Cryptococcal and Histoplasma Antigen Screening Among People With Human Immunodeficiency Virus in Ghana and Comparative Analysis of OIDx Histoplasma Lateral Flow Assay and IMMY Histoplasma Enzyme Immunoassay

Abstract

Background Cryptococcal meningitis (CM) and disseminated histoplasmosis (DH) are common in people with HIV (PWH) and diagnosed by detecting cryptococcal antigen (CrAg) and Histoplasma antigen (Histo Ag) respectively. In Ghana, CM and DH are rarely suspected by clinicians due to limited epidemiological data. Methods This study was conducted among PWH in Ghana who are unwell. Sociodemographic and clinical data were collected by questionnaire. Serum and/or urine were screened for CrAg and Histo Ag, using IMMY CrAg lateral flow assay (LFA) and IMMY Histoplasma enzyme immunoassay (EIA) kits, respectively, regardless of symptoms. Samples run with IMMY Histoplasma EIA were simultaneously run with OIDx Histoplasma LFA. Laboratory investigations were conducted by the research team while diagnosis incorporating clinical assessment, screening and confirmatory testing results and treatment decisions were made by the clinical team. Treatment and outcome information on CM and DH patients were evaluated. Results Overall, 150 participants were recruited. There were 73% (n = 109) females, and the age range was 18–62 years. The prevalence rates of CrAg and Histo Ag were 2.7% (4/150) and 4.7% (5/107), respectively. The OIDx Histoplasma LFA showed a high concordance (98.4%) with the IMMY Histoplasma EIA. All antigen-positive cases by standard tests were diagnosed with CM and DH. Antifungal treatment was given in five patients and follow-up revealed two deaths and three recoveries. Conclusion Histoplasmosis among PWH may be more common than previously anticipated and may be more frequent than cryptococcosis in Ghana. The performance of the OIDx Histoplasma LFA should be further explored.

Gastrointestinal Histoplasmosis: A Descriptive Review, 2001–2021

“…It is thus not surprising that despite the increasing cases of DH, GIH is rarely reported. Underreporting is surprisingly pronounced in Africa, a region known to have documented several cases of DH [ 4 , 6 , 125 , 126 , 127 ]. An extensive review on histoplasmosis in Africa that spanned seven decades identified 470 cases of histoplasmosis, of which only one case was reported with GIH [ 5 ].…”

“…An extensive review on histoplasmosis in Africa that spanned seven decades identified 470 cases of histoplasmosis, of which only one case was reported with GIH [ 5 ]. The paucity of data on GIH is first and foremost probably because histoplasmosis is still a neglected fungal disease in most parts of Africa, although with recent epidemiological studies, awareness is improving [ 125 , 126 , 127 ]. Recognition and reporting of GIH may also be hampered by a lack of adequate diagnostic procedures such as colonoscopy.…”

Invasive Fungal Diseases in Africa: A Critical Literature Review

“…It is the leading cause of morbidity and mortality in AIDS patients worldwide, affecting one million people annually [9,10]. The invasive form of the disease, cryptococcal meningitis (CM) kills more than 180,000 HIVpositive patients annually, with over 70% in low-income countries, including sub-Saharan African (SSA) countries [11,12]. Rare forms of extra-neuromeningococcal cryptococcosis exist in Africa [13].…”

Improving awareness, diagnosis and management of invasive fungal infections in Ghana: establishment of the Ghana Medical Mycology Society

“…For example, a recently published study revealed that disseminated histoplasmosis may be more common than cryptococcal meningitis in Ghana contradicting the findings from the model study. 8 The few epidemiological studies are often spearheaded by foreign clinicians and the upskilled diagnostic capacity declines after the study. 9 , 10 Going forward, study investigators must engage policy makers and clinical leads towards drawing a framework for implementation and ensuring the integration of the research laboratory testing into clinical practice.…”