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

• Published in: Journal of clinical microbiology Vol. 61; no. 11; p. e0059823
• Main Authors: Träger, Johannes, Dräger, Sarah, Mihai, Sidonia, Cipa, Franziska, Busse Grawitz, Andrea, Epting, Thomas, Meyer, Renate, Rappold, Elfriede, Held, Jürgen
• Format: Journal Article
• Language: English
• Published: United States 21.11.2023
• Subjects: Adult; Antigens, Fungal; beta-Glucans; Biomarkers; Candidemia - diagnosis; Candidemia - drug therapy; Candidemia - microbiology; Glucans - therapeutic use; Humans; Mannans; Prospective Studies; Recurrence; Sensitivity and Specificity; Candida; Platelia; glucan; mannan; Fungitell; biomarker; sepsis
• ISSN: 0095-1137; 1098-660X
• DOI: 10.1128/jcm.00598-23

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 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.