DETECTION OF ANTIBODIES TO CANDIDA-ALBICANS GERM TUBES FOR DIAGNOSIS AND THERAPEUTIC MONITORING OF INVASIVE CANDIDIASIS IN PATIENTS WITH HEMATOLOGIC MALIGNANCIES

We prospectively investigated the ability of detection of antibodies t o Candida albicans germ tubes (CAGT) to diagnose invasive candidiasis in 95 consecutive admissions of 73 patients with hematologic disorders undergoing intensive chemotherapy, The episodes were divided into thr ee groups according to clinical and microbiological diagnosis. Group 1 comprised eight admissions of eight patients with invasive candidiasi s, Group 2 comprised 42 admissions of 34 patients without evidence of invasive candidiasis. Group 3 comprised the remaining 45 admissions of 37 patients with febrile episodes which were not diagnosed by microbi ological culture. Antibodies to CAGT were detected in 87.5% of group 1 patients, Detection of antibodies to CAGT in patients with Candida fu ngemia was delayed somewhat relative to the time the blood culture was positive, but antibodies to CAGT were detected earlier than a diagnos is was made in patients,vith deep-tissue candidiasis. Sera from 2 admi ssions in group 2 and 12 admissions in group 3 revealed antibodies to CAGT, At a titer of greater than or equal to 1:20, detection of antibo dies to CAGT had a sensitivity of 87.5%, specificity of 95.2%, positiv e predictive value of 77.8%, and negative predictive value of 97.6%. A ntibodies to CAGT were usually detected before beginning of empiric an tifungal therapy, Titers of antibodies to CAGT were maintained in mast patients who died but declined and eventually disappeared in the pati ents who survived. Since antibodies to CAGT were detected in all patie nts with tissue-proven invasive candidiasis but negative by blood cult ure, detection of antibodies to CAGT complemented blood cultures for d iagnosis and therapeutic monitoring of patients with hematologic malig nancies and invasive candidiasis.