Diagnosis of invasive candidiasis by detection of mannan antigen by using the avidin-biotin enzyme immunoassay

Abstract

The diagnosis of invasive candidiasis was attempted by detection of circulating mannan antigen by using an avidin-biotin-amplified enzyme-linked immunosorbent assay (AB-ELISA), and this method was compared with the conventional culture method. Mannan antigen was detected by AB-ELISA in the sera of 16 (84.2%) of the 19 patients with invasive candidiasis. On the other hand, for 34 immunocompromised candidiasis-free patients, including 8 with aspergillosis or cryptococcosis, mannan antigen was positive during only 1 of the 67 febrile episodes and in the serum of none of the 50 outpatients without infections. The results were also negative for all patients with deep-seated mycoses other than candidiasis. However, the mannan level was low (less than 2.0 ng/ml) in the serum of 63.2% of the patients with invasive candidiasis. The positivity rate of blood cultures was 31.6%, and that of blood cultures and/or cultures of samples from sterile sites combined was 47.4%. The advantages of the diagnosis based on antigen detection by AB-ELISA are considered to be a higher sensitivity and elimination of nonspecific reactions by the introduction of the avidin-biotin system and pretreatment of sera by heating. In addition, it is considered essential for high sensitivity that transient mannan antigenemia be determined frequently so that it is not overlooked. In light of its sensitivity and specificity, this method is considered to be clinically useful in the diagnosis of invasive candidiasis.