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Enhanced IgE response to Candida albicans in postoperative invasive candidiasis
J Savolainen1, A Rantala, M Nermes
1Department of Clinical Allergology, University of Turku, Finland.
Background:
Invasive candidiasis is a life-threatening complication problem in post-operative and immunocompromized patients, e.g. those treated by intensive care. Candida is frequently cultured from the mucous membranes of hospital patients and fungal cultures offer little diagnostic help. Other diagnostic methods, such as blood cultures, serology and diagnostic imaging techniques produce results too late and, if positive, low sensitivity.
Objective:
To study the value of Candida-specific antibodies, especially those of IgE class, in diagnosing invasive Candida infection.
Methods:
The immunoglobulins IgE, IgG and IgM responses to antigens of Candida albicans in the sera of 14 patients with culture, biopsy and/or autopsy proven postoperative invasive candidiasis and of 11 colonized and 19 non-colonized operated patients were studied by mannan radioallergosorbent test (RAST), mannan enzyme-linked immunosorbent assay (ELISA) and immunoblotting.
Results:
Detection of IgE antibodies to C. albicans polysaccharide (mannan) and protein antigens proved specific and sensitive in diagnostics of invasive candidiasis after major abdominal surgery. IgE rose early in the course of the infection and the method made a clear distinction between invasive infection and mucous colonization. Immunoblotting for protein antibodies was most sensitive while nitrocellulose-RAST for mannan antibodies was most specific. The combined use of immunoblotting and RAST increased the sensitivity and the specificity. Determinations of anti-Candida IgG and IgM antibodies had low sensitivity and specificity.
Conclusion:
Critically ill patients with invasive candidiasis develop IgE antibodies to Candida antigens probably because of disturbed TH1/TH2 responses. Determination of specific IgE antibodies can be used as a diagnostic aid in the early stage of invasive Candida infection.
Insights
Detecting IgE antibodies to Candida antigens aids in early diagnosis of invasive candidiasis. This method distinguishes infection from colonization, offering a valuable tool for critically ill patients.
Area of Science:
- Medical Mycology
- Immunology
- Infectious Diseases
Background:
- Invasive candidiasis poses a life-threatening risk to post-operative and immunocompromised patients, particularly in intensive care settings.
- Current diagnostic methods like blood cultures and imaging often yield results too late or lack sensitivity.
- Fungal cultures from mucous membranes provide limited diagnostic value.
Purpose of the Study:
- To evaluate the diagnostic utility of Candida-specific antibodies, focusing on immunoglobulin E (IgE).
- To assess the role of IgE in differentiating invasive Candida infection from colonization.
Main Methods:
- Studied IgE, IgG, and IgM responses to Candida albicans antigens in patient sera.
- Employed mannan radioallergosorbent test (RAST), mannan enzyme-linked immunosorbent assay (ELISA), and immunoblotting techniques.
- Compared antibody responses in patients with proven invasive candidiasis, colonization, and no colonization.
Main Results:
- IgE antibodies to Candida antigens demonstrated high specificity and sensitivity for diagnosing invasive candidiasis post-surgery.
- IgE levels rose early, effectively distinguishing invasive infection from mucous colonization.
- Immunoblotting showed highest sensitivity for protein antibodies, while nitrocellulose-RAST was most specific for mannan antibodies.
Conclusions:
- Invasive candidiasis in critically ill patients is associated with IgE antibody development, possibly due to altered TH1/TH2 immune responses.
- Specific IgE antibody determination serves as a valuable early diagnostic aid for invasive Candida infections.