
de Repentigny, L., Reiss, E.: Current trends in immunodiagnosis of candidasis and aspergillosis. Reviews of Infectious Diseases 1984, 6: 301–302.
de Repentigny, L., Marr, L. D., Keller, J. W., Carter, A. W., Kuykendall, R. J., Kaufman, L., Reiss, E.: Comparison of enzyme immunoassay and gas-liquid chromatography for the rapid diagnosis of invasive candidiasis in cancer patients. Journal of Clinical Microbiology 1985, 21: 972–979.
Hopwood, V., Warnock, D. W.: New developments in the diagnosis of opportunistic fungal infection. European Journal of Clinical Microbiology 1986, 5: 379–388.
Gentry, L. O., Wilkinson, I. D., Lea, A. S., Price, M. F.: Latex agglutination test for detection ofCandida antigen in patients with disseminated disease. European Journal of Clinical Microbiology 1983, 2: 122–128.
Burnie, J. P., Williams, J. D.: Evaluation of the Ramco latex agglutination test in the early diagnosis of systemic candidasis. European Journal of Clinical Microbiology 1985, 4: 98–101.
Bailey, J. W., Sada, E., Brass, C., Bennett, J. E.: Diagnosis of systemic candidasis by latex agglutination for serum antigen. Journal of Clinical Microbiology 1985, 21: 749–752.
Kahn, F. W., Jones, J. M.: Latex agglutination tests for the detection ofCandida antigens in sera of patients with invasive candidasis. Journal of Infectious Diseases 1986, 153: 579–585.
Price, M. F., Gentry, L. O.: Incidence and significance ofCandida antigen in low risk and high risk patient populations. European Journal of Clinical Microbiology 1986, 5: 416–419.
Fung, J. C., Donta, S. T., Tilton, R. C.:Candida detection system (Cand-Tec) to differentiate betweenCandida albicans colonization and diseases. Journal of Clinical Microbiology 1986, 24: 542–547.
Ness, M. J., Vaughan, V. P., Woods, G. L.:Candida antigen latex test for detection of invasive candidasis in immunocompromised patients. Journal of Infectious Diseases 1989, 159: 495–502.
Pfaller, M., Cabezudo, I., Koontz, F., Bale, M., Gingrich, R.: Predictive value of surveillance cultures for systemic infection due toCandida species. European Journal of Clinical Microbiology 1987, 6: 628–633.
Body, B. A., Pfaller, M. A., Durrer, J., Koontz, F., Groschel, D. H. M.: Comparison of the lysis centrifugation and radiometric blood culture systems for recovery of yeast. European Journal of Clinical Microbiology and Infectious Diseases 1988, 7: 417–420.
Galen, R. S., Gambino, S. R.: Beyond normality: The predictive value and efficiency of medical diagnosis. John Wiley, New York, 1975.
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Cabezudo, I., Pfaller, M., Gerarden, T. et al. Value of the cand-tec candida antigen assay in the diagnosis and therapy of systemic candidiasis in High-Risk patients. Eur. J. Clin. Microbiol. Infect. Dis. 8, 770–777 (1989). https://doi.org/10.1007/BF02185843
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DOI: https://doi.org/10.1007/BF02185843