1887

Abstract

A non-invasive, non-culture-based method of determining urinary -/-arabinitol (-/-ARA) ratios was investigated as a tool for the diagnosis of invasive candidiasis in nosocomial paediatric infection cases. The study encompassed 138 children aged 4 days to 16 years (mean±=1.6±4.2 years) with congenital heart defects (91.4 %) or with rhythm disorders or circulatory failure (8.6 %). ARA enantiomers were detected by GC using an electron capture detector. Positive -/-ARA ratios were found for 11/11 patients with proven candidiasis and 17/19 patients with clinically suspected invasive candidiasis. Thirty children were undergoing antifungal chemotherapy. -/-ARA ratios (mean±) were 2.601±0.544 in hospitalized cardiac patients without fungal infection and 5.120±1.253 in those receiving antifungal therapy (<0.001). The sensitivity of the method was 100 %, the specificity 97.2 %, the positive predictive value was 78.6 % and the negative predictive value was 100 %.

Loading

Article metrics loading...

/content/journal/jmm/10.1099/jmm.0.018135-0
2010-12-01
2024-04-26
Loading full text...

Full text loading...

/deliver/fulltext/jmm/59/12/1490.html?itemId=/content/journal/jmm/10.1099/jmm.0.018135-0&mimeType=html&fmt=ahah

References

  1. Benjamin D. K. Jr, DeLong E. R., Steinbach W. J., Cotton C. M., Walsh T. J., Clark R. H. 2003; Empirical therapy for neonatal candidemia in very low birth weight infants. Pediatrics 112:543–547 [CrossRef]
    [Google Scholar]
  2. Benjamin D. K. Jr, Miro J. M., Hoen B., Steinbach W. J., Fowler W. G. Jr, Olaison L., Habib G., Abrutyn E., Perfect J. other authors 2004; Candida endocarditis: contemporary casus from the International Collaboration of Infectious Endocarditis Merged Database (ICE-mD. Scand J Infect Dis 36:453–455 [CrossRef]
    [Google Scholar]
  3. Bernard E. M., Christiansen K. J., Tsang S., Kiehn T. E., Armstrong D. 1981; Rate of arabinitol production by pathogenic yeast species. J Clin Microbiol 14:189–194
    [Google Scholar]
  4. Chakrabarti C., Sood S. K., Parnell V., Rubin L. G. 2003; Prolonged candidemia in infants following surgery for congenital heart disease. Infect Control Hosp Epidemiol 24:753–757 [CrossRef]
    [Google Scholar]
  5. Chandrasekar P. H. 2001; Empirical antifungal therapy for persistent fever in patients with neutropenia. Clin Infect Dis 32:320 [CrossRef]
    [Google Scholar]
  6. Christensson B., Wiebe T., Pehrson K., Larsson L. 1997; Diagnosis of invasive candidiasis in neutropenic children with cancer by determination of d-arabinitol/l-arabinitol ratios in urine. J Clin Microbiol 35:636–640
    [Google Scholar]
  7. Debusk C. H., Daoud R., Thirumoorthi M. C., Wilson F. M., Khatib R. 1994; Candidemia: current epidemiologic characteristics and a long-term follow-up of the survivors. Scand J Infect Dis 26:697–703 [CrossRef]
    [Google Scholar]
  8. Denning D. W., Kibbler C. C., Barnes R. A. British Society for Medical Mycology 2003; British Society for Medical Mycology proposed standards of care for patients with invasive fungal infections. Lancet Infect Dis 3:230–240 [CrossRef]
    [Google Scholar]
  9. Eggimann P., Garbino J., Pittet D. 2003; Management of Candida species infections in critically ill patients. Lancet Infect Dis 3:772–785 [CrossRef]
    [Google Scholar]
  10. Ellis M. E., Al-Abdely H., Sandridge A., Greer W., Ventura W. 2001; Fungal endocarditis: evidence in the world literature, 1965–1995. Clin Infect Dis 32:50–62 [CrossRef]
    [Google Scholar]
  11. Ellis M., al-Ramadi B., Finkelman M., Hedstrom U., Kristensen J., Ali-Zadeh H., Klingspor L. 2008; Assessment of the clinical utility of serial β -d-glucan concentrations in patients with persistent neutropenic fever. J Med Microbiol 57:287–295 [CrossRef]
    [Google Scholar]
  12. Giamarellou H. 2002; Nosocomial cardiac infections. J Hosp Infect 50:91–105 [CrossRef]
    [Google Scholar]
  13. Gutiérrez J., Maroto C., Piédrola G., Martín E., Perez J. A. 1993; Circulating Candida antigens and antibodies: useful markers of candidemia. J Clin Microbiol 31:2550–2552
    [Google Scholar]
  14. Johnston P. G., Lee J., Domanski M., Dressler F., Tucker E., Rothenberg M., Cunnion R. E., Pizzo P. A., Walsh T. J. 1991; Late recurrent Candida endocarditis. Chest 99:1531–1533 [CrossRef]
    [Google Scholar]
  15. Kossoff E. H., Buescher E. S., Karlowicz M. G. 1998; Candidemia in a neonatal intensive care unit: trends during fifteen years and clinical features of 111 cases. Pediatr Infect Dis J 17:504–508 [CrossRef]
    [Google Scholar]
  16. Larsson L., Pehrson C., Wiebe T., Christensson B. 1994; Gas chromatographic determination of d-arabinitol/l-arabinitol ratios in urine: a potential method for diagnosis of disseminated candidiasis. J Clin Microbiol 32:1855–1859
    [Google Scholar]
  17. Levy I., Ovadia B., Erez E., Rinat S., Ashkenazi S., Birk E., Konisberger H., Vidne D., Dagan O. 2003; Nosocomial infections after cardiac surgery in infants and children: incidence and risk factors. J Hosp Infect 53:111–116 [CrossRef]
    [Google Scholar]
  18. MacDonald L., Baker C., Chenoweth C. 1998; Risk factors for candidemia in a children's hospital. Clin Infect Dis 26:642–645 [CrossRef]
    [Google Scholar]
  19. McDonald L. C., Weinstein M. P., Fune J., Mirrett S., Reimer R. G., Reller L. B. 2001; Controlled comparison of BacT/ALERT FAN aerobic medium and BACTEC fungal blood culture medium for detection of fungemia. J Clin Microbiol 39:622–624 [CrossRef]
    [Google Scholar]
  20. Millar B. C., Jugo J., Moore J. E. 2005; Fungal endocarditis in neonates and children. Pediatr Cardiol 26:517–536 [CrossRef]
    [Google Scholar]
  21. Rabalais G. P., Samiec T. D., Bryant K. K., Lewis J. J. 1996; Invasive candidiasis in infants weighing more than 2500 grams at birth admitted to a neonatal intensive care unit. Pediatr Infect Dis J 15:348–352 [CrossRef]
    [Google Scholar]
  22. Reiss E., Obayashi T., Orle K., Yoshida M., Zancopé-Oliveira R. M. 2000; Non-culture based diagnostic tests for mycotic infections. Med Mycol 38:147–159 [CrossRef]
    [Google Scholar]
  23. Rex J. H., Walsh T. J., Sobel J. D., Filler S. G., Pappas P. G., Dismukes W. E., Edwards J. E. 2000; Practice guidelines for the treatment of candidiasis. Clin Infect Dis 30:662–678 [CrossRef]
    [Google Scholar]
  24. Roboz J. 1994; Diagnosis and monitoring of disseminated candidiasis based on serum/urine d/l-arabinitol ratios. Chirality 6:51–57 [CrossRef]
    [Google Scholar]
  25. Roboz J., Katz R. N. 1992; Diagnosis of disseminated candidiasis based on serum d-/l-arabinitol ratios using negative chemical ionization mass spectrometry. J Chromatogr 575:281–286 [CrossRef]
    [Google Scholar]
  26. Saxen H. S., Virtanen M., Carlson P., Hoppu K., Pohjavuori M., Vaara M., Vuopio-Varkila J., Peltola H. 1995; Neonatal Candida parapsilosis outbreak with a high case fatality rate. Pediatr Infect Dis J 14:776–781 [CrossRef]
    [Google Scholar]
  27. Sendid B., Cotteau A., François N., D'Haveloose A., Standaert A., Camus D., Poulain D. 2006; Candidemia and antifungal therapy in a French University Hospital: rough trends over a decade and possible links. BMC Infect Dis 6:80 [CrossRef]
    [Google Scholar]
  28. Sigmundsdottir G., Larsson L., Wiebe T., Björklund L. J., Christensson B. 2007; Clinical experience of urine d-arabinitol/l-arabinitol ratio in the early diagnosis of invasive candidiasis in paediatric high risk populations. Scand J Infect Dis 39:146–151 [CrossRef]
    [Google Scholar]
  29. Stradomska T. J., Mielniczuk Z. 2002; Gas chromatographic determination of d-/l-arabinitol ratio in healthy Polish children. J Chromatogr B Analyt Technol Biomed Life Sci 773:175–181 [CrossRef]
    [Google Scholar]
  30. Stradomska T. J., Bobula-Milewska B., Bauer A., Mielniczuk Z., Dąbkowska M., Syczewska M., Dzierżanowska D. 2005; Urinary d-/l-arabinitol levels in infants undergoing long-term antibiotic therapy. J Clin Microbiol 43:5351–5354 [CrossRef]
    [Google Scholar]
  31. Tissières P., Jaeggi E. T., Beghetti M., Gervaix A. 2005; Increase of fungal endocarditis in children. Infection 33:267–272 [CrossRef]
    [Google Scholar]
  32. Tylki-Szymańska A., Stradomska T. J., Wamelink M. M. C., Salomons G. S., Taybert J., Pawłowska J., Jakobs C. 2009; Transaldolase deficiency in two new patients with a relative mild phenotype. Mol Genet Metab 97:15–17 [CrossRef]
    [Google Scholar]
  33. Walsh T. J., Merz W. G., Lee J. W., Schaufele R., Sein T., Whitcomb P. O., Ruddel M., Burns W., Wingard J. R. other authors 1995; Diagnosis and therapeutic monitoring of invasive candidiasis by rapid enzymatic detection of serum d-arabinitol. Am J Med 99:164–172 [CrossRef]
    [Google Scholar]
  34. Weems J. J. Jr 1992; Candida parapsilosis : epidemiology, pathogenicity, clinical manifestations, and antimicrobial susceptibility. Clin Infect Dis 14:756–766 [CrossRef]
    [Google Scholar]
  35. Wong B., Bernard E. M., Gold J. W. M., Fong D., Amstrong D. 1982; The arabinitol appearance rate in laboratory animals and humans: estimation from the arabinitol/creatinine ratio and relevance to the diagnosis of candidiasis. J Infect Dis 146:353–359 [CrossRef]
    [Google Scholar]
  36. Yeo S. F., Huie S., Sofair A. N., Campbell S., Durante A., Wong B. 2006; Measurement of serum d-arabinitol/creatinine ratios for initial diagnosis and for predicting outcome in an unselected, population-based sample of patients with Candida fungemia. J Clin Microbiol 44:3894–3899 [CrossRef]
    [Google Scholar]
  37. Zaoutis T. E., Greves H. M., Lautenbach E., Bilker W. B., Coffin S. E. 2004; Risk factors for disseminated candidiasis in children with candidemia. Pediatr Infect Dis J 23:635–641 [CrossRef]
    [Google Scholar]
http://instance.metastore.ingenta.com/content/journal/jmm/10.1099/jmm.0.018135-0
Loading
/content/journal/jmm/10.1099/jmm.0.018135-0
Loading

Data & Media loading...

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error