Enzyme-linked immunosorbent assay measurement of fluctuations in antibody titer and antigenemia in cancer patients with and without candidiasis.

Antibody titers against purified sulfate-soluble fraction (PSSF) obtained from cytoplasmic extracts of Candida albicans were determined retrospectively over a 2-year period for 123 cancer patients by enzyme-linked immunosorbent assay. Antibody against cell wall mannan (CWM) was also measured by the hemagglutination test and the production of precipitins by a serum interacting with a yeast cell homogenate by immunodiffusion. Invasive candidiasis determined by histological evidence at autopsy was present in 10 patients. Fourfold or greater rises in anti-CWM and anti-PSSF antibodies were detected for eight of the patients with invasive candidiasis at 14 to 22 days after the onset of fever. The immunodiffusion test was positive for four patients with invasive candidiasis. For patients with no evidence of candidiasis, significant rises in anti-CWM and anti-PSSF antibodies were observed at a frequency of 20 and 10%, respectively. The concentrations of serum mannan were sequentially measured by the enzyme-linked immunosorbent assay. Antigenemia (greater than or equal to 3 ng/ml) was found in 9 of the 10 patients with invasive candidiasis and in 2 of the 4 patients with thrush, whereas the serum of 1 of the 36 patients with no evidence of candidiasis was positive for antigen. The first antigenemia antedated significant rises in antibody levels against Candida species by 6 to 23 days.