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Mannose-Binding Lectin Deficiency Facilitates Abdominal Candida Infections in Patients with Secondary Peritonitis

Department of Surgery, Academic Medical Center, Amsterdam,¹ Department of Immunopathology, Sanquin Research at the Central Laboratory of The Netherlands Red Cross Blood Transfusion Service, Amsterdam,² Department of Blood Cell Research, Sanquin Research at the Central Laboratory of The Netherlands Red Cross Blood Transfusion Service, Amsterdam,³ Department of Clinical Virology, Academic Medical Center, Amsterdam, The Netherlands⁴

Received 6 July 2007/ Returned for modification 20 August 2007/ Accepted 19 October 2007

Mannose-binding lectin (MBL) deficiency due to variations in the MBL gene is associated with increased susceptibility to infections. In this study, the association between MBL deficiency and the occurrence of abdominal yeast infection (AYI) in peritonitis patients was examined. Eighty-eight patients with secondary peritonitis requiring emergency laparotomy were included. MBL genotype (wild type [WT] versus patients with variant genotypes), MBL plasma concentrations, and Candida risk factors were examined in patients with and those without AYI (positive abdominal yeast cultures during [re]laparotomy). A variant MBL genotype was found in 53% of patients with AYI and 38% of those without AYI (P = 0.18). A significantly higher proportion of variant patients had an AYI during early peritonitis (during first laparotomy) than WT patients (39% versus 16%, respectively; P = 0.012). Patients with AYI had lower MBL levels than did patients without AYI (0.16 µg/ml [0.0 to 0.65 µg/ml] versus 0.65 µg/ml (0.19 to 1.95 µg/ml); P = 0.007). Intensity of colonization (odds ratio [OR], 1.1; 95% confidence interval [CI], 1.0 to 1.1), MBL plasma concentrations of <0.5 µg/ml (OR, 4.5; 95% CI, 1.2 to 16.3), and numbers of relaparotomies (OR, 1.7; 95% CI, 1.0 to 2.8) were independently associated with AYI. In summary, deficient MBL plasma levels were independently associated with the development of AYI in patients with secondary peritonitis and seemed to facilitate early infection.

Published ahead of print on 31 October 2007.