Immune response in patients with persistent candiduria and occult candidemia

Purpose: We evaluated the immunological response in patients with persisten t candiduria with or without occult candidemia. Materials and Methods: Levels of Th1 (pro-inflammatory interleukin [IL]-1, IL-2 and tumor necrosis factor-alpha) and Th2 (anti-inflammatory IL-4 and I L-10) cytokines were measured in the sera of patients with persistent candi duria. Polymerase chain reaction assessment of the 158 base pair candidal a ctin gene was used to detect Candida albicans in blood to identify occult c andidemia. Results: During a 14-month period 66 hospitalized patients with a mean age of 63 years (range 44 to 80) with persistent candiduria were evaluated. Occ ult candidemia developed in 27 patients (41%) as evidenced by detection of candidal actin gene in the sera by polymerase chain reaction. Risk factors included antibiotics in 27 patients (100%), central venous catheter in 22 ( 81%), urinary catheter in 21 (78%), total parenteral nutrition in 18 (66%), diabetes mellitus in 16 (59%) and abdominal surgery in 14 (52%). A total o f 17 age matched patients with a mean age of 59 years hospitalized for elec tive general or vascular surgical procedures with no clinical or laboratory evidence of urinary or hematogenous fungal or bacterial infection served a s controls. Serum levels of Th2 cytokines were elevated in 18 of 39 patient s with persistent candiduria alone, and in 22 of 27 patients with candiduri a and occult candidemia compared to controls (p <0.002). Th1 cytokines were within normal Limits or slightly decreased in all patients with persistent candiduria with or without candidemia. Conclusions: These observations indicate that an abnormal immune response d evelops in patients with persistent candiduria with or without candidemia.