Table 1 Eight clinical cases with candidemia gra.; granulocytopenia (<400/ml) before candidemia AMoL; acute monocytic leukemia VH; intravenous yperali

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Transcription:

Key words: candidemia, HA-test, Cand-Tec, D-arabinitol, Ĉ-d-glucan

Table 1 Eight clinical cases with candidemia gra.; granulocytopenia (<400/ml) before candidemia AMoL; acute monocytic leukemia VH; intravenous yperalimentation CPDI; continuous peripheral drip infusion I postope.; postoperative state cath. tip; catheter tip CVP; central venous pressure

Fig. 1 Clinical course and results with four serological and biochemical diagnostic methods-case 1 BH-AC; behenoyl ara-c MCZ; miconazole AMPH; amphotericin B A/C ratio; D-arabinitollcreatinine ratio Fig. 2 Clinical course and results with four serological and biochemical diagnostic methods case 2 - A/C ratio; D-arabinitol/creatinine ratio MCZ; miconazole FCZ; fluconazole AMPH; amphotericin B

Fig. 3 Resultsoneight clinical cases with candidemia obtained with four serological and biochemical diagnostic methods before, after; before or after treatment with antifungal agents A/C ratio; D-arabtnitol/creatinine ratio

Fig. 4 Experimentalresults of serological and biochemical tests on rabbits intravenously inoculated with 1.0 x 106CFU (lml) of Candida albicans type A

1) Wong, B., Bernard, E. M., Gold, J. W. M., Fong, D. & Armstrong, D.: The arabinitol appearance rate in laboratory animals and humans: Estimation from the arabinitol/creatinine ratio and relevance to the diagnosis of candidiasis. J. Infect. Dis., 146: 353-359, 1982. 2) Bernard, E. M., Christiansen, K. J., Tsang, S.F., Kiehn, T.E. & Armstrong, D.: Rate of arabinitol production by pathogenic yeast species. J. Clin. Microbiol., 14 : 189-194, 1981.

11) Kiehn, T. E., Bernard, E. M., Gold, J. W. M. & Armstrong, D.: Candidiasis : Detection by gas-liquid chromatography of D-arabinitol, a fungal metabolite, in human serum. Science, 206: 577-580, 1979. 4) Muller, H.L.: Serologische Diagnostik der Mykosen. Chemotherapy (Basal). 22 (s-1): 87 102, 1976. - 5) Filice, G. & Armstrong, D.: Immunodiffusion and agglutination tests for Candida in patients with neoplastic disease: Inconsistent correlation of results with invasive infections. J. Infect. Dis., 135: 349-357, 1977. 6) Repentigny, L.D. & Reiss, E.: Current trends in immunodiagnosis of candidiasis and aspergillosis. Rev. Infect. Dis., 6: 301-312, 1984. 7) Bisbe, J., Miro, J.M., Torres, J.M., Latorre, X., Alia, C., Amaral, M., Estivill, D., Mallolas, J., Trilla, A. & Soriano, E.: Diagnostic value of serum antibody and antigen detection in heroin addicts with systemic candidiasis. Rev. Infect. Dis., 11: 310-315, 1989. 8) Ness, M. J., Vaughan, W. P. & Woods, G. L.: Candida antigen latex test for detection of invasive candidiasis in immunocompromised patients. J Infect. Dis., 159: 495-502, 1989. 9) Burnie, J.P. & Williams, J. D.: Evaluation of the ramco latex agglutination test in the early diagnosis of systemic candidiasis. Eur. J. Clin. Microbiol., 4: 98-101, 1985. 10) Matthews, R. C. & Burnie, J. P.: New developments in the serological diagnosis of Candida infection. Mycoses, 31 (s-2): 34-38, 1988. 12) Soyama, K. & Ono, E.: Enzymatic fluorometric method for the determination of D- arabinitol in serum by initial rate analysis. Clin. Chim. Acta, 149: 149-154, 1985. 17) Eng, R. H. K., Chmel, H. & Buse, M.: Serum levels of arabinitol in the detection of invasive candidiasis in animals and humans. J. Infect. Dis., 143: 677-683, 1981. 18) Greenfield, R. A., Troutt, D. L., Rickard, R. C. & Altmiller, D. H.: Comparison of antibody, antigen, and metabolite assays in rat models of systemic and gastrointestinal candidiasis. J. Clin. Microbiol., 26: 409-417, 1988.

Evaluation of Serological and Biochemical Diagnosis of Candidemia Division of Infectious Diseases, Department Masayoshi INAGAKI of Internal Medicine, Juntendo University School of Medicine In order to compare 4 serological and biochemical diagnostic tests, HA-test (Candida-HA-test), Cand-Tec, D-arabinitol detective test and Fungal Index (F.I.) were carried out in a total of 8 patients with candidemia, 6 were diagnosed to have systemic candidosis and 2 transient fungemia due to colonized catheters. Rabbits were given venous injections of 1.0 X 106 CFU (1 ml) of living Candida albicans type A to study the 4 diagnostic methods by sequential blood culture. Prior to clinical administration of antimycotics the diagnostic methods produced almost the same positive ratios. After administration of antimycotics, the HA-test became positive later than Cand-Tec or D-arabinitol because it detected antibodies in the serum, but its conversion to negative also tended to be slightly slower. Accordingly, the HA-test is considered to be useful for retrospective diagnosis of systemic candidosis. In Cand-Tec, D-arabinitol and F.I., the cases where reversion to normal was not achieved soon after therapy were intractable. In one case, the antigen values after therapy were four times as high as prior to treatment. To differentiate the two cases with transient fungemia from those with systemic candidosis HA- and D-arabinitol tests were considered to be superior to Cand-Tec and F.I. In the experiments with rabbits Cand-Tec was, in spite of its being positive in blood culture, always negative.

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