Pediatric Infectious Disease

Register      Login

VOLUME 4 , ISSUE 1 ( January-March, 2022 ) > List of Articles

Notes From The Lab

T2 Candida Panel: A Game Changer in Diagnosis of Fungal Infections

Citation Information : T2 Candida Panel: A Game Changer in Diagnosis of Fungal Infections. Pediatr Inf Dis 2022; 4 (1):24-25.

DOI: 10.5005/jp-journals-10081-1333

License: CC BY-NC 4.0

Published Online: 08-02-2022

Copyright Statement:  Copyright © 2022; The Author(s).


Abstract

In invasive fungal infections, early initiation of treatment within the day of symptom onset is related with a significantly reduced mortality. Early initiation of treatment and specifically treatment initiation within the day of symptom onset and blood culture draw is related to a significantly reduced mortality. However, automated blood culture methodologies, which are routinely used for the diagnosis of candidemia, take up to 2–5 days to grow and lead to a crucial delay in treatment initiation. Therefore, a highly sensitive, specific, and rapid diagnostic method is expected to allow early initiation of antifungal therapy and subsequently improve outcomes. Rapid diagnostic methods for fungal infections are long-awaited and are expected to improve outcomes through early initiation of targeted antifungal therapy. T2 Candida panel is a novel qualitative diagnostic platform that was recently approved by the US Food and Drug Administration (FDA) for diagnosis of candidemia with a mean time to species identification of <5 hours. Technological advances in the field of nanotechnology coupled with the proven applications of magnetic resonance have recently presented a rapid, fully automated, qualitative, sensitive, and specific diagnostic platform, the “T2 Candida panel”. The introduction of this technology in diagnostic algorithms will increase the cost per patient tested, but it is expected to provide an economically self-supporting policy if savings from shorter hospital stays and termination of excess empiric antifungal treatment are taken into account. Expected benefits in terms of morbidity, mortality, and costs remain to be confirmed in clinical practice. The T2 Magnetic Resonance (T2MR) assay can detect and speciate the five most common Candida spp.; namely, Candida albicans, Candida glabrata, Candida parapsilosis, Candida tropicalis, and Candida krusei, in approximately 5 hours. The five detectable Candida spp. are responsible for >95% of the total Candida infections. T2 Magnetic Resonance demonstrated a sensitivity and specificity of 91.1 and 98.1%, respectively. The utility of T2MR in candidemia depends on the prevalence of the disease in each clinical setting. In intensive care units and other high-prevalence settings, the incorporation of T2MR in diagnostic algorithms is very appealing. T2 Magnetic Resonance is expected to allow timely initiation of antifungal therapy and help with antifungal stewardship. In low-prevalence settings, the positive predictive value of T2MR might not be enough to justify the initiation of antifungal treatment in itself.


PDF Share
  1. Singh T, Kashyap AK, Ahluwalia G, et al. Epidemiology of fungal infections in critical care setting of a tertiary care teaching hospital in North India: a prospective surveillance study. Mortality 2014;1:19–25.
  2. Bassetti M, Giacobbe DR, Vena A, et al. Incidence and outcome of invasive candidiasis in intensive care units (ICUs) in Europe: results of the EUCANDICU project. Critical Care 2019;23(1):1–7. DOI: 10.1186/s13054-019-2497-3.
  3. Avni T, Leibovici L, Paul M. PCR diagnosis of invasive candidiasis: systematic review and meta-analysis. J Clin Microbiol 2011;49(2):665–670. DOI: 10.1128/JCM.01602-10.
  4. Neely LA, Audeh M, Phung NA, et al. T2 magnetic resonance enables nanoparticle-mediated rapid detection of candidemia in whole blood. Sci Translat Med 2013;5(182):182ra54. DOI: 10.1126/scitranslmed.3005377.
  5. Zervou FN, Zacharioudakis IM, Kurpewski J, et al. T2 magnetic resonance for fungal diagnosis. In Human fungal pathogen identification. New York, USA: Humana Press; 2017. pp. 305–319.
  6. Beyda ND, Alam MJ, Garey KW. Comparison of the T2Dx instrument with T2 Candida assay and automated blood culture in the detection of Candida species using seeded blood samples. Diagnos Microbiol Infect Dis 2013;77(4):324–326. DOI: 10.1016/j.diagmicrobio.2013. 07.007.
  7. Mylonakis E, Clancy CJ, Ostrosky-Zeichner L, et al. T2 magnetic resonance assay for the rapid diagnosis of candidemia in whole blood: a clinical trial. Clin Infect Dis 2015;60(6):892–899. DOI: 10.1093/cid/ciu959.
  8. Pappas PG, Kauffman CA, Andes D, et al. Clinical practice guidelines for the management of candidiasis: 2009 update by the Infectious Diseases Society of America. Clin Infect Dis 2009;48(5):503. DOI: 10.1086/596757.
  9. Bilir SP, Ferrufino CP, Pfaller MA, et al. The economic impact of rapid Candida species identification by T2 Candida among high-risk patients. Fut Microb 2015;10(7):1133–1144. DOI: 10.2217/fmb.15.29.
  10. Pfaller MA, Jones RN, Castanheira M. Regional data analysis of Candida non-albicans strains collected in United States medical sites over a 6-year period, 2006–2011. Mycoses 2014;57(10):602–611. DOI: 10.1111/myc.12206.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.