Diagnosis of Acute Pulmonary Histoplasmosis by Antigen Detection

Swartzentruber, S.; Rhodes, Luther V.; Kurkjian, Katie M.; Zahn, Matt; Brandt, Mary E.; Connolly, Patricia; Wheat, L. Joseph

doi:10.1086/648421

Cited by 118 publications

(115 citation statements)

References 36 publications

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“…More cases were tested in the current report than the previous report: 28 and 11, respectively. However, antigenemia was detected less frequently in patients with blastomycosis than in those with histoplasmosis: 90% in patients with disseminated histoplasmosis (11) and 80% in those with acute pulmonary histoplasmosis (12).…”

Section: Discussionmentioning

confidence: 88%

Blastomyces dermatitidis Antigen Detection by Quantitative Enzyme Immunoassay

Connolly¹,

Hage

Bariola

et al. 2012

Clin Vaccine Immunol

100

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The second-generation MVista Blastomyces antigen enzyme immunoassay was not quantitative; therefore, specimens obtained previously were tested in the same assay as new specimens to assess the change in antigen levels. Furthermore, the sensitivity in serum had not been fully evaluated. The purpose of this study was to evaluate a quantitative Blastomyces antigen assay and detection of antigen in serum. Calibrators containing known concentrations of Blastomyces galactomannan were used to quantify antigen in urine and serum from patients with proven blastomycosis and from controls. Paired current and previously obtained urine specimens were tested to determine if quantification eliminated the need for concurrent testing to assess change in antigen. Pretreatment of serum with EDTA at 104°C was evaluated to determine if dissociation of immune complexes improved detection of antigenemia. Antigenuria was detected in 89.9% of patients with culture-or histopathology-proven blastomycosis. Specificity was 99.0% in patients with nonfungal infections and healthy subjects, but cross-reactions occurred in 95.6% of patients with histoplasmosis. Change in antigen level categorized as increase, no change, or decrease based on antigen units determined in the same assay agreed closely with the category of change in ng/ml determined from different assays. Pretreatment increased the sensitivity of detection of antigenemia from 35.7% to 57.1%. Quantification eliminated the need for concurrent testing of current and previously obtained specimens for assessment of changes in antigen concentration. Pretreatment increased the sensitivity for detection of antigenemia. Differentiation of histoplasmosis and blastomycosis is not possible by antigen detection.A ntigen detection is a useful method for diagnosis of blastomycosis. The sensitivity has been reported to be over 90% and specificity has been reported to be 100% in healthy subjects, but cross-reactions occur in most patients with histoplasmosis (6). In a recent report of 59 patients with proven blastomycosis (4), culture was positive in 86%, histopathology in 81%, antigen in 74%, cytopathology in 38%, and immunodiffusion for antibody in 32% (4). Antigen detection was considered to be a "reliable method to make an accurate and rapid diagnosis of blastomycosis, particularly when a large burden of disease is present, and when cytological analysis is performed at less-experienced centers" (4). Blastomyces antigen detection was also reported to be useful for diagnosis of blastomycosis in solid organ transplant patients (7).Because of interassay variability, specimens obtained earlier have been tested simultaneously with current specimens to assess the change in antigen levels. In a Histoplasma antigen assay, quantification of galactomannan antigen eliminated the need to test the previously obtained specimen with the current specimen to determine change in antigen level (5). In a recent study, quantification and improved detection of antigen in serum following EDTA treatment at 104°C in the t...

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Section: Discussionmentioning

confidence: 88%

Blastomyces dermatitidis Antigen Detection by Quantitative Enzyme Immunoassay

Connolly¹,

Hage

Bariola

et al. 2012

Clin Vaccine Immunol

100

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“…Combining both urine and serum testing increases the likelihood of antigen detection (16). Antigen testing has also been applied to other body fluids, including BAL fluid and cerebrospinal fluid (CSF).…”

Section: Antigen Detectionmentioning

confidence: 99%

Laboratory Diagnostics for Histoplasmosis

2017

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The diagnosis of histoplasmosis is based on a multifaceted approach that includes clinical, radiographic, and laboratory evidence of disease. The gold standards for laboratory diagnosis include demonstration of yeast on pathological examination of tissue and isolation of the mold in the culture of clinical specimens; however, antigen detection has provided a rapid, noninvasive, and highly sensitive method for diagnosis and is a useful marker of treatment response. Molecular methods with improved sensitivity on clinical specimens are being developed but are not yet ready for widespread clinical use. This review synthesizes currently available laboratory diagnostics for histoplasmosis, with an emphasis on complexities of testing and performance in various clinical contexts.

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“…Although >90% of histoplasmosis infections are asymptomatic, mediastinal/hilar lymphadenopathy and associated nonspecific symptoms may be present in 5-10% of immunocompetent patients [2]. Currently, testing for antibodies by immunodiffusion or complement fixation technique is considered more sensitive for SPH than tests for an antigen, as fungal burden is low and pulmonary infection is often very localized in immunocompetent patients [3].…”

Section: Discussionmentioning

confidence: 99%

“…The morbidity and mortality of histoplasmosis are related to the duration and extent of systemic infection as well as underlying comorbidities. Around 1-5% may advance to subacute pulmonary histoplasmosis (SPH) [3].…”

Section: Introductionmentioning

confidence: 99%