Laboratory diagnosis of deep-seated fungal infection : III. Diagnosis siginificance of serum D-arabinitol coccenrtation

Criteria for the diagnosisi of deep-seared fungal ingection by quantification of D-arabinitol in serum by gas chromatography were proposed, and their sensitivity and specificity were discussed. Either serum D-arabinitol ≧3.0μg/ml (creatinine＜1.5mg/dl) or D-arabinitol/creatinine ratio≧0.2 (creatinine≧1.5mg/dl) was considered to be appropriate for diagnostic ceiterion. According to these ceiteria, twenty-one od the 44 cases with deep-seated fungal infection, whose diagnosis was eatablished by autopasy, were accutately diagnosed, but only one of 97 uninfected controls (sensitivity 48%, soecificity 99%). Candidiasis (including cases with co-infection bu other fungi) (18/31, ore 58%) and cryptococcosis (2/3, or 67%) had relatively hifh positicity, while infection by other fungi (asperogillosis, mucor infection etc.) rarely gave positive results (one case of aspergillosis out of 10 such cases). Fifteen of 31 cases with negative blood culture in spite of proved deep-seated fungal infection had high serum D-arabinitol concentration or D-arabinitol/creatinine ratio over the diagnositic value. Aithough quantification of serum D-arabinitol is nor bery sensitive to the diagnosis of deep-seated fungal infection, this method makes up for the limitation of culturing.