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The use of mannan antigen and anti-mannan antibodies in the diagnosis of invasive candidiasis: recommendations from the Third European Conference on Infections in Leukemia
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INTRODUCTION: Timely diagnosis of invasive candidiasis (IC) remains difficult as the clinical presentation is not specific and blood cultures lack sensitivity and need a long incubation time. Thus, non-culture-based methods for diagnosing IC have been developed. Mannan antigen (Mn) and anti-mannan antibodies (A-Mn) are present in patients with IC. On behalf of the Third European Conference on Infections in Leukemia, the performance of these tests was analysed and reviewed. METHODS: The literature was searched for studies using the commercially available sandwich enzyme-linked immunosorbent assays (Platelia™, Bio-Rad Laboratories, Marnes-la-Coquette, France) for detecting Mn and A-Mn in serum. The target condition of this review was IC defined according to 2008 European Organization for Research and Treatment of Cancer/Mycoses Study Group criteria. Sensitivity, specificity and diagnostic odds ratios (DOR) were calculated for Mn, A-Mn and combined Mn/A-Mn testing. RESULTS: Overall, 14 studies that comprised 453 patients and 767 controls were reviewed. The patient populations included in the studies were mainly haematological and cancer cases in seven studies and mainly intensive care unit and surgery cases in the other seven studies. All studies but one were retrospective in design. Mn sensitivity was 58% (95% confidence interval [CI], 53-62); specificity, 93% (95% CI, 91-94) and DOR, 18 (95% CI 12-28). A-Mn sensitivity was 59% (95% CI, 54-65); specificity, 83% (95% CI, 79-97) and DOR, 12 (95% CI 7-21). Combined Mn/A-Mn sensitivity was 83% (95% CI, 79-87); specificity, 86% (95% CI, 82-90) and DOR, 58 (95% CI 27-122). Significant heterogeneity of the studies was detected. The sensitivity of both Mn and A-Mn varied for different Candida species, and it was the highest for C. albicans, followed by C. glabrata and C. tropicalis. In 73% of 45 patients with candidemia, at least one of the serological tests was positive before the culture results, with mean time advantage being 6 days for Mn and 7 days for A-Mn. In 21 patients with hepatosplenic IC, 18 (86%) had Mn or A-Mn positive test results at a median of 16 days before radiological detection of liver or spleen lesions. CONCLUSIONS: Mn and A-Mn are useful for diagnosis of IC. The performance of combined Mn/A-Mn testing is superior to either Mn or A-Mn testing.
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“An assay that detects both mannan and anti-mannan IgG (Platelia, Bio-rad, Hercules, CA, USA) has a combined sensitivity and specificity of 83% and 86%, respectively [81].”
From Treatment of Invasive Candidiasis: A Narrative Review (2018) · cites this paper as [81]
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Metadata
- Authors
- Mikulska, M., Calandra, T., Sanguinetti, M., Poulain, D., Viscoli, C., & the Third European Conference on Infections in Leukemia Group
- Affiliations
- Ospedale Policlinico San Martino (IT)
- Centre Hospitalier Universitaire Vaudois (CH)
- Università Cattolica del Sacro Cuore (IT)
- Inserm (FR)
- Corresponding author
- Mikulska, Małgorzata
- Venue
- Critical Care
- Published
- 2010-12-08
- Volume
- 14
- Issue
- 6
- Pages
- R222-R222
- ISSN
- 1364-8535 (ISSN-L)
- PMC
- PMC3219989
- OpenAlex
- W2141329212
- Cited by
- 319
- References
- 38
- Citations by year
- 2026: 8 · 2025: 25 · 2024: 10 · 2023: 25 · 2022: 17 · 2021: 22 · 2020: 25 · 2019: 21 · 2018: 19 · 2017: 14 · 2016: 22 · 2015: 27 · 2014: 29 · 2013: 29 · 2012: 19
- FWCI
- 2.06
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- Critical Care (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- HAL (submittedVersion, other-oa)
- IRIS (submittedVersion)
- CINECA IRIS Institutial Research Information System (University of Genoa) (submittedVersion)
- SERVAL (Université de Lausanne) (submittedVersion, other-oa)
- Topics
- Health Sciences › Medicine › Infectious Diseases › Antifungal resistance and susceptibility
- Health Sciences › Medicine › Infectious Diseases › Fungal Infections and Studies
- Life Sciences › Immunology and Microbiology › Microbiology › Yeasts and Rust Fungi Studies
- Keywords
- mannan antigen, anti-mannan antibodies, candidemia, diagnostic accuracy, sensitivity and specificity, Candida species, Candida albicans, Candida glabrata, Candida tropicalis, hematologic malignancies, intensive care unit patients, sandwich ELISA
- MeSH terms
- Animals, Antibodies, Fungal, Antigens, Fungal, Candida, Congresses as Topic, Europe, Humans, Leukemia, Mannans, Randomized Controlled Trials as Topic, Practice Guidelines as Topic, Candidiasis, Invasive
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