CANDIDA ANTIGEN TITER IS A MARKER OF NEUTROPHIL DYSFUNCTION AFTER SEVERE INJURY

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Abstract
Trauma patients with positive Candida antigen titers have high mortality rates. Death is the result of sepsis and multi-organ system failure. Considerations of host immunity to Candida led us to concurrently study the function of neutrophils (PMNs) from severely injured adults with positive titers (n = 20), patients with negative titers matched for age, sex, and injury (n = 20), and volunteers (n = 20). Anticandidal PMN function was determined using a 3H-glucose incorporation assay. RESULTS are expressed as mean percentage of growth inhibition +/- SEM. PMN, from all groups inhibited Candida growth, although PMNs from titer-positive patients demonstrated less growth inhibition. In vitro cytokines granulocyte macrophage-colony stimulating factor [(GM-CSF), interferon-gamma (IFN-gamma), and interleukin 8 (IL-8)] improved function of PMNs from each group and corrected the impaired anticandidal function of PMNs from titer-positive patients, with GM-CSF being most effective. Seriously injured patients with positive Candida antigen titers have PMNs with impaired anticandidal function, which can be restored by cytokines. These findings begin to explain why seriously injured patients with positive Candida antigen titers have increased mortality and to offer hope of therapeutic intervention.

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