Laboratory of Parasitology and Mycology, Grenoble University Hospital, Joseph Fourier University, Grenoble, France
Laboratory of Parasitology and Mycology, Grenoble University Hospital, Joseph Fourier University, Grenoble, France.
Med Mycol. 2014 Jul;52(5):462-71. doi: 10.1093/mmy/myu018. Epub 2014 Jun 15.
The gold standard laboratory tests used to diagnose invasive Candida infection (ICI) are based on the in vitro culture of blood or samples from other sterile sites. However, these tests have limited sensitivity (Se) and are generally not diagnostic until late in the infectious process. The Serion Candida mannan kit was evaluated for the diagnosis of ICI at Grenoble University Hospital (France) between 2007 and 2011. The results were then compared with worldwide data published between 1997 and 2011. This retrospective study was based on follow-up from the investigation of 162 patients of whom 91 had proven ICI; 13 had Candida colonization index (CCI) scores ≥0.42, positive mannan tests, with nonconcomitant infections; and 58 had no evidence of Candida infection. Candida albicans, C. glabrata, C. tropicalis, and C. parapsilosis were the etiologic agents in 104 patients. For patients with or without ICI, the 12-week mortality rates were 35/104 (33.7%) and 6/58 (10.3%), respectively. The mannan diagnostic specificity was 51% and Se was 77%. However, in the meta-analysis (n = 1,536), values were 86% and 62%, respectively. Positive mannan test results may appear early (median 6 days) in the development of candidemia and have moderate diagnostic value for ICI, with a negative predictive value of 83%. In patients at risk of ICI with negative candidemia, the combination of Candida mannan test data with a CCI score ≥0.42 may improve the diagnosis of probable ICI.
用于诊断侵袭性念珠菌感染（ICI）的金标准实验室检测方法基于血液或其他无菌部位样本的体外培养。然而，这些检测方法的灵敏度有限，通常直到感染过程后期才具有诊断价值。2007 年至 2011 年，在格勒诺布尔大学医院（法国）评估了 Serion 念珠菌甘露聚糖试剂盒用于诊断 ICI 的效果。然后将结果与 1997 年至 2011 年期间发表的全球数据进行了比较。这项回顾性研究基于对 162 例患者的随访，其中 91 例患者确诊为 ICI；13 例患者的念珠菌定植指数（CCI）评分≥0.42，甘露聚糖检测阳性，同时无合并感染；58 例患者无念珠菌感染证据。白色念珠菌、近平滑念珠菌、热带念珠菌和克柔念珠菌是 104 例患者的病原体。有 ICI 和无 ICI 的患者的 12 周死亡率分别为 35/104（33.7%）和 6/58（10.3%）。甘露聚糖检测的特异性为 51%，灵敏度为 77%。然而，在荟萃分析（n=1536）中，这两个值分别为 86%和 62%。阳性甘露聚糖检测结果可能在念珠菌血症发生的早期（中位数 6 天）出现，对 ICI 具有中等的诊断价值，阴性预测值为 83%。在有 ICI 风险且念珠菌血症阴性的患者中，将甘露聚糖检测数据与 CCI 评分≥0.42 相结合可能有助于提高可能的 ICI 诊断。
