Detection of antibodies and antigenemia in leukemic patients with candidiasis by enzyme-linked immunosorbent assay.

Standard tests and two enzyme-linked immunosorbent assays (ELISAs) were compared for detecting systemic candidiasis in 92 leukemic patients. Antibodies to Candida were detected by immunodiffusion (ID), latex agglutination (LA), and indirect ELISA; antigenemia was evaluated by indirect ELISA inhibition. In 48 patients without candidiasis (group 1), sera from 27% reacted in ID and 13% in LA tests; titers of antibody by ELISA occurred in all patients. In 34 patients without disseminated candidiasis (groups 2 and 3), Candida species were isolated; sera from 35% and 32% were positive in the ID and the LA test, respectively. In nine of 10 patients with disseminated candidiasis (group 4), LA and ID tests were negative. Seven patients in groups 1-3 without disseminated candidiasis were antigenemic (false-positive rate, 9%). Antigenemia was detected in seven of 10 patients with disseminated candidiasis; in the remaining three patients sera were drawn too early to be of diagnostic value. Thus, monitoring of immunosuppressed patients for mannan antigenemia is useful for the detection of disseminated candidiasis.