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- Title
A Multicenter Evaluation of Tests for Diagnosis of Histoplasmosis.
- Authors
Hage, Chadi A.; Ribes, Julie A.; Wengenack, Nancy L.; Baddour, Larry M.; Assi, Maha; McKinsey, David S.; Hammoud, Kassem; Alapat, Daisy; Babady, N. Esther; Parker, Michelle; Fulle, DeAnna; Noor, Aliya; Davis, Thomas E.; Rodgers, Mark; Connolly, Patricia A.; Haddad, Boutros El; Wheat, L. Joseph
- Abstract
Background. The sensitivity of theMVista Histoplasma antigen enzyme immunoassay (MiraVista Diagnostics) has been evaluated in disseminated histoplasmosis in patients with AIDS and in the ''epidemic'' form of acute pneumonia. Moreover, there has been no evaluation of the sensitivity of antigenemia detection in disseminated histoplasmosis after the implementation of methods to dissociate immune complexes and denature released antibodies. The goal of this study was to determine the sensitivity of the current antigen assay in different categories of histoplasmosis. Methods. Urine and serum specimens obtained from 218 patients with histoplasmosis and 229 control subjects, including 30 with blastomycosis, were tested. Results. Antigenuria was detected in 91.8% of 158 patients with disseminated histoplasmosis, 83.3% of 6patients with acute histoplasmosis, 30.4% of 46 patients with subacute histoplasmosis, and 87.5% of 8 patients with chronic pulmonary histoplasmosis; antigenemia was present in 100% of 31 tested cases of disseminated histoplasmosis. Among patients with disseminated cases, antigenuria was detected more often and at higher concentrations in immunocompromised patients and those with severe disease. Specificity was 99.0% for patients with nonfungal infections (n = 130) and in healthy subjects (n = 69), but cross-reactivity occurred in 90% of patients with blastomycosis. Conclusions. The sensitivity of antigen detection in disseminated histoplasmosis is higher in immunocompromised patients than in immunocompetent patients and in patients with more severe illness. The sensitivity for detection of antigenemia is similar to that for antigenuria in disseminated infection.
- Subjects
HISTOPLASMOSIS diagnosis; ENZYME-linked immunosorbent assay; AIDS patients; IMMUNE complexes; IMMUNODIFFUSION
- Publication
Clinical Infectious Diseases, 2011, Vol 53, Issue 5, p448
- ISSN
1058-4838
- Publication type
Article
- DOI
10.1093/cid/cir435