Detailed β-(1→3)-D-glucan and mannan antigen kinetics in patients with candidemia

Träger J, Dräger S, Mihai S, Cipa F, Grawitz AB, Epting T, Meyer R, Rappold E, Held J (2023)

Publication Type: Journal article

Publication year: 2023

Journal

Journal of Clinical Microbiology American Society for Microbiology

Book Volume: 61

Article Number: e00598-23

Journal Issue: 11

DOI: 10.1128/jcm.00598-23

Abstract

Fungal antigens such as β-(1→3)-D-glucan (BDG) or mannan (Mn) are useful for detection of candidemia. However, detailed data on serum levels before diagnosis and during treatment are scarce. We conducted a prospective study at two German tertiary care centers for 36 months. Sera from adult patients with candidemia were tested for BDG (Fungitell assay) and Mn (Platelia Candida Ag-Plus assay). For each patient, the clinical course and biomarker kinetics were closely followed and compared. 1,243 sera from 131 candidemia episodes and 15 relapses were tested. In 35% of episodes, empirical therapy included an antifungal drug. Before blood culture sampling, BDG and Mn levels were elevated in 62.4% and 30.8% of patients, respectively. Sensitivity at blood culture sampling was 78.6% (BDG) and 35.1% (Mn). BDG levels of non-survivors were significantly higher than those of survivors. During follow-up, a therapeutic response was associated with decreasing BDG and Mn levels in 84.3% or 70.5% of episodes, respectively. A median increase of 513 pg BDG/mL and 390 pg Mn/mL indicated a relapse of candidemia with a sensitivity of 80% or 46.7%, respectively. In 72.9% and 46.8% of patients, increasing BDG or Mn levels were associated with a fatal outcome. Prior to discharge, BDG and Mn levels had dropped or normalized in 65.7% or 82.1% of patients, respectively. Summarising, in patients with candidemia, biomarker positivity usually precedes culture positivity. Relapses are mostly accompanied by secondary biomarker increases. Rising concentrations of BDG and Mn predict lethality, whereas decreasing levels suggest a favorable outcome in the majority of patients.

Authors with CRIS profile

Johannes Träger Institute of Microbiology – Clinical Microbiology, Immunology and Hygiene Jürgen Held Institute of Microbiology – Clinical Microbiology, Immunology and Hygiene

Involved external institutions

Universitätsklinikum Freiburg DE Germany (DE) Universitätsspital Basel CH Switzerland (CH)

How to cite

APA:

Träger, J., Dräger, S., Mihai, S., Cipa, F., Grawitz, A.B., Epting, T.,... Held, J. (2023). Detailed β-(1→3)-D-glucan and mannan antigen kinetics in patients with candidemia. Journal of Clinical Microbiology, 61(11). https://dx.doi.org/10.1128/jcm.00598-23

MLA:

Träger, Johannes, et al. "Detailed β-(1→3)-D-glucan and mannan antigen kinetics in patients with candidemia." Journal of Clinical Microbiology 61.11 (2023).

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