Progressive disseminated histoplasmosis: a systematic review on the performance of non-culture-based diagnostic tests

Abstract

The diagnosis of progressive disseminated histoplasmosis is often a challenge to clinicians, especially due to the low sensitivity and long turnaround time of the classic diagnostic methods. In recent years, studies involving a variety of non-culture-based diagnostic tests have been published in the literature. We performed a systematic review by selecting studies evaluating non-culture-based diagnostic methods for progressive disseminated histoplasmosis. We searched for articles evaluating detection of antibody, antigens, as well as DNA-based diagnostic methods. A comprehensive PUBMED, Web of Science, and Cochrane Library search was performed between the years 1956 and 2016. Case reports, review articles, non-human models and series involving less than 10 patients were excluded. We found 278 articles and after initial review 18 articles were included: (12) involved antigen detection methods, (4) molecular methods, and (2) antibody detection methods. Here we demonstrate that the pursuit of new technologies is ultimately required for the early and accurate diagnosis of disseminated histoplasmosis. In particular, urinary antigen detection was the most accurate tool when compared with other diagnostic techniques.

Clinical features and endemic trend of histoplasmosis in China: A retrospective analysis and literature review

“…The reason why little patients’ cultures were positive is probably that blood cultures would take up to 6 weeks for diagnostic growth to occur, which results in false‐negative. Henceforth, though the golden standard of diagnosis for histoplasmosis is the culture of pathogens, histological examination plays a more significant role in timely diagnosis because of the less time it would take, which is 3‐5 days in general . Direct microscopy and tissue biopsy should be considered as quick and reliable method to diagnose histoplasmosis .…”

“…Henceforth, though the golden standard of diagnosis for histoplasmosis is the culture of pathogens, histological examination plays a more significant role in timely diagnosis because of the less time it would take, which is 3-5 days in general. 24 Direct microscopy and tissue biopsy should be considered as quick and reliable method to diagnose histoplasmosis. 25,26 Notably, direct microscopy in bone marrow smear for the first time might find no Histoplasma capsulatum and the detection rates can be improved by repeating bone marrow puncture in multiple locations.…”

The Role of Molecular Tests in the Diagnosis of Disseminated Histoplasmosis

“…Most of these studies have used whole blood, serum or fungal culture as the appropriate specimen for PCR testing, with a very high sensitivity and specificity. Molecular diagnosis can be effectively applied to lung biopsies, in situations in which other classical methods of pathogen identification are usually not effective [15,29]. Molecular tests are arguably important in regions where DH is not endemic, due to limited expertise in H. capsulatum identification.…”

Immunotherapy against Systemic Fungal Infections Based on Monoclonal Antibodies

“…capsulatum is a dimorphic fungus with a worldwide distribution, endemic in North America-with high prevalence in the soil from the midwestern and southern regions of the US [138] and areas within Latin America, and is associated with outbreaks in particular regions of Africa and Asia [139]. Despite the cosmopolitan characteristic, the exact frequency of the mycosis is still unclear as only few laboratories in endemic countries are prepared to effectively establish the diagnosis, particularly since histoplasmosis may simulate prevalent diseases such as cancer or tuberculosis [140,141].…”