Use of Urine Antigen Testing for &lt;i&gt;Blastomyces&lt;/i&gt; in an Integrated Health System

Baumgardner, Dennis J

doi:10.17294/2330-0698.1452

Cited by 9 publications

(4 citation statements)

References 19 publications

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“…We found that Blastomyces EIA, immunodiffusion, and complement fixation have a low sensitivity. It has been concluded elsewhere that ordering urine Blastomyces antigen for suspected disease without serology testing is associated with lower healthcare expenses without compromising sensitivity [31]. We found a high sensitivity of PCR on respiratory specimens.…”

Section: Discussionmentioning

confidence: 48%

Diagnostic Methods and Risk Factors for Severe Disease and Mortality in Blastomycosis: A Retrospective Cohort Study

O’Dowd

Hugh

Theel

et al. 2021

JoF

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Background: Blastomycosis can cause severe disease with progressive respiratory failure and dissemination even in immunocompetent individuals. We sought to evaluate risk factors for severe disease and mortality using clinical and laboratory data within a large health system in an endemic area. Methods: We performed a retrospective cohort study of patients diagnosed with blastomycosis at all Mayo Clinic sites from 1 January 2004 through 31 March 2020. Diagnosis was established by culture, histopathology/cytopathology, serology, antigen testing, or PCR. Disease was categorized as mild for patients treated in the outpatient setting, moderate for hospitalized patients who did not require intensive care, and severe for patients admitted to the intensive care unit. Logistic regression was used to evaluate risk factors for severe disease. A Cox proportional hazards model was constructed to evaluate mortality. Findings: We identified 210 patients diagnosed with blastomycosis. Mean age was 51 years (range, 6–84). Most subjects were male (71.0%). Extrapulmonary disease was confirmed in 24.8%. In this cohort, 40.5% of patients had mild disease, 37.6% had moderate disease, and 21.9% had severe disease. Independent risk factors for severe disease were neutrophilia (odds ratio (OR) 3.35 (95% CI 1.53–7.35), p = 0.002) and lymphopenia (OR 3.34 (95% CI 1.59–7.03), p = 0.001). Mortality at 90 days was 11.9%. Median time from diagnosis to death was 23 days (interquartile range 8–31 days). Independent risk factors for mortality were age (OR 1.04 (95% CI 1.01–1.08), p = 0.009), neutrophilia (OR 2.84 (95% CI 1.04–7.76), p = 0.041), and lymphopenia (OR 4.50 (95% CI 1.67–12.11), p = 0.003). Blastomyces immunodiffusion had an overall sensitivity of 39.6% (95% CI 30.1–49.8). Sensitivity was higher among those who were tested 4 weeks or longer after the onset of symptoms. Urine Blastomyces antigen had a significantly higher sensitivity of 80.8% (95% CI 68.1–89.2) compared to serology. There was a trend towards higher antigen concentration in patients with severe disease. The sensitivity of PCR from respiratory specimens was 67.6% (95% CI 50.1–85.5). Conclusion: In this cohort, we did not find an association between pharmacologic immunosuppression and disease severity. Lymphopenia at diagnosis was an independent risk factor for mortality. This simple marker may aid clinicians in determining disease prognosis.

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Section: Discussionmentioning

confidence: 48%

Diagnostic Methods and Risk Factors for Severe Disease and Mortality in Blastomycosis: A Retrospective Cohort Study

O’Dowd

Hugh

Theel

et al. 2021

JoF

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“…A more recent study comprised mostly of Wisconsin case patients reported 87.9% sensitivity, but when sensitivity was calculated based on culture positive cases (positive predictive value), as was done in the present study, sensitivity was 76.3%. 15 We found that the urine antigen assay is capable of detecting both species of Blastomyces at about the same sensitivity. This may have been somewhat expected due to its previously recognized cross-reactivity of the assay to Histoplasma capsulatum.…”

Section: Discussionmentioning

confidence: 73%

Urine Antigen Testing is Equally Sensitive to B. dermatitidis and B. gilchristii Infections

et al. 2020

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“…This assay can be performed with urine, serum, bronchoalveolar lavage (BAL), and cerebrospinal fluid (CSF) samples [ 26 , 27 , 28 ]. The majority of the data about efficiency are stated for urine, in which sensitivity varies from 76% to 90% in several studies [ 24 , 26 , 27 , 29 ]. Sensitivity of the sandwich EIA is lower in serum, ranging from 56% to 82% [ 25 , 27 , 28 ].…”

Section: Blastomycosismentioning

confidence: 99%

Immunologic Diagnosis of Endemic Mycoses

Almeida‐Paes

Bernardes-Engemann

Motta

et al. 2022

JoF

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The endemic mycoses blastomycosis, coccidioidomycosis, histoplasmosis, paracoccidioidomycosis, cryptococcosis, sporotrichosis, talaromycosis, adiaspiromycosis, and emergomycosis are mostly caused by geographically limited thermally dimorphic fungi (except for cryptococcosis), and their diagnoses can be challenging. Usual laboratory methods involved in endemic mycoses diagnosis include microscopic examination and culture of biological samples; however, serologic, histopathologic, and molecular techniques have been implemented in the last few years for the diagnosis of these mycoses since the recovery and identification of their etiologic agents is time-consuming and lacks in sensitivity. In this review, we focus on the immunologic diagnostic methods related to antibody and antigen detection since their evidence is presumptive diagnosis, and in some mycoses, such as cryptococcosis, it is definitive diagnosis.

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Use of Urine Antigen Testing for <i>Blastomyces</i> in an Integrated Health System

Abstract: Centered Research and Reviews (JPCRR) is a peer-reviewed scientific journal whose mission is to communicate clinical and bench research findings, with the goal of improving the quality of human health, the care of the individual patient, and the care of populations.

Cited by 9 publications

References 19 publications

Diagnostic Methods and Risk Factors for Severe Disease and Mortality in Blastomycosis: A Retrospective Cohort Study

Diagnostic Methods and Risk Factors for Severe Disease and Mortality in Blastomycosis: A Retrospective Cohort Study

Urine Antigen Testing is Equally Sensitive to B. dermatitidis and B. gilchristii Infections

Immunologic Diagnosis of Endemic Mycoses

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