Mannose-binding lectin deficiency facilitates abdominal Candida infections in patients with secondary peritonitis

Abstract

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 microg/ml [0.0 to 0.65 microg/ml] versus 0.65 microg/ml (0.19 to 1.95 microg/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 microg/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.

FIG. 1.

Proportional differences of early (during index laparotomy), late (during relaparotomy), or no AYI in patients with WT or variant MBL genotypes. *, P value of the comparison of proportions of patients with no, early, or late AYI between WT and variant groups in a chi-square test.

FIG. 2.

Scatter plots of MBL plasma concentrations in patients with and those without AYI (AYI+ and AYI−, respectively) and controls from the general population (lines represent median concentrations). P values were derived by comparisons between those with AYI and those without AYI and between those with and without AYI and controls (Mann-Whitney U test).