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In an attempt to clarify the comparative values of serological and microbiological examinations for the early diagnosis of systemic candidiasis, antibodies against Candida albicans, serum mannan, and the D-arabinitol creatinine ratio were investigated in a patient with aortic valve endocarditis associated with carcinoma of the bile duct. Candida precipitins and the antibody titer against Candida cell wall mannan were examined by an immunodiffusion technique and hemagglutination test, respectively. Serum mannan was tested by enzyme-linked immunosorbent assay (ELISA) using the biotin-streptavidin procedure. The upper limit of negativity of the assay was determined by adding 0.06 to the absorbance of pooled serum from healthy laboratory workers. This value was about 0.8 ng/ml with ELISA. The D-arabinitol concentration in serum was examined by an enzymatic fluorometric method. Rising antibody titers against C. albicans, mannan antigenemia, and an elevated D-arabinitol creatinine ratio were first observed between the 11th and 12th hospital days. Blood cultures obtained on 8th, 9th, and 11th hospital days grew C. albicans after 3 to 4 days of incubation. Of 11 serum samples, 5 were positive for mannan, whereas D-arabinitol creatinine ratio was positive in 7 of 9 samples. Blood cultures was the earliest evidence of Candida infections in our cases. However, because of saprophytic nature of Candida species, tests for antibodies, antigenemia, and the D-arabinitol creatinine ratio in combination with blood cultures are necessary to confirm systemic candidiasis at an early stage of infection.

A clinical study was carried out on 11 patients with Candida urinary tract infection; 4 with chronic cystitis and 7 with acute pyelonephritis including 2 patients associated with candidemia. The patients received 1.5 to 6.0 g of 5-fluorocytosine (5-FC) orally daily for 6 to 22 days. The response was excellent in 6, moderate in 4 and poor in 1 case, overall efficacy rate being 90.9%. No patients showed any adverse reaction. The antibody against the Candida species was measured by an indirect hemagglutination test and the serum level of D-arabinitol, a major metabolite of Candida species, was determined by gas-liquid chromatography. A 4-fold or greater rise in anti-Candida antibody was detected in 4 of the 6 patients with pyelonephritis, including one patient associated with candidemia, 14 to 31 days following the treatment. Serum D-arabinitol levels in all of the 4 patients with pyelonephritis exceeded the detection limit of 0.2 microgram/ml before treatment. The levels decreased promptly during treatment and normalized 10 to 20 days after the start of treatment. These results suggest that 5-FC is an effective drug for Candida urinary tract infections. The determinations of anti-Candida antibody titer and serum D-arabinitol level may be clinically useful for the diagnosis of Candida pyelonephritis. In particular, the serum levels of D-arabinitol appear to be a useful parameter to follow-up the effect of anti-fungal treatment on Candida pyelonephritis.

The study was performed to compare the galactose tolerance of male and female pigs to 5% galactose and 25% hydrolysed whey (HW; containing 5% galactose) diets. Plasma galactose and dulcitol levels were measured throughout the diet period and correlated with the lens dulcitol contents at the end of the period. On the first day of the diet there was no significant difference between male and female blood galactose levels after galactose ingestion. The consumption of HW resulted in a significant 30% decrease in the blood galactose peak in females; there was no parallel difference in males on the HW diet. The 30-day diet induced a significant decrease in galactosaemia peaks resulting from galactose ingestion in both males and females, indicating an activation of galactose metabolism. The HW diet resulted in an equivalent decrease in peak galactosaemia only in males, cancelling the initial differences observed between males and females. The final dulcitol content in the lenses appeared to be correlated with plasma galactose but not with plasma dulcitol. However, the differences in plasma galactose between males and females, or between the two diets, resulted in smaller and often non-significant differences in lens dulcitol.

D-Arabinitol was identified by mass spectrometry as a metabolite of Candida albicans and Candida tropicalis. For quantification, serum was deproteinized with acetone, the supernatant was evaporated to dryness, the silyl derivative was formed, and a portion was injected into a combined gas chromatograph-mass spectrometer system. Erythritol or 2-deoxy-galactitol was the internal standard. The protonated molecular ions, obtained in chemical ionization with isobutane, were monitored. For 39 normal subjects the mean endogenous arabinitol concentration was 0.52 microgram/ml (standard deviation, +/- 0.34). An increment of 0.2 microgram of arabinitol per ml could be quantified. Of 11 cases with diagnosed invasive candidiasis, 9 had arabinitol levels > 1.2 microgram/ml (8 microM) in the range of 1.2 to 25.0 micrograms/ml; the remaining 2 cases had levels in the normal range. Six cases of diagnosed colonized candidiasis showed normal arabinitol levels.

Gas-liquid chromatographic procedures for measuring sugar and polyol concentrations in biological fluids are reviewed. Such methods require the preparations of derivatives such as methyl ethers, trimethylsilyl ethers or acetyl esters. Prior to derivatisation samples must be deproteinised and dried. Complex mixtures of sugars and sugar alcohols may be resolved. Quantitative analyses are precise, sensitive and linear. If internal standardisation is used recoveries approaching 100% are obtained.

Visceral candidiasis in 56 patients, 39 of whom were thought to be immune deficient, was investigated using three serological detection methods--whole cell agglutination, haemagglutination, and counterimmunoelectrophoresis for antibodies; two determinations of circulating antigens--haemagglutination inhibition and latex agglutination; and determination of the arabinitol:creatinine ratio. Of the 39 patients with suspected immune deficiency, 13 had confirmed invasive candidiasis and 26 were colonised; of those without signs of immune deficiency, 10 patients also had invasive candidiasis and seven were colonised. Twenty three patients with invasive candidiasis were analysed in total. For suspected immune deficient patients the best discrimination between visceral candidiasis and colonisation was obtained by combining the results of haemagglutination inhibition and arabinitol:creatinine ratio. For patients without signs of immune deficiency the best discrimination between invasive candidiasis and colonisation was achieved with counterimmunoelectrophoresis. The results of the serological tests confirmed the classification on clinical grounds of those with and without immune deficiency.