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[Diagnosis of systemic Candida infections. Evaluation of serology, molecular biology and D-arabinitol detection].

In order to diagnose systemic Candida infection in ICU patients, several methods were compared. In the first round, antigens and antibodies of 104 patients were investigated. Seventeen patients were infected; in nine of these patients a positive antigen was detected; elevated antibodies were detected in 11 patients. Only 42 patients were colonized. In this group, one positive antigen and six elevated antibody titres were detected. Combining these results, the sensitivity of the antigen only (58.5%) or the antibodies only (52.9%) increased to 100%. In the second round (n = 83 patients) the D-arabinitol/L-arabinitol quotient was also determined in the urine. 18.1% of the patients had elevated antibodies and 26.5% elevated D-arabinitol/L-arabinitol quotients. In the third round, PCR was also applied (n = 27 patients). Five patients had elevated D-arabinitol/L-arabinitol quotients and one of these had a positive PCR result. In conclusion, serological methods (antigen and antibody detection) should only be applied in strictly selected patients. In uncertain cases, the addition of PCR or determination of D-arabinitol/L-arabinitol might be helpful.