Non-Culture Diagnostics for Invasive Candidiasis: Promise and Unintended Consequences

Journal of Fungi
Cornelius J Clancy, M Hong Nguyen

Abstract

Blood cultures are positive forCandidaspecies in < 50% and < 20% of hematogenously disseminated and intra-abdominal candidiasis, respectively. Non-culture tests such as mannan, anti-mannan antibody,Candida albicansgerm tube antibody (CAGTA), 1,3-β-d-glucan (BDG), the T2Candida nanodiagnostic panel, and polymerase chain reaction (PCR) are available for clinical use, but their roles in patient care are uncertain. Sensitivity/specificity of combined mannan/anti-mannan, BDG, T2Candida and PCR for candidemia are ~80%/80%, ~80%/80%, ~90%/98%, and ~90%/90%, respectively. Limited data for intra-abdominal candidiasis suggest CAGTA, BDG sensitivity/specificity of ~65%/75% and PCR sensitivity of ~85-90%. PCR specificity has varied widely for intra-abdominal candidiasis (33-97%), and T2Candida data are lacking. Tests will be useful if restricted to cases in which positive and negative predictive values (PPVs, NPVs) differ in a clinically meaningful way from the pre-test likelihood of invasive candidiasis. In some patients, PPVs are sufficient to justify antifungal treatment, even if blood cultures are negative. In most patients, NPVs of each test are excellent, which may support decisions to withhold antifungal therapy. If test results are...Continue Reading

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Methods Mentioned

BETA
PCR

Software Mentioned

DIRECT2
DIRECT
CAGTA
Fungitell

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