Cited by 320Antifungal resistance and susceptibilityFungal Infections and StudiesYeasts and Rust Fungi Studies

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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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Mikulska, Małgorzata, Calandra, Thierry, Sanguinetti, Maurizio, Poulain, Daniel, Viscoli, Claudio, the Third European Conference on Infections in Leukemia Group·2010·Critical Care

DOI 10.1186/cc9365PMC PMC3219989

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Abstract

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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Figure 1 Single-study and overall sensitivity, specificity and diagnostic odds ratio (DOR) for mannan antigen testing. Total number of patients and a weight of each single study in meta-analysis are reported.CC BY · PubMed Central

Figure 2 Single-study and overall sensitivity, specificity and DOR for anti-mannan antibody testing. Total number of patients and a weight of each single study in meta-analysis are reported.CC BY · PubMed Central

Figure 3 Single-study and overall sensitivity, specificity and DOR for combined mannan antigen and anti-mannan antibody testing. Total number of patients and a weight of each single study in meta-analysis are reported.CC BY · PubMed Central

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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
ORCID: Mikulska, Małgorzata
Calandra, Thierry
Sanguinetti, Maurizio
Poulain, Daniel
Venue: Critical Care
Publisher: Springer Science and Business Media LLC
Published: 2010-12-08
Volume: 14
Issue: 6
Pages: R222-R222
ISSN: 1364-8535 (ISSN-L)
DOI: 10.1186/cc9365
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
Licence: cc-by
creativecommons.org/licenses/by/2.0/ (tdm)
creativecommons.org/licenses/by/2.0/ (vor)
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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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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