PubMed · 7265437
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M A Gordon. 1981-09-25. Cryptococcal antigen test.. https://pubmed.ncbi.nlm.nih.gov/7265437/
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Among the systemic mycotic infections, disseminated candidiasis is the most frequent and is constantly on the increase. Candidiasis occurs in patients with particular risks, i.e., in oncologic neutropenic patients and in surgical patients after intraabdominal surgery. Independent predictive factors are multiple prior antibiotic therapy, the presence of intravascular devices and previous colonization by Candida, as well as the rupture of skin or cutaneous anatomical barriers. C. albicans is still the predominant species. Diagnosis of disseminated candidiasis is difficult and sometimes delayed. It relies essentially on a high index of suspicion, on blood cultures and the analysis of other samples (biopsies) by a combination of microbiological and anatomopathological procedures. The detection of Candida antigens, antibodies or metabolites still suffers from suboptimal sensitivity and specificity. Molecular diagnosis by amplification (PCR) is promising. The reservoir of Candida is mainly the human digestive tract, and a colonization stage usually precedes an established infection. Transmission of Candida by human carriage or through the environment could play an important role, particularly in intensive care units.
The utility of serum Aspergillus antigen in invasive aspergillosis was determined by identifying patients with >50 ng/mL Aspergillus carbohydrate antigen by ELISA. Patients were identified from a university hospital over a 65-month period. Nineteen patients with antigenemia had proven invasive aspergillosis, 16 had probable invasive aspergillosis, and 14 had an indeterminate diagnosis. There were 5 patients with false-positive results. Antigen levels were higher in disseminated infection than in invasive pulmonary aspergillosis (median levels, 500 and 121 ng/mL, respectively). Survival also correlated with antigenemia. Serial samples were obtained from 31 of 35 patients with proven or probable invasive aspergillosis. Fifteen of 19 patients with rising or persistent antigenemia died, whereas only 1 of 12 patients who cleared antigenemia died. Higher antigen levels were useful in predicting disseminated disease, and the course of antigenemia correlated with clinical outcome. Antigen detection may be a useful addition in the management of invasive aspergillosis.
Epithelial adhesion and expression of the integrin analog, a putative candidal adhesion, were correlated for 33 clinical and laboratory isolates of Candida albicans, other Candida species, and Saccharomyces cerevisiae. On flow cytometry with saturating concentrations of the monoclonal antibody OKM1, surface fluorescence was highest for C. albicans at 67.8% +/- 1.7% and significantly reduced for Candida tropicalis (32.0% +/- 2.6%), Candida parapsilosis (18.3% +/- 2.4%), Candida glabrata (3.3% +/- 0.8%), Candida lusitaniae (2.9% +/- 1.0%), Candida krusei (0.7% +/- 0.1%), and Saccharomyces cerevisiae (1.7% +/- 0.2%) (P < .006 for all other species vs. C. albicans). Adhesion to a human epithelial cell line was highest for C. albicans at 49.8% +/- 3.5%, lower for C. tropicalis (44.7% +/- 4.6%), and incrementally reduced for all other species (< 25%) (P < .012). The correlation between integrin expression and epithelial adhesion was highly significant (P = .0066; r2 = .8). Surface expression of the integrin analog predicts epithelial adhesion for yeast species isolated in opportunistic infections.