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[Laboratory diagnostic possibilities in fungus infections in intensive care patients]
G Marklein1, H P Weil, K Rommelsheim
1Institut für Medizinische Mikrobiologie und Immunologie, Universität Bonn.
Abstract:
Severe yeast infections of intensive care patients are promoted by numerous predisposing factors among which antibacterial broad spectrum therapy plays an important role. Since typical clinical pictures are lacking, basic procedures of mycological diagnostics are culture and differentiation of yeast strains and detection of immunological reactions against yeast antigens as well. Among 200 intensive-care patients with suspected systemic mycosis, Candida albicans was the prevailing yeast, followed by Torulopsis glabrata and Candida krusei. In the immunocompetent patient, serological procedures discriminating between antibodies of the IgG and IgM class may be suitable for the surveillance of the course of the disease. - In early stages of endomycotic infections and in the immunocompromised host as well, detection of candida antigens by means of specific latex tests and the detection of yeast-specific metabolites (e.g. arabinitol) by gas chromatographic methods provide helpful tools in the diagnosis of severe opportunistic fungal infections.
Insights
Severe yeast infections in intensive care are common, often linked to antibiotic use. Diagnostic methods like antigen detection and metabolite analysis aid in identifying these opportunistic fungal infections early.
Area of Science:
- Medical Mycology
- Infectious Diseases
- Intensive Care Medicine
Background:
- Broad-spectrum antibiotic therapy is a significant predisposing factor for severe yeast infections in intensive care units (ICUs).
- Typical clinical signs of systemic mycosis are often absent in ICU patients, necessitating reliable diagnostic approaches.
- Opportunistic fungal infections pose a serious threat to critically ill patients.
Purpose of the Study:
- To investigate the prevalence of different yeast species in ICU patients with suspected systemic mycosis.
- To evaluate diagnostic methods for early detection of severe opportunistic fungal infections in ICU settings.
- To assess the utility of serological tests and antigen/metabolite detection for diagnosing yeast infections.
Main Methods:
- Mycological diagnostics including yeast strain culture and differentiation.
- Detection of immunological reactions against yeast antigens.
- Serological procedures for IgG and IgM antibody detection.
- Latex tests for Candida antigen detection.
- Gas chromatographic methods for yeast-specific metabolite (arabinitol) detection.
Main Results:
- Candida albicans was the most prevalent yeast species (among 200 patients), followed by Torulopsis glabrata and Candida krusei.
- Serological tests distinguishing IgG and IgM antibodies can monitor disease course in immunocompetent patients.
- Detection of Candida antigens and arabinitol levels are valuable for diagnosing early-stage and disseminated infections, especially in immunocompromised hosts.
Conclusions:
- Early and accurate diagnosis of yeast infections in ICU patients is crucial for effective management.
- A combination of mycological, immunological, and biochemical diagnostic methods improves the detection of opportunistic fungal infections.
- Diagnostic tools like antigen and metabolite detection are essential for managing severe yeast infections in critically ill patients.