this type of infection is related , among others , to the type of the transplanted organ . invasive candidiasis occurs more often in liver recipients , and invasive aspergillosis in lung recipients [ 13 ] . invasive candidiasis is one of the main post transplant complications , presenting a high risk of death . there are three phases , depending on the time since transplant : early ( 1 month after transplant ) , intermediate ( 2 - 6 months ) , and late ( > 6 months ) . there might be different types of complications , because of different risk factors depending on how long ago the transplant was performed . invasive candidiasis is a risk in the early , intermediate and late phase , however , each phase is characterised by different predisposing factors [ 1 , 3 ] . rapid and precise fungal infection diagnosis and appropriate antifungal treatment administration are crucial in post transplant patients . tests confirming diagnosis are being developed because of the difficulty in detecting fungal infections , because of scarce and unspecific symptoms , and because of insufficient sensitivity and specificity of classical methods [ 1 , 4 ] . besides classical / culture methods , new ones to detect yeast infections , such as highly immunogenic components of yeast cell walls mannan [ platelia candida ag plus ( biorad , marne - la- coquette , france ) ] , and also ( 1 - 3)--d - glucan ( such as fungitec- g , glucatell  fungitell ) , are being researched [ 2 , 5 , 6 ] . rapid serological tests seem useful to monitor the physical condition of patients at high risk of fungal infections , and also make it possible to quickly detect them [ 6 , 7 ] . cell wall components are transient and rapidly taken up by endocytosis or by the forming immune complexes in invasive infections . for practical reasons , it is advisable to regularly monitor the levels of those markers in body fluids in high - risk patients . the simple detection of yeast cell wall components does not provide any information on strain antimycotic susceptibility . with mannan , a polysaccharide antigen with strong immunogenic and immunomodulatory properties , it was possible to come up with a new strategy of invasive candidiasis detection . it focuses on simultaneously monitoring the levels of circulating mannan and anti - mannan antibodies in patients at risk of invasive candidiasis . this strategy increases the chances of detecting invasive infections , since a high mannan level is related to a decrease in anti- mannan antibodies . study , where a single identification of mannan or anti - mannan antibodies detected the infection in 40 - 50% of individuals . simultaneous testing for these two markers resulted in an 80% increase in sensitivity and 93% increase in specificity in the same patients . as it was proven by sendid et al . , simultaneous testing for mannanaemia and anti - mannan antibodies in diagnosing invasive candidiasis , especially in immunocompetent patients , increased the chances of detecting an infection [ 7 , 8 ] . sendid et al . investigated their correlation in patients presenting invasive candidiasis symptoms , but no neutropenia symptoms [ 2 , 4 , 7 ] . despite quite thorough descriptions of the importance of testing for mannan and anti - mannan antibodies in bone - marrow transplant recipients , there is still little information about the usefulness of these tests in surgical and transplant patients , especially because of the administered immunosuppression . it could become a helpful parameter in diagnosing invasive candidiasis in recipients with stable organ transplants and without additional aggravations . however , these tests are most sensitive with candida albicans , c. glabrata , and c. tropicalis infections . for c. krusei , c. parapsilosis , and c. guillermondii infections the sensitivity is only of 40 - 50% [ 6 , 7 , 9 ] . since so little is known about the usefulness of mannan antigen and anti - mannan antibodies testing , the idea was to try assessing the usefulness of this test in surgical and transplant patients . the present study was to determine the usefulness of mannan antigen and anti - mannan antibody testing in diagnosing invasive candidiasis in liver / kidney transplant recipients . twenty - five patients were selected and had serum samples collected at least twice , as part of routine diagnostic procedures , and additionally were examined for clinical symptoms of fungal infections , had their fungal prevention routines assessed , and fungi were cultured out of various clinical materials , including blood . mycological tests were performed on 66 clinical samples from 25 patients hospitalised at the warsaw teaching hospital in 2011 - 2012 . additionally , 35 clinical samples collected from those patients were analysed during that period of time as part of routine mycological diagnostic procedures , including blood ( 4 ) , bal ( 4 ) , sputum ( 5 ) , and urine ( 4 ) ; other materials included : throat swab , fluid after liver re - transplantation , aortic abscess , wounds , drains , samples of tissues , peritoneal fluid , anal swabs , stool samples , and 66 blood serum samples . the clinical material was collected during routine diagnostic procedures from patients hospitalised at the warsaw medical university institute of transplantology in 2011 - 2012 . strains were cultured on sabouraud agar with chloramphenicol for 24 - 48 hours at 30c , and then on chromagar candida media ( graso biotech , starogard gdanski , poland ) . strain identification was performed using biochemical traits with the automated i d 32 c test ( bio- meriux , marcy l'etoile , france ) according to manufacturer 's guidelines . all collected serum samples were stored at 20c before testing , according to test manufacturer 's guidelines . the levels of mannan and anti - mannan antibodies were assessed with platelia candida ag plus , and platelia candida ab plus ( biorad , marne - la - coquette , france ) commercial tests , according to manufacturer 's guidelines . result interpretation followed manufacturer 's mannan cutoffs : negative < 62.5 pg / ml ; positive > 125 pg / ml , for anti - mannan antibodies : negative < 5 au / ml ; positive > 10 au / ml . after analysing 66 serums from 25 patients ( 9 liver transplant recipients , 7 kidney transplant recipients , and 9 patients prepared for a kidney transplant ) , 29 serum samples from 15 patients tested positive for mannan antigen . thirty - one serum samples from 14 patients presented a high level of anti - mannan antibodies . eleven serum samples from 7 patients presented a high level of both soluble mannan antigen and anti - mannan antibodies . in those patients , candida spp . was also cultured in different clinical material from 11 patients with a high mannan antigen or anti - mannan antibody levels . the biggest percentage of fungal infections occurs in bone marrow transplants , more rarely in liver transplants , most rarely in kidney transplants . mycological tests , including sample microscopy analysis , culture on different media , and identification using biochemical traits , are still insufficient to detect fungal infections [ 3 , 10 ] . according to eortc / ificg guidelines , there are three types of fungal infections in high - risk patients : confirmed , probable and possible . positive blood cultures , which enable identification of systemic mycoses with manifesting clinical signs , indicating organ invasion , are one of the most important diagnostic criteria ; furthermore , additional tests confirm fungal presence in tissues . additional tests , such as direct microscopic examination confirm the presence of fungi in tissues . probable invasive mycosis is diagnosed in the presence of clinical signs of infection and the detection of biomarkers ( fungal antigen ) in at least two serum samples . fungal infections in high - risk patients , not presenting any clinical signs , but with positive cultures in material collected from various sites but not blood , should be considered possible [ 11 , 12 ] . elisa , the used serological methods , detecting highly immunogenic cell wall components  mannan antigens , and also anti - mannan antibodies , are more and more often used in early detection of fungal infections . serological monitoring of mannan antigen and anti - mannan antibody level in high - risk patients might be a key in detecting or ruling out invasive mycoses . testing for mannan and anti - mannan antibodies in systemic candidiasis may be performed about six days earlier to positive blood cultures . many studies emphasise the fact that fungal antigen detection in blood serum in patients under immunosuppression , especially with neutropenia , suggests that adequate antifungal treatment should be administered . different treatment strategies are used , depending on patient condition and laboratory results . preventive empirical treatment , used in patients with prolonged neutropenia and fever lasting over five days despite antibiotic treatment , and also with mucosal candidiasis , or with inflammatory lung lesions , is administered in high - risk patients in order to reduce the risk of invasive fungal infections . patients with positive biomarker results undergo preemptive treatment if fungal biomarkers in their blood serum are regularly monitored [ 15 , 16 ] . targeted therapy is used in patients with a diagnosed fungal infection according to the antimicrobial resistance profile of the pathogen [ 11 , 14 , 17 ] . treatment in patients with suspected invasive candidiasis as well as in those with a diagnosed infection is difficult and depends on patient condition , infection localisation , and infectious strain . the infectious diseases society of america ( idsa ) recommends the following preventive antifungal drugs : fluconazole , itraconazole , and amphotericin b [ 18 , 19 ] . echinocandins ( caspofungin , anidulafungin , micafungin ) , drugs with a proven high effectiveness in treating candida spp . infections , are also often used in empirical treatment , besides fluconazole and amphotericin b . rescue treatment , consisting of a combination of antimycotics or non - standard doses , is used in patients with advanced fungal infections not responding to standard treatments . a thorough assessment of study results demonstrates that serological tests may be used to confirm or rule out invasive candidiasis in high - risk patients . the findings of the present study were analogous to those of foreign research centres [ 10 , 20 ] . n n401 042738 ) . project manager : e. swoboda - kope , md , phd