Sendid Boualem, Caillot Denis, Baccouch-Humbert Bénédicte, Klingspor Lena, Grandjean Monique, Bonnin Alain, Poulain Daniel
Laboratoire de Mycologie Fondamentale et Appliquée et Equipe INSERM 0360, F-59045 Lille, France.
J Clin Microbiol. 2003 Oct;41(10):4551-8. doi: 10.1128/JCM.41.10.4551-4558.2003.
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.
使用Bio-Rad Laboratories公司的白色念珠菌特异性抗原和抗体检测方法，对7例患有血液系统恶性肿瘤且发生热带念珠菌全身感染的中性粒细胞减少成年患者的系列血清样本进行检测。念珠菌病的诊断基于血培养阳性（所有7例患者）以及从通常无菌部位分离出热带念珠菌（6例患者）。所有患者均接受了两性霉素B和/或唑类衍生物的早期抗真菌治疗，且治疗结果均成功。当将联合检测应用于首次血培养阳性前后不同时间点采集的血清时，所有患者检测均为阳性。在6例患者中，平均在首次血培养阳性前5天（范围为2至10天）采集的血清至少有一次检测呈阳性，而此时血培养一直为阴性。在中性粒细胞减少期间，所有患者均检测到高水平且持续的甘露聚糖血症。在5例患者中，当患者从再生障碍中恢复时，检测到抗体反应增强。对照组包括12例发热性中性粒细胞减少患者的48份血清样本，这些患者分别患有曲霉病（4例）、菌血症（4例）或无感染证据（4例）。仅在一份血清样本中检测到低水平的甘露聚糖血症，且无一例显示出显著的念珠菌抗体滴度。因此，我们的数据证实了在有念珠菌血症风险的个体中联合检测甘露聚糖血症和抗甘露聚糖抗体的价值，并表明在中性粒细胞减少患者中，基于定期监测这两种标志物的方法可能有助于早期诊断热带念珠菌全身感染。
