Max von Pettenkofer-Institut für Hygiene und Medizinische Mikrobiologie, Medizinische Fakultät, LMU München, Munich, Germany.
Sektion Klinische Infektiologie, Medizinische Klinik und Poliklinik IV, Klinikum der Universität, LMU Munich, Munich, Germany.
Infection. 2019 Apr;47(2):217-224. doi: 10.1007/s15010-018-1224-3. Epub 2018 Sep 27.
Serologic testing allows for rapid detection of candidemia. More data are needed for the Virion\Serion ELISA antigen test (Ag), Hemkit Candida IHA antibody test (Ab), and Wako β-1,3-D-glucan assay (BDG).
Tests were performed on serum samples from 120 cases of culture-confirmed candidemia and 44 Candida-negative controls. Sensitivities and specificities of individual tests as well as combinations were assessed.
The overall sensitivity of Ag, Ab, and Ag/Ab testing was 30, 40, and 54%, respectively, while in transplant patients it significantly dropped to 16, 26, and 40% (p = 0.02). For BDG testing it was 67%, both overall and in transplant patients. Especially Ag testing performed poorly among women ≤ 65 years with a significantly reduced sensitivity of 9% (p < 0.002). While the sensitivity of Ag/Ab testing was somewhat higher at 67% for C. albicans, it was significantly lower for non-albicans species at 42% (p = 0.006). The sensitivity of BDG testing for C. albicans and non-albicans species was not significantly different at 64 and 69%, respectively. Both Ag/Ab and BDG testing had a high specificity of 93%, for Ag testing it was 100%. Similar sensitivities were calculated for sera sampled on the day of and 4-6 days before sampling of positive blood cultures.
Serological markers are valuable tools for the early diagnosis of candidemia. Ab, Ag, and BDG testing are all characterized by high specificity. The Wako BDG test is significantly more sensitive compared to combined Candida-Ag/Ab testing, particularly in the setting of non-albicans species and specific host factors.
血清学检测可快速检测出念珠菌血症。Virion\Serion ELISA 抗原检测（Ag）、Hemkit Candida IHA 抗体检测（Ab）和 Wako β-1,3-D-葡聚糖检测（BDG）需要更多的数据。
对 120 例经培养证实的念珠菌血症和 44 例念珠菌阴性对照的血清样本进行了检测。评估了单项检测和联合检测的敏感性和特异性。
Ag、Ab 和 Ag/Ab 检测的总体敏感性分别为 30%、40%和 54%，而在移植患者中则显著降至 16%、26%和 40%（p=0.02）。BDG 检测的总体和移植患者中的敏感性均为 67%。尤其是，≤65 岁的女性患者 Ag 检测表现不佳，敏感性显著降低至 9%（p<0.002）。虽然 Ag/Ab 检测对 C. albicans 的敏感性略高，为 67%，但对非白念珠菌的敏感性显著降低，为 42%（p=0.006）。BDG 检测对 C. albicans 和非白念珠菌的敏感性无显著差异，分别为 64%和 69%。Ag/Ab 和 BDG 检测的特异性均较高，分别为 93%和 100%。阳性血培养标本采集当天和 4-6 天前采集的血清标本具有相似的敏感性。
血清学标志物是念珠菌血症早期诊断的有价值工具。Ab、Ag 和 BDG 检测均具有较高的特异性。与联合 Candida-Ag/Ab 检测相比，Wako BDG 检测的敏感性显著更高，尤其是在非白念珠菌和特定宿主因素的情况下。
