Screening for acute disseminated histoplasmosis in HIV disease using urinary antigen detection enzyme immunoassay: A pilot study in Cameroon

Kuate, Marius Paulin Ngouanom; Nyasa, Raymond Babila; Mandengue, Christine; Tendongfor, Nicholas; Bongomin, Felix; Denning, David W.

doi:10.1016/j.mimet.2021.106226

Cited by 13 publications

(19 citation statements)

References 22 publications

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“…In this study, the prevalence of histoplasmosis in the AHD population was 7.3% (3/41). This finding was lower than reports from other studies done in Africa and other regions, probably because our study was not focused on people living with HIV/AIDS [ 25–28 ]. A recent report from Cameroon revealed a 26% (36/138) prevalence in the AHD population using urinary antigen test [ 25 ].…”

Section: Discussioncontrasting

confidence: 73%

“…This finding was lower than reports from other studies done in Africa and other regions, probably because our study was not focused on people living with HIV/AIDS [ 25–28 ]. A recent report from Cameroon revealed a 26% (36/138) prevalence in the AHD population using urinary antigen test [ 25 ]. An earlier report in 2015 from Cameroon reported a prevalence of 13% (7/56) in the AHD population [ 26 ].…”

Section: Discussioncontrasting

confidence: 73%

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Prevalence of Histoplasmosis and Molecular Characterization of Histoplasma species in Patients with Presumptive Pulmonary Tuberculosis in Calabar, Nigeria

Ekeng

Oladele

Emanghe

et al. 2022

Open Forum Infectious Diseases

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Background Several case reports abound in literature about cases of histoplasmosis misdiagnosed as tuberculosis (TB). Nigeria is one of the highest TB burdened countries but data on histoplasmosis in Nigeria are sparse in the literature. The aim of this research was to investigate patients with presumptive pulmonary tuberculosis (TB) in Calabar, Nigeria, for histoplasmosis. Methods This was a descriptive cross-sectional study of 213 participants with presumptive diagnosis of pulmonary TB between April 2020 and March 2021. Urine samples were collected from selected patients for Histoplasma antigen test using enzyme immunoassay assay kits (IMMY, USA), while sputum samples were collected for GeneXpert test for confirmed diagnosis of TB and conventional PCR for the diagnosis of histoplasmosis. Results Of the 213 participants enrolled into the study, ninety-four subjects (44.0%) were confirmed TB patients, 75 (35.0%) were HIV-positive, 41 (19.0%) had advanced HIV disease (AHD), while 138 (37.0%) were HIV-negative. Twenty-seven of the 213 participants were positive for Histoplasma by antigen test and/or PCR, giving an overall prevalence rate of 12.7%. The prevalence of histoplasmosis amongst confirmed TB patients of 7.0% (7/94) was significantly lower than 16.8% (20/119) in unconfirmed TB patients (p = 0.04). Participants on anti-TB therapy also had significantly lower rate of histoplasmosis compared to those not on anti-TB drugs (p = 0.00006). Conclusion Histoplasmosis is not uncommon amongst presumptive TB patients. There should be proper microbiological investigation of patients presenting with symptoms suggestive of TB to exclude cases of histoplasmosis.

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Section: Discussioncontrasting

confidence: 73%

Section: Discussioncontrasting

confidence: 73%

Prevalence of Histoplasmosis and Molecular Characterization of Histoplasma species in Patients with Presumptive Pulmonary Tuberculosis in Calabar, Nigeria

Ekeng

Oladele

Emanghe

et al. 2022

Open Forum Infectious Diseases

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“…A burden of 1800 cases of histoplasmosis/year was estimated in Cameroon [9]. Moreover, two prospective studies reported a prevalence of 13% and 26% in 2015 and 2021 respectively [10,11]. Approximately 10-25% of AIDS patients with disseminated histoplasmosis develop skin lesions [12], and this is usually associated with severe immunosuppression [13].…”

Section: Discussionmentioning

confidence: 99%

“…It is a technique that compensate the lack of laboratory infrastructure and laboratory personnel trained in diagnostic mycology [16]. Culture remains the gold standard but has a poor sensitivity [17,11]. Skin biopsy is rapid method of arriving at a speci c diagnosis of disseminated histoplasmosis.…”

Section: Discussionmentioning

confidence: 99%

Diagnosing disseminated histoplasmosis in advanced HIV/AIDS disease in Cameroon using a point of care lateral flow assay – a case series

Kuate

Abessolo

Denning

et al. 2022

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Background Histoplasmosis is an AIDS-defining opportunistic infection. Disseminated histoplasmosis (DH) can be fatal without early diagnosis and treatment initiation. We present four cases of disseminated histoplasmosis in advanced HIV/AIDS disease patients diagnosed using Histoplasma lateral flow assay (LFA) in Yaoundé, Cameroon. Cases presentation : Four women with HIV but unknown CD4 + T cell count were received at the Hospital presenting with asthenia, weight loss, productive cough and fever (39°C) as common symptoms for at least three weeks. Two of the patients had skin lesions. These included facial papules, macules and umbilicated vesicles scattered over the trunk and limbs. These were diffuse lesions which were purulent, itching and papillomatous lesions with a necrotic center, and one patient had a right forearm ulcer. We performed the Histoplasma antigen tests using the Histoplasma antigen lateral flow assay (LFA) and they were strongly positive in all four patients. Histopathology in skin biopsy allowed identification of the species as Histoplasma capsulatum var capsulatum in one patient. In this same patient, Pseudomonas aeruginosa and Proteus mirabilis were cultured from the forearm ulcer. This patient later commenced antibiotics (Levofloxacin 500 mg) and oral itraconazole (800mg/day) with immediate improvement. Unfortunately, the other three patients could not afford itraconazole, were discharged and lost to follow up. Conclusion Early diagnosis and treatment are essential for the management of DH. LFA is a test that can be set up in any setting with limited resource. Access to this can be a major advance in the diagnosis of histoplasmosis in resource limited settings.

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“…Several antigen detection assays exist for CM and DH, and they have been exploited in screening programs or studies in some countries in the Americas and Africa [ 23–29 ]. These assays have been evaluated in previous studies [ 22 , 23 , 26 , 28 , 29 , 30–32 ]. In Guatemala, an implemented screening for CM, DH, and TB reduced HIV deaths by 7% [ 24 ].…”

mentioning

confidence: 99%

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

Ocansey

Otoo

Asamoah

et al. 2022

Open Forum Infectious Diseases

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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.

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Screening for acute disseminated histoplasmosis in HIV disease using urinary antigen detection enzyme immunoassay: A pilot study in Cameroon

Cited by 13 publications

References 22 publications

Prevalence of Histoplasmosis and Molecular Characterization of Histoplasma species in Patients with Presumptive Pulmonary Tuberculosis in Calabar, Nigeria

Prevalence of Histoplasmosis and Molecular Characterization of Histoplasma species in Patients with Presumptive Pulmonary Tuberculosis in Calabar, Nigeria

Diagnosing disseminated histoplasmosis in advanced HIV/AIDS disease in Cameroon using a point of care lateral flow assay – a case series

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

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