Significance of Histoplasma Antigen in the Cerebrospinal Fluid of Patients With Meningitis

Wheat, L. Joseph; Köhler, Richard; Tewari, Ram P.; Garten, Melinda; French, Morris L. V.

doi:10.1001/archinte.1989.00390020044009

Cited by 50 publications

(11 citation statements)

References 8 publications

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“…Also important is the possibility of false-positive results from non-culture-based tests, including the Histoplasma antigen assay [4]. The sensitivity and specificity of the commonly used diagnostic tests are summarized in table 1 [1,[5][6][7][8][9][10][11]. Although diagnosis may be simple for patients with widely disseminated PDH-since organisms may be identified in multiple organs-difficulty occurs for those with isolated CNS involvement.…”

Section: Discussionmentioning

confidence: 99%

Diagnosis and Management of Central Nervous System Histoplasmosis

Wheat¹,

Musial²,

Jenny-Avital

2005

Clinical Infectious Diseases

175

144

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Two cases of Histoplasma meningitis are presented, illustrating the difficulty in diagnosis and treatment. The first case occurred in a patient with acquired immunodeficiency syndrome as a relapse of disseminated histoplasmosis and resolved after prolonged treatment and ongoing antiretroviral therapy. The second case occurred in a cardiac allograft recipient as meningitis and focal brain lesions that responded to liposomal amphotericin B, but the patient died shortly after therapy was completed. Unfortunately, there are no prospective studies addressing the diagnosis and management of patients with histoplasmosis of the central nervous system from which to provide evidence-based guidelines for care. In the absence of such data, an approach will be presented on the basis of our experience and opinions.

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Section: Discussionmentioning

confidence: 99%

Diagnosis and Management of Central Nervous System Histoplasmosis

Wheat¹,

Musial²,

Jenny-Avital

2005

Clinical Infectious Diseases

175

144

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“…There have been no reported data on the usefulness of this assay on bronchoalveolar lavage fluid from non-AIDS patients. Antigen was shown to be present in cerebrospinal fluid of patients with Histoplasma meningitis by using the original radioimmunoassay (143). The sensitivity of the EIA has been reported to be from 40 to 66%, with the higher rates noted in immunosuppressed patients who presumably had a higher burden of organisms in the central nervous system (151).…”

Section: Antigen Detectionmentioning

confidence: 99%

Histoplasmosis: a Clinical and Laboratory Update

2007

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SUMMARY Infection with Histoplasma capsulatum occurs commonly in areas in the Midwestern United States and Central America, but symptomatic disease requiring medical care is manifest in very few patients. The extent of disease depends on the number of conidia inhaled and the function of the host's cellular immune system. Pulmonary infection is the primary manifestation of histoplasmosis, varying from mild pneumonitis to severe acute respiratory distress syndrome. In those with emphysema, a chronic progressive form of histoplasmosis can ensue. Dissemination of H. capsulatum within macrophages is common and becomes symptomatic primarily in patients with defects in cellular immunity. The spectrum of disseminated infection includes acute, severe, life-threatening sepsis and chronic, slowly progressive infection. Diagnostic accuracy has improved greatly with the use of an assay for Histoplasma antigen in the urine; serology remains useful for certain forms of histoplasmosis, and culture is the ultimate confirming diagnostic test. Classically, histoplasmosis has been treated with long courses of amphotericin B. Today, amphotericin B is rarely used except for severe infection and then only for a few weeks, followed by azole therapy. Itraconazole is the azole of choice following initial amphotericin B treatment and for primary treatment of mild to moderate histoplasmosis.

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“…During infection with H. capsulatum, antigen can be released by the fungal cells and detected in body fluids such as serum (blood), pleural fluid, bronchoalveolar lavage fluid, cerebrospinal fluid and urine (145,149,150). Antigen detection can be particularly useful in acute disease, especially in individuals also infected with HIV, who frequently have the disseminated form of histoplasmosis without detectable antibodies to the fungus (146-148).…”

Section: Antigen Detectionmentioning

confidence: 99%

Diagnosis of histoplasmosis

Guimarães

Nosanchuk²,

Zancopé‐Oliveira³

2006

Braz. J. Microbiol.

171

206

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Endemic mycoses can be challenging to diagnose and accurate interpretation of laboratory data is important to ensure the most appropriate treatment for the patients. Although the definitive diagnosis of histoplasmosis (HP), one of the most frequent endemic mycoses in the world, is achieved by direct diagnosis performed by micro and/or macroscopic observation of Histoplasma capsulatum (H. capsulatum), serologic evidence of this fungal infection is important since the isolation of the etiologic agents is time-consuming and insensitive. A variety of immunoassays have been used to detect specific antibodies to H. capsulatum. The most applied technique for antibody detection is immunodiffusion with sensitivity between 70 to 100 % and specificity of 100%, depending on the clinical form. The complement fixation (CF) test, a methodology extensively used on the past, is less specific (60 to 90%). Detecting fungal antigens by immunoassays is valuable in immunocompromised individuals where such assays achieve positive predictive values of 96-98%. Most current tests in diagnostic laboratories still utilize unpurified antigenic complexes from either whole fungal cells or their culture filtrates. Emphasis has shifted, however, to clinical immunoassays using highly purified and well-characterized antigens including recombinant antigens. In this paper, we review the current conventional diagnostic tools, such as complement fixation and immunodiffusion, outline the development of novel diagnostic reagents and methods, and discuss their relative merits and disadvantages to the immunodiagnostic of this mycosis.

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Significance of Histoplasma Antigen in the Cerebrospinal Fluid of Patients With Meningitis

Cited by 50 publications

References 8 publications

Diagnosis and Management of Central Nervous System Histoplasmosis

Diagnosis and Management of Central Nervous System Histoplasmosis

Histoplasmosis: a Clinical and Laboratory Update

Diagnosis of histoplasmosis

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