Diagnostic value of mannan and mannan-IgG antibody in cadidemia:a clinical research

Abstract

Abstract: Objective To discuss the diagnostic value of mannan and mannan IgG antibody in candidemia.Method Total 181 serum samples from 107 persons of inpatients and healthy people were collected from May 2013 to January 2014 in our hospital.These people were divided into three groups:candidemia group with Candida blood-culture positivity (13/107), risk factor group with probable invasive candidiasis, hematologic malignancies or risk factors of invasive candida infection (63/107), control group of health examination people (31/107).The mannan and anti-mannan IgG antibody were determined by ELISA, and then compared with each other.The diagnosis value of mannan and anti-mannan IgG anti-body were evaluated through the sensitivity, specificity, positive predictive value, negative predictive value, the area of ROC curve and Kappa score.Result Five isolates of Candida albicans (38.46%) and 5 isolates of Candida grabrata (38.46%) were the main pathogens of candidemia.Among all 14 isolates of candidemia, 7 stains were from Intensive Care Unit and 2 strains were from Infectious Disease Department.There were 12 patients being performed mannan and anti-mannan-IgG antibody detection, except one.Four patients were tested positive and one was suspicious positive in the first mannan detection.Eleven were tested positive and one was suspicious positive in the first anti-mannan IgG antibody detection.Undergoing anti-fungal therapy, anti-mannan IgG antibody persisted longer positivity than mannan during 14 days supervision.For candidemia, the sensitivity, specificity, positive predictive value and negativity predictive value of mannan and anti-mannan antibody were 41.7%, 98.8%, 92.4%, 100% and 91.7%, 52.8%, 100%, 27.5% respectively.The areas under the Receive Operating Characteristic curve of mannan and mannan and antimannan antibody were both 0.708 (95%CI:0.517-0.900).The Kappa scores were respectively 0.520 and 0.559.Conclusion Candida albicans and Candida grabrata were the main pathogens of candidemia.And Intensive Care Unit was the main risk unit for candidemia.In diagnosis of candidemia, mannan has the high specificity while mannan IgG antibody has the high sensitivity.Mannan combined with anti-mannan antibody could improve the sensitivity and specificity to some extent for diagnosis of candidemia.

Key words: candidemia, Mannan, Mannan-IgG antibody

CLC Number:

R379.4

CHEN Ling, WANG Hong, ZHANG Shu-wen, REN Ai-min, WANG Chao, DUAN Meili, WANG Zhao. Diagnostic value of mannan and mannan-IgG antibody in cadidemia:a clinical research[J]. Chinese Journal of Mycology, 2014, 9(6): 325-330.

References

[1] De Pauw B,Walsh TJ,Donnelly JP,et al.Revised definitions of invasive fungal disease from the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG) Consensus Group[J].Clin Infect Dis,2008,46(12):1813-1821.
[2] Hii IM,Chang HL,Lin LC,et al.Changing epidemiology of candidemia in a medical center in middle Taiwan[J].Microbiol Immunol Infect,2013 http://dx.doi.org/10.1016/j.jmii.2013.08.017.
[3] Silva S,Negri M,Henriques M,et al.Candida glabrata,Candida parapsilosis and Candida tropicalis:biology,epidemiology,pathogenicity and antifungal resistance[J].FEMS Microbiol Rev,2012,36(2):288-305.
[4] Ma CF,Li FQ,Shi LN,et al.Surveillance study of species distribution,antifungal susceptibility and mortality of nosocomial candidemia in a tertiary care hospital in China[J].BMC Infect Dis,2013,13:337.
[5] Yap HY,Kwok KM,Gomersall CD,et al.Epidemiology and outcome of Candida bloodstream infection in an intensive care unit in Hong Kong[J].Hong Kong Med J,2009,15(4):255-261.
[6] Guimarães T,Nucci M,Mendona JS,et al.Epidemiology and predictors of a poor outcome in elderly patients with candidemia[J].Int J Infect Dis,2012,16(6):e442-447.
[7] Pemán J,Zaragoza R.Current diagnostic approaches to invasive candidiasis in critical care settings[J].Mycoses,2010,53(5):424-433.
[8] Falagas ME,Apostolou KE,Pappas VD.Attributable mortality of candidemia:a systematic review of matched cohort and case-control studies[J].Clin Microbiol Infect Dis,2006,25(7):419-425.
[9] Maertens J,Theunissen K,Verhoef G,et al.Galactomannan and computed tomography-based preemptive antifungal therapy in neutropenic patients at high risk for invasive fungal infection:a prospective feasibility study[J].Clin Infect Dis,2005,41(9):1242-1250.
[10] Cuenca-Estrella M,Verweij PE,Arendrup MC,et al.ESCMID guideline for the diagnosis and management of Candida diseases 2012:diagnostic procedures[J].Clin Microbiol Infect,2012,18(Suppl 7):9-18.
[11] 中华内科杂志编辑委员会.侵袭性肺部真菌感染的诊断标准与治疗原则(草案)[J].中华内科杂志,2006,45(8):697-700.
[12] De Pauw B,Walsh TJ,Donnelly JP,et al.Revised definitions of invasive fungal disease from the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG) Consensus Group[J].Clin Infect Dis,2008,46(12):1813-1821.
[13] Von Eiff M,Roos N,Schulten R,et al.Pulmonary aspergillosis:early diagnosis improves survival[J].Respiration,1995,62(6):341-347.
[14] Ellis M,Al-Rmandi B,Bernsen R,et al.Prospective evaluation of mannan and anti-manna antibodies for diagnosis of invasive Candida infections in patients with neutropenic fever[J].Med Microbiol,2009,58(3):606-615.
[15] Laín A,Elguezabal N,Moragues M.D,et al.Contribution of serum biomarkers to the diagnosis of invasive candidiasis[J].Expert Rev Mol Diagn,2008,8(3):315-325.
[16] Pontón J.Usefulness of biological markers in the diagnosis of invasive candidiasis[J].Rev Iberoam Micol,2009,26(1):8-14.
[17] Prella M,Bille J,Pugnale M,et al.Early diagnosis of invasive candidiasis with mannan antigenemia and antimannan antibodies[J].Diagn Microbiol Infect Dis,2005,51(2):95-101.
[18] Pemán J,Zaragoza R.Combined Use of Nonculturebased Lab Techniques in the Diagnosis and Management of Critically ill Patients with Invasive Fungal Infections[J].Expert Rev Anti Infect Ther,2012,10(11):1321-1330.
[19] Giuseppina Caggiano,Filomena Puntillo,Caterina Coretti,et al.Candida Colonization Index in Patients Admitted to an ICU[J].Int J Mol Sci,2011,12(10):7038-7047.
[20] Ellepola A N,Morrison C J.Laboratory diagnosis of invasive candidiasis[J].Microbiol,2005,43(spec):65-84.
[21] Eloy O,Tabella C,Harzic M,et al.Detection of circulating Candida albicans mannan and antimannan antibodies:useful for diagnosis of deep seated candidiasis[J].Ann Biol Clin (Paris),2002,60(6):711-714.
[22] 宋秋荷,王鲁.白念珠菌系统性感染中白念珠菌相关抗原检测的意义[J].国外医学(皮肤性病学分册),2004,30(3):188-190.
[23] Sendid B,Poirot JL,Tabouret M,et al.Combined detection of mannanaemia and antimannan antibodies as a strategy for the diagnosis of systemic infection caused by pathogenic Candida species[J].Med Microbiol,2002,51(5):433-442.
[24] Sun HY,Chiu YS,Tang JL,et al.The usefulness of the Platelia Candida antigen in a patient with acute lymphocytic leukemia and chronic disseminated candidiasis[J].Med Mycol,2006,44(7):647-650.
[25] Mikulska M,Calandra T,Sanguinetti M,et al.The use of mannan antigen and anti-mannan antibodies in the diagnosis of invasive candidiasis:recommendations from the Third European Conference on Infections in Leukemia[J].Crit Care,2010,14(6):222.
[26] 陈桂山.念珠菌病患者血清中甘露糖抗原的临床诊断价值探讨[C].//2008年全国抗菌药物临床规范应用与新进展(昆明)学术研讨会论文集.2008:5-7.
[27] Held J,Kohlberger I,Rappold E,et al.Comparison of (1->3)-β-D-glucan,mannan/anti-mannan antibodies,and Cand-Tec Candida antigen as serum biomarkers for candidemia[J].Clin Microbiol,2013,51(4):1158-1164.