Western blot analysis of the immune response to Candida albicans antigens in 391 long-term intensive care patients.

The aim of this study was to determine, using Western blot, the prevalence of anti-Candida albicans antibodies in long-term intensive care patients and to characterize specific immune responses that may only occur in patients with invasive candidosis. A total of 1751 serum samples from 391 patients of a German multicentre study, which was designed to determine the incidence of systemic candidosis, was examined. Significantly enhanced antibody production against specific antigens was observed in several subgroups of patients, i.e. those with underlying disease of the pancreas (29 kDa, P = 0.006), cholecystolithiasis (47 kDa, P = 0.029), gastrointestinal tract disease (47 kDa, P = 0.03), steroid therapy (58 kDa, P = 0.02), thrush (58 kDa, P = 0.032), urogenital infection (58 kDa, P = 0.034), Candida antigen titre > or = 1:4 (58 kDa, P = 0.002) and positive fungal culture (36 kDa, P = 0.033) and those who had died (36 kDa, P = 0.011). In contrast to earlier publications, an immune response against the 29 and 47 kDa antigens was relatively common among long-term intensive care patients (37% and 70% antibody positive respectively). A single antigen that provided satisfactory sensitivity and specificity for the discrimination between fungal infection and no fungal infection or between superficial and invasive fungal infection was not identified in this study.