Effect of successful treatment with amphotericin B on Histoplasma capsulatum variety capsulatum polysaccharide antigen levels in patients with AIDS and histoplasmosis

Wheat, L. Joseph; Connolly‐Stringfield, Patricia; Blair, Robinette; Connolly, Kathleen; Garringer, Todd; Katz, Barry P.; Gupta, Mala

doi:10.1016/0002-9343(92)90106-l

Cited by 63 publications

(27 citation statements)

References 8 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Also, unlike other diagnostic methods, monitoring of quantitative Histoplasma antigen values in urine and/or serum can be used to follow treatment responses and to monitor disease progression (13,14). The primary limitation of the MVista assay is the requirement that all specimens be submitted to MiraVista Diagnostics for testing, which can delay result reporting and affect patient management.…”

mentioning

confidence: 99%

Reevaluation of Commercial Reagents for Detection of Histoplasma capsulatum Antigen in Urine

et al. 2015

View full text Add to dashboard Cite

Detection of the Histoplasma capsulatum urinary antigen (UAg) is among the most sensitive and rapid means to diagnose histoplasmosis. Previously, we evaluated analyte-specific reagents (ASR) manufactured by IMMY (Norman, OK) for detection of Histoplasma galactomannan (GM) in urine using an enzyme immunoassay (EIA), and we showed low positive agreement (64.5%) with the MiraVista (MVista) Histoplasma antigen (Ag) quantitative EIA (MiraVista Diagnostics, Indianapolis, IN). Here we reevaluated the IMMY GM ASR following modification of our original assay protocol and introduction of an indeterminate range. A total of 150 prospectively collected urine samples were tested with both the IMMY and MVista EIAs, and clinical histories were recorded for all study subjects. The IMMY GM ASR showed positive and negative agreements of 82.3% (14/17 samples) and 100% (121/121 samples), respectively (with exclusion of 12 indeterminate results), and overall agreement of 90% (135/150 samples) with respect to the MVista EIA. Of the three patients with negative IMMY GM ASR results and positive MVista EIA results, testing was performed for initial diagnostic purposes for one patient (<0.4 ng/ml by the MVista EIA) and UAg levels were being monitored for the remaining two patients (both <0.7 ng/ml by the MVista EIA). The MVista EIA results were positive for 6/12 samples that tested indeterminate by the IMMY GM ASR. We also show that the IMMY GM ASR can be used to serially monitor Histoplasma UAg levels. In conclusion, we demonstrate that, with modification, the IMMY GM ASR is a reliable rapid assay for detection of Histoplasma UAg. Localized largely along the Ohio River and Mississippi River valleys, Histoplasma capsulatum continues to be a significant cause of morbidity and death, particularly among individuals with weakened cellular immunity and those over the age of 65 years (1, 2). Despite the high rates of exposure (60 to 90%) among residents of these regions of endemicity, otherwise healthy individuals are able to control infections with minimal disease manifestations (3, 4). However, immunocompromised patients exposed to H. capsulatum typically present with a nonspecific febrile illness, which can rapidly progress to pneumonia, respiratory insufficiency, disseminated disease, and death (2, 5). Histoplasmosis can be treated effectively with proper antifungal management, but timely diagnosis is essential.Due to the nonspecific clinical presentation of histoplasmosis, as well as lengthy, costly, and potentially toxic therapeutic regimens, laboratory testing to confirm the diagnosis is critical. Many methods are available for this purpose, including culture, nucleic acid amplification testing (NAAT), histopathological examination, and antibody and antigen (Ag) detection. The individual performance characteristics of these methods vary, with their overall clinical utility being largely dependent on disease presentation (localized versus disseminated), level of patient immunosuppression, and symptom duration prior to testing. Briefly, wh...

show abstract

mentioning

confidence: 99%

Reevaluation of Commercial Reagents for Detection of Histoplasma capsulatum Antigen in Urine

et al. 2015

View full text Add to dashboard Cite

show abstract

“…These findings have led many health care providers to rely heavily on this assay as an indicator of active disease. Furthermore, as both urine and serum Histoplasma antigen levels generally decrease following the initiation of treatment, quantitative Histoplasma antigen values are routinely monitored as indicators of responses to antifungal therapy (11,12). Despite the clinical utility of antigen detection, the MVista Histoplasma UAg assay has a number of limitations, including cross-reactivity with other fungi (i.e., Blastomyces dermatitidis, Coccidioides species, Sporothrix schenckii, Paracoccidioides brasiliensis, and Penicillium marneffei) (13,14).…”

mentioning

confidence: 99%

Evaluation of an Enzyme Immunoassay for Detection of Histoplasma capsulatum Antigen from Urine Specimens

Theel¹,

Jespersen²,

Harring³

et al. 2013

J Clin Microbiol

View full text Add to dashboard Cite

show abstract

“…Antigen levels decline with effective therapy (9,11) and increase with relapse (10). The Infectious Diseases Society of America (IDSA) guidelines for treatment of patients with progressive disseminated histoplasmosis (PDH) recommend monitoring antigen levels during and after completion of treatment (13).…”

mentioning

confidence: 99%

“…The Infectious Diseases Society of America (IDSA) guidelines for treatment of patients with progressive disseminated histoplasmosis (PDH) recommend monitoring antigen levels during and after completion of treatment (13). Prior studies of antigen clearance in PDH used the original Histoplasma antigen radioimmunoassay (11) and enzyme immunoassay (EIA) (2,9). Subsequently, the assay was modified to reduce false-positive results caused by interfering substances (14) and to provide quantification (1).…”

mentioning

confidence: 99%

Histoplasma Antigen Clearance during Treatment of Histoplasmosis in Patients with AIDS Determined by a Quantitative Antigen Enzyme Immunoassay

Hage

Kirsch

Stump

et al. 2011

Clin. Vaccine Immunol.

View full text Add to dashboard Cite

Clearance of Histoplasma antigen has been used as a marker for response to treatment of progressive disseminated histoplasmosis (PDH) in patients with AIDS. Advancements in Histoplasma antigen detection permit accurate quantification of antigen concentration. We compared the clearance of antigenemia and antigenuria during effective treatment of PDH. Urine and serum specimens were serially collected from patients with AIDS who were successfully treated for PDH as part of two prospective clinical trials. Samples were stored frozen until they were tested in the quantitative Histoplasma antigen enzyme immunoassay. The kinetics of antigen clearance during the first 12 weeks of therapy were assessed in urine and serum during treatment with liposomal or deoxycholate amphotericin B followed by itraconazole and, in a separate analysis, in patients receiving only itraconazole. Latent class growth analysis was performed to define patterns of antigen clearance over time. In patients receiving amphotericin B, antigen levels declined the most during the first 2 weeks of treatment and antigenemia decreased more rapidly than antigenuria (5.90 ng/ml per week versus 4.21 ng/ml per week, respectively; P ‫؍‬ 0.09). Mean reductions of antigen levels from baseline at weeks 2 and 12 were greater in sera than in urine: 11.26 ng/ml versus 7.65 ng/ml (P ‫؍‬ 0.0948) and 18.52 ng/ml versus 14.64 ng/ml (P ‫؍‬ 0.0440), respectively. In patients who received itraconazole alone, most of the decline in antigenuria occurred later during treatment and was overall slower than that seen with amphotericin B (P < 0.0001). Results of latent class growth modeling showed two distinct trajectories for each parameter. With effective therapy, Histoplasma antigenemia decreases more rapidly than antigenuria, providing a more sensitive early laboratory marker for response to treatment. Antigenuria declines earlier with amphotericin B than with itraconazole.

show abstract

Effect of successful treatment with amphotericin B on Histoplasma capsulatum variety capsulatum polysaccharide antigen levels in patients with AIDS and histoplasmosis

Cited by 63 publications

References 8 publications

Reevaluation of Commercial Reagents for Detection of Histoplasma capsulatum Antigen in Urine

Reevaluation of Commercial Reagents for Detection of Histoplasma capsulatum Antigen in Urine

Evaluation of an Enzyme Immunoassay for Detection of Histoplasma capsulatum Antigen from Urine Specimens

Histoplasma Antigen Clearance during Treatment of Histoplasmosis in Patients with AIDS Determined by a Quantitative Antigen Enzyme Immunoassay

Contact Info

Product

Resources

About