Finding the "missing 50%" of invasive candidiasis: How non-culture diagnostics will improve understanding of disease spectrum and transform patient care.
Clin Infect Dis. 2013 Jan 11;
Authors: Clancy CJ, Nguyen MH
Blood cultures are limited for diagnosing invasive candidiasis by poor sensitivity and slow turn-around time. New diagnostics are needed to complement cultures, in particular to identify the "missing 50%" of patients who are blood culture-negative. Mannan/anti-mannan IgG, â-D-glucan (BDG) and PCR assays can diagnose candidemia before blood cultures and show promising sensitivity/specificity, but they are not widely-investigated in blood culture-negative, deep-seated candidiasis. In a recent study, BDG and PCR were superior to blood cultures in deep-seated candidiasis, suggesting they may identify currently-undiagnosed patients and expand our understanding of disease spectrum. Positive predictive values of non-culture tests are limited by the low prevalence of invasive candidiasis, which mandates that results be interpreted judiciously. Employed as biomarkers that assess a patient's risk of having invasive candidiasis, tests will facilitate pre-emptive antifungal strategies. Since negative predictive values are excellent, tests will also be useful for ruling-out invasive candidiasis and discontinuing unnecessary antifungal therapy.
PMID: 23315320 [PubMed - as supplied by publisher]