PROSPECTIVE EVALUATION OF CANDIDA ANTIGEN AND ANTIBODY-ASSAYS FOR DETECTION OF CANDIDA INFECTIONS IN CHILDREN WITH MALIGNANT DISEASE

The clinical efficacy of assays for Candida albicans antigens by latex agglutination and for antibodies by indirect haemagglutination were p rospectively evaluated in the diagnosis of invasive Candida infections in 38 children suffering from acute leukaemia or other malignant dise ase. The controls were 74 other patients without any malignancy; 72 of these had no signs or symptoms of fungal infections, but 2 had an inv asive C. albicans infection. During a period of 21 months, 302 serum s amples were tested by both assays, and the results were compared with clinical and other microbiological data. Invasive fungal infection was diagnosed on clinical grounds in 2 of the immunocompromised children, and periodic gut colonization was demonstrated in 11 of 36 (31%) chil dren in this group. Positive Candida antigen was detected in 14 patien ts (37%) and a positive antibody titre in 7 patients (18%). Colonizati on was not correlated with antigen or antibody titre. Compared with th e presence of invasive fungal infection, the antibody assay detected a ll four infections, whereas the antigen assay detected one of the two C. albicans septicaemias. Although the Candida antibody assay performe d well, a detectable change in antibody titres appeared only slowly. T hus it was of no clinical help when antifungal treatment was to be con sidered. Follow-up of antibody titres, however, gave confirmation of t he presence of fungal infection as well as the response to antifungal treatment.