Laboratory diagnosis of invasive candidiasis: A rationale for complementary use of culture- and nonculture-based detection systems

Invasive candidiasis has emerged as an important cause of morbidity and mortality in immunocompromised patients; unfortunately, clinical manifestations are seldom specific and early laboratory detection of these infections remains difficult. Diagnosis of invasive candidiasis in immunocompromised patients can be optimized through an integrated approach of clinical and laboratory data. In the future, advances in new blood culture systems should be complemented by developments in diagnostic biochemical and antigenic markers. Among the promising markers for future development, in a panel format, are D-arabinitol, enolase antigen and antibody, 90 kD heat shock protein (HSP-90)-related cytoplasmic Candida antigen, and 1,3-β-D- glucan. A diagnostic panel of these markers would complement existing blood culture systems, enhance the ability of investigators to detect invasive candidiasis more readily, identify earlier stages of infection more consistently, and monitor therapeutic response more precisely.