Separation and quantification by gas chromatography-mass spectrometry of arabinitol enantiomers to aid the differential diagnosis of disseminated candidiasis

To differentiate increased arabinitol due to fungal (only d-arabinitol) and nonfungal origin, O-trifluoroacetyl derivatives of the enantiomers were separated using α-perpentylated cyclodextrin columns and measured by selected ion monitoring. Mean±S.D. d/l in normal serum: 1.40±0.42. l/l ratios > 2.24, defined as normal mean+2S.D., were considered outside normal range. D/L was > 2.2 in 10 of 12 confirmed candidiasis cases with one false negative and one borderline. Renal dysfunction without candidiasis yielded normal d/l despite high arabinitol concentrations. d/l in normal urine was nearly identical to that in serum despite 60 times larger concentration. d/l ratios, determined by peak heights or areas, could be used without the need to determine concentrations.