The Experts below are selected from a list of 279 Experts worldwide ranked by ideXlab platform
George A. Sarosi - One of the best experts on this subject based on the ideXlab platform.
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Histoplasmosis Infections Worldwide: Thinking Outside of the Ohio River Valley
Current Tropical Medicine Reports, 2015Co-Authors: Nathan C. Bahr, Spinello Antinori, L. Joseph Wheat, George A. SarosiAbstract:In the USA, Histoplasmosis is generally thought to occur mainly in the Ohio and Mississippi river valleys, and the classic map of Histoplasmosis distribution reflecting this is second nature to many US physicians. With the advent of the HIV pandemic, reports of patients with progressive disseminated Histoplasmosis and AIDS came from regions of known endemicity, as well as from regions not thought to be endemic for Histoplasmosis throughout the world. In addition, our expanding armamentarium of immunosuppressive medications and biologics has increased the diagnosis of Histoplasmosis worldwide. While our knowledge of areas in which Histoplasmosis is endemic has improved, it is still incomplete. Our contention is that physicians should consider Histoplasmosis with the right constellations of symptoms in any febrile patient with immune suppression, regardless of geographic location or travel history.
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Histoplasmosis infections worldwide thinking outside of the ohio river valley
Current tropical medicine reports, 2015Co-Authors: Nathan C. Bahr, Spinello Antinori, Joseph L Wheat, George A. SarosiAbstract:In the United States, Histoplasmosis is generally thought to occur mainly in the Ohio and Mississippi River Valleys, and the classic map of Histoplasmosis distribution reflecting this is second nature to many U.S. physicians. With the advent of the HIV pandemic reports of patients with progressive disseminated Histoplasmosis and AIDS came from regions of known endemicity, as well as from regions not thought to be endemic for Histoplasmosis throughout the world. In addition, our expanding armamentarium of immunosuppressive medications and biologics has increased the diagnosis of Histoplasmosis worldwide. While our knowledge of areas in which Histoplasmosis is endemic has improved, it is still incomplete. Our contention is that physicians should consider Histoplasmosis with the right constellations of symptoms in any febrile patient with immune suppression, regardless of geographic location or travel history.
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Gastrointestinal Histoplasmosis.
The American journal of gastroenterology, 2005Co-Authors: Charles J Kahi, L. Joseph Wheat, Stephen D. Allen, George A. SarosiAbstract:Gastrointestinal Histoplasmosis (GIH) is an uncommon disease with protean manifestations. It may occur as a result of mediastinal Histoplasmosis or in the setting of progressive dissemination. GIH may be misdiagnosed as inflammatory bowel disease, malignancy, or other intestinal diseases leading to inappropriate therapies and unnecessary surgical interventions. Patients with bowel obstruction, perforation, or bleeding, and systemic findings suggestive of Histoplasmosis should be evaluated for GIH. This is especially true for immunosuppressed patients, especially those with AIDS. Diagnosis first requires consideration of Histoplasmosis in the differential in patients with the above types of gastrointestinal abnormalities, and second, familiarity with a battery of mycologic and serologic tests. Progressive disseminated Histoplasmosis (PDH) is lethal if left untreated, and treatment is highly effective. This review will focus on the clinical and histopathologic features of GIH, the approach to diagnosis, and recommendations for treatment.
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practice guidelines for the management of patients with Histoplasmosis
Clinical Infectious Diseases, 2000Co-Authors: George A. Sarosi, James E. Loyd, David S. Mckinsey, Richard J. Hamill, Joe Wheat, Robert W Bradsher, Philip C Johnson, Carol A. KauffmanAbstract:Objective The objective of this guideline is to provide recommendations for treating patients with the more common forms of Histoplasmosis. PARTICIPANTS AND CONSENSUS PROCESS: A working group of 8 experts in this field was convened to develop this guideline. The working group developed and refined the guideline through a series of conference calls. Outcomes The goal of treatment is to eradicate the infection when possible, although chronic suppression may be adequate for patients with AIDS and other serious immunosuppressive disorders. Other important outcomes are resolution of clinical abnormalities and prevention of relapse. Evidence The published literature on the management of Histoplasmosis was reviewed. Controlled trials have been conducted that address the treatment of chronic pulmonary and disseminated Histoplasmosis, but clinical experience and descriptive studies provide the basis for recommendations for other forms of Histoplasmosis. VALUE: Value was assigned on the basis of the strength of the evidence supporting treatment recommendations, with the highest value assigned to controlled trials, according to conventions established for developing practice guidelines. BENEFITS AND COSTS: Certain forms of Histoplasmosis cause life-threatening illnesses and result in considerable morbidity, whereas other manifestations cause no symptoms or minor self-limited illnesses. The nonprogressive forms of Histoplasmosis, however, may reduce functional capacity, affecting work capacity and quality of life for several months. Treatment is clearly beneficial and cost-effective for patients with progressive forms of Histoplasmosis, such as chronic pulmonary or disseminated infection. It remains unknown whether treatment improves the outcome for patients with the self-limited manifestations, since this patient population has not been studied. Other chronic progressive forms of Histoplasmosis are not responsive to pharmacologic treatment. Treatment options Options for therapy for Histoplasmosis include ketoconazole, itraconazole, fluconazole, amphotericin B (Fungizone; Bristol-Meyer Squibb, Princeton, NJ), liposomal amphotericin B (AmBisome; Fujisawa, Deerfield, IL), amphotericin B colloidal suspension (ABCD, or Amphotec; Seques, Menlo Park, CA), and amphotericin B lipid complex (ABLC, or Abelcet; Liposome, Princeton, NJ).
David S. Mckinsey - One of the best experts on this subject based on the ideXlab platform.
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Pulmonary Histoplasmosis.
Seminars in respiratory and critical care medicine, 2011Co-Authors: David S. Mckinsey, Joel P MckinseyAbstract:Pulmonary Histoplasmosis is an important cause of morbidity in the United States. Several outbreaks of acute pulmonary Histoplasmosis have been linked to potentially preventable environmental exposures. Progressive disseminated Histoplasmosis, which is seen frequently in the growing population of immunocompromised hosts, often presents with prominent pulmonary manifestations and is more commonly encountered in hospitalized patients than acute, subacute, or chronic pulmonary Histoplasmosis. A battery of diagnostic studies including serology, antigen, cytology/histopathology, and culture should be obtained in suspected cases of Histoplasmosis. The yield of antigenuria detection is highest when the multiple body fluids are tested; the level of antigenuria correlates with severity of disease. Amphotericin B is the treatment of choice for severe pulmonary or disseminated Histoplasmosis, and itraconazole is effective for mild to moderately severe infection. Posaconazole exhibits promise as a salvage agent. Antifungal prophylaxis is not routinely recommended for at-risk populations. Measures to minimize environmental contamination may reduce the risk of epidemic-type acute pulmonary Histoplasmosis related to high-risk exposures.
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A Multicenter Evaluation of Tests for Diagnosis of Histoplasmosis
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2011Co-Authors: Chadi A. Hage, Julie A. Ribes, Nancy L. Wengenack, Larry M. Baddour, Maha Assi, David S. Mckinsey, Kassem Hammoud, Daisy Alapat, N. Esther Babady, Michelle ParkerAbstract:Background. The sensitivity of the MVista 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 6 patients 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 5 130) and in healthy subjects (n 5 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.
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practice guidelines for the management of patients with Histoplasmosis
Clinical Infectious Diseases, 2000Co-Authors: George A. Sarosi, James E. Loyd, David S. Mckinsey, Richard J. Hamill, Joe Wheat, Robert W Bradsher, Philip C Johnson, Carol A. KauffmanAbstract:Objective The objective of this guideline is to provide recommendations for treating patients with the more common forms of Histoplasmosis. PARTICIPANTS AND CONSENSUS PROCESS: A working group of 8 experts in this field was convened to develop this guideline. The working group developed and refined the guideline through a series of conference calls. Outcomes The goal of treatment is to eradicate the infection when possible, although chronic suppression may be adequate for patients with AIDS and other serious immunosuppressive disorders. Other important outcomes are resolution of clinical abnormalities and prevention of relapse. Evidence The published literature on the management of Histoplasmosis was reviewed. Controlled trials have been conducted that address the treatment of chronic pulmonary and disseminated Histoplasmosis, but clinical experience and descriptive studies provide the basis for recommendations for other forms of Histoplasmosis. VALUE: Value was assigned on the basis of the strength of the evidence supporting treatment recommendations, with the highest value assigned to controlled trials, according to conventions established for developing practice guidelines. BENEFITS AND COSTS: Certain forms of Histoplasmosis cause life-threatening illnesses and result in considerable morbidity, whereas other manifestations cause no symptoms or minor self-limited illnesses. The nonprogressive forms of Histoplasmosis, however, may reduce functional capacity, affecting work capacity and quality of life for several months. Treatment is clearly beneficial and cost-effective for patients with progressive forms of Histoplasmosis, such as chronic pulmonary or disseminated infection. It remains unknown whether treatment improves the outcome for patients with the self-limited manifestations, since this patient population has not been studied. Other chronic progressive forms of Histoplasmosis are not responsive to pharmacologic treatment. Treatment options Options for therapy for Histoplasmosis include ketoconazole, itraconazole, fluconazole, amphotericin B (Fungizone; Bristol-Meyer Squibb, Princeton, NJ), liposomal amphotericin B (AmBisome; Fujisawa, Deerfield, IL), amphotericin B colloidal suspension (ABCD, or Amphotec; Seques, Menlo Park, CA), and amphotericin B lipid complex (ABLC, or Abelcet; Liposome, Princeton, NJ).
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prospective study of Histoplasmosis in patients infected with human immunodeficiency virus incidence risk factors and pathophysiology
Clinical Infectious Diseases, 1997Co-Authors: David S. Mckinsey, Richard A Spiegel, Lori Hutwagner, James Stanford, Michael R Driks, Joseph H Brewer, Mala R Gupta, David L Smith, Mary C Oconnor, Lawrence DallAbstract:Histoplasmosis is a common opportunistic infection in patients with human immunodeficiency virus (HIV) infection who reside in areas where Histoplasma capsulatum is endemic. We undertook a prospective study of a cohort of 304 HIV-infected patients in Kansas City from October 1990 through March 1993 to define the incidence-specific risk factors, and pathophysiology of Histoplasmosis. The annual incidence of Histoplasmosis was 4.7%; 74% of the patients with Histoplasmosis were symptomatic (all of whom had disseminated disease). A history of exposure to chicken coops, a positive baseline serology for complement-fixing antibodies to Histoplasma mycelium antigen, and a baseline CD4 / lymphocyte count of o150/mL were associated with an increased risk for Histoplasmosis. Histoplasmin reactivity and the presence of pulmonary calcifications were not useful markers for patients at high risk. Symptomatic infection occurred in 9.9% of patients with evidence of prior exposure to H. capsulatum, in 4.0% of patients without documented prior exposure, and in 3.0% of patients who were anergic; these findings suggest that the pathophysiology of Histoplasmosis in patients with AIDS involves reactivation of latent infection in some cases and dissemination of exogenously acquired infection in other cases.
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Fluconazole Therapy for Histoplasmosis
Clinical Infectious Diseases, 1996Co-Authors: David S. Mckinsey, Carol A. Kauffman, Peter G. Pappas, Gretchen A. Cloud, William M. Girard, Patricia K. Sharkey, Richard J. Hamill, Carolynn J. Thomas, William E. DismukesAbstract:: We assessed the efficacy of oral fluconazole (200-800 mg daily) in the treatment of non-life-threatening acute pulmonary Histoplasmosis, chronic pulmonary Histoplasmosis, or disseminated Histoplasmosis in patients without human immunodeficiency virus infection. Of 27 evaluable patients, two had progressive acute pulmonary Histoplasmosis, 11 had chronic pulmonary Histoplasmosis, and 14 had disseminated Histoplasmosis. Median durations of treatment in each of the three groups were 6 months, 7 months, and 11 months, respectively. Nineteen patients were treated with 400 mg of fluconazole daily (two of these patients received 800 mg daily for a portion of their treatment courses), seven were treated with 200 mg daily, and one was treated with 800 mg daily. Treatment was successful in 17 (63%) of 27 cases. Both of the patients with acute pulmonary infection responded to therapy, as did five (46%) of 11 patients with chronic pulmonary infection and 10 (71%) of 14 patients with disseminated infection. No substantial toxicity was observed. We conclude that fluconazole therapy for Histoplasmosis is only moderately effective and should be reserved for patients who cannot take itraconazole.
L. Joseph Wheat - One of the best experts on this subject based on the ideXlab platform.
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Histoplasmosis Infections Worldwide: Thinking Outside of the Ohio River Valley
Current Tropical Medicine Reports, 2015Co-Authors: Nathan C. Bahr, Spinello Antinori, L. Joseph Wheat, George A. SarosiAbstract:In the USA, Histoplasmosis is generally thought to occur mainly in the Ohio and Mississippi river valleys, and the classic map of Histoplasmosis distribution reflecting this is second nature to many US physicians. With the advent of the HIV pandemic, reports of patients with progressive disseminated Histoplasmosis and AIDS came from regions of known endemicity, as well as from regions not thought to be endemic for Histoplasmosis throughout the world. In addition, our expanding armamentarium of immunosuppressive medications and biologics has increased the diagnosis of Histoplasmosis worldwide. While our knowledge of areas in which Histoplasmosis is endemic has improved, it is still incomplete. Our contention is that physicians should consider Histoplasmosis with the right constellations of symptoms in any febrile patient with immune suppression, regardless of geographic location or travel history.
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Diagnosis of Histoplasmosis by Antigen Detection in BAL Fluid
Chest, 2009Co-Authors: Chadi A. Hage, L. Joseph Wheat, Thomas E. Davis, Deanna Fuller, Lindsey Egan, John Witt, Kenneth S. KnoxAbstract:Background Detection of antigen in BAL is useful for diagnosis of Histoplasmosis. The MVista Histoplasma antigen enzyme immunoassay has been modified to permit quantification. The purpose of this study is to compare the sensitivity of the quantitative antigen detection assay with cytopathology and culture of BAL specimens. Methods BAL from patients with Histoplasmosis who were evaluated at the Indiana University Medical Center and controls without Histoplasmosis were studied. BAL fluid was tested in the quantitative Histoplasma antigen assay. Results Antigen was detected in the BAL in 93.5% of patients with Histoplasmosis, 80% with blastomycosis, and 0% of controls with nonfungal infections. Antigen was detected in the urine of 79% and serum in 65% of patients with Histoplasmosis. Cytopathology was positive in 48% and culture in 48% of patients with Histoplasmosis, and 40% and 60% of patients with blastomycosis, respectively. Serology was positive in 65%. Combining BAL antigen detection and BAL cytopathology, both methods for rapid diagnosis, the sensitivity was 96.8% in Histoplasmosis and 80% in blastomycosis. Conclusions Detection of antigen in BAL complements antigen detection in serum and urine as an objective diagnostic test for Histoplasmosis.
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Gastrointestinal Histoplasmosis.
The American journal of gastroenterology, 2005Co-Authors: Charles J Kahi, L. Joseph Wheat, Stephen D. Allen, George A. SarosiAbstract:Gastrointestinal Histoplasmosis (GIH) is an uncommon disease with protean manifestations. It may occur as a result of mediastinal Histoplasmosis or in the setting of progressive dissemination. GIH may be misdiagnosed as inflammatory bowel disease, malignancy, or other intestinal diseases leading to inappropriate therapies and unnecessary surgical interventions. Patients with bowel obstruction, perforation, or bleeding, and systemic findings suggestive of Histoplasmosis should be evaluated for GIH. This is especially true for immunosuppressed patients, especially those with AIDS. Diagnosis first requires consideration of Histoplasmosis in the differential in patients with the above types of gastrointestinal abnormalities, and second, familiarity with a battery of mycologic and serologic tests. Progressive disseminated Histoplasmosis (PDH) is lethal if left untreated, and treatment is highly effective. This review will focus on the clinical and histopathologic features of GIH, the approach to diagnosis, and recommendations for treatment.
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Pulmonary Histoplasmosis syndromes: recognition, diagnosis, and management.
Seminars in respiratory and critical care medicine, 2004Co-Authors: L. Joseph Wheat, Dewey J. Conces, Stephen D. Allen, Deborah Blue-hnidy, James E. LoydAbstract:Pulmonary manifestations are the hallmark of Histoplasmosis. Clinical syndromes range from asymptomatic infection to diffuse alveolar disease causing respiratory difficulty and even death. Serologic tests for antibodies and antigen detection are especially helpful in the diagnosis of Histoplasmosis but are frequently overlooked. Detection of Histoplasma capsulatum antigen in bronchoalveolar lavage fluid may be particularly helpful in patients with acute pulmonary Histoplasmosis or disseminated disease with pulmonary involvement. Topics of special importance for pulmonary disease specialists include the approach to the exclusion of Histoplasmosis in the evaluation of patients with suspected sarcoidosis, differentiation of pulmonary Histoplasmosis and malignancy in those with lung masses or mediastinal lymphadenopathy, and recognition and management of chronic pulmonary and mediastinal manifestations of Histoplasmosis. Although Histoplasmosis is mild and self-limited in most healthy individuals, antifungal therapy is indicated in those with acute diffuse pulmonary infection, chronic pulmonary Histoplasmosis, progressive disseminated disease, and perhaps mediastinal adenitis accompanied by obstructive symptoms. Antifungal therapy to prevent reactivation of Histoplasmosis during immunosuppressive therapy, or transition of mediastinal adenitis to fibrosing mediastinitis, although controversial, is not recommended. Several new drugs active against H. capsulatum offer alternatives in patients failing or intolerant of current therapies.
James E. Loyd - One of the best experts on this subject based on the ideXlab platform.
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Pulmonary Histoplasmosis syndromes: recognition, diagnosis, and management.
Seminars in respiratory and critical care medicine, 2004Co-Authors: L. Joseph Wheat, Dewey J. Conces, Stephen D. Allen, Deborah Blue-hnidy, James E. LoydAbstract:Pulmonary manifestations are the hallmark of Histoplasmosis. Clinical syndromes range from asymptomatic infection to diffuse alveolar disease causing respiratory difficulty and even death. Serologic tests for antibodies and antigen detection are especially helpful in the diagnosis of Histoplasmosis but are frequently overlooked. Detection of Histoplasma capsulatum antigen in bronchoalveolar lavage fluid may be particularly helpful in patients with acute pulmonary Histoplasmosis or disseminated disease with pulmonary involvement. Topics of special importance for pulmonary disease specialists include the approach to the exclusion of Histoplasmosis in the evaluation of patients with suspected sarcoidosis, differentiation of pulmonary Histoplasmosis and malignancy in those with lung masses or mediastinal lymphadenopathy, and recognition and management of chronic pulmonary and mediastinal manifestations of Histoplasmosis. Although Histoplasmosis is mild and self-limited in most healthy individuals, antifungal therapy is indicated in those with acute diffuse pulmonary infection, chronic pulmonary Histoplasmosis, progressive disseminated disease, and perhaps mediastinal adenitis accompanied by obstructive symptoms. Antifungal therapy to prevent reactivation of Histoplasmosis during immunosuppressive therapy, or transition of mediastinal adenitis to fibrosing mediastinitis, although controversial, is not recommended. Several new drugs active against H. capsulatum offer alternatives in patients failing or intolerant of current therapies.
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practice guidelines for the management of patients with Histoplasmosis
Clinical Infectious Diseases, 2000Co-Authors: George A. Sarosi, James E. Loyd, David S. Mckinsey, Richard J. Hamill, Joe Wheat, Robert W Bradsher, Philip C Johnson, Carol A. KauffmanAbstract:Objective The objective of this guideline is to provide recommendations for treating patients with the more common forms of Histoplasmosis. PARTICIPANTS AND CONSENSUS PROCESS: A working group of 8 experts in this field was convened to develop this guideline. The working group developed and refined the guideline through a series of conference calls. Outcomes The goal of treatment is to eradicate the infection when possible, although chronic suppression may be adequate for patients with AIDS and other serious immunosuppressive disorders. Other important outcomes are resolution of clinical abnormalities and prevention of relapse. Evidence The published literature on the management of Histoplasmosis was reviewed. Controlled trials have been conducted that address the treatment of chronic pulmonary and disseminated Histoplasmosis, but clinical experience and descriptive studies provide the basis for recommendations for other forms of Histoplasmosis. VALUE: Value was assigned on the basis of the strength of the evidence supporting treatment recommendations, with the highest value assigned to controlled trials, according to conventions established for developing practice guidelines. BENEFITS AND COSTS: Certain forms of Histoplasmosis cause life-threatening illnesses and result in considerable morbidity, whereas other manifestations cause no symptoms or minor self-limited illnesses. The nonprogressive forms of Histoplasmosis, however, may reduce functional capacity, affecting work capacity and quality of life for several months. Treatment is clearly beneficial and cost-effective for patients with progressive forms of Histoplasmosis, such as chronic pulmonary or disseminated infection. It remains unknown whether treatment improves the outcome for patients with the self-limited manifestations, since this patient population has not been studied. Other chronic progressive forms of Histoplasmosis are not responsive to pharmacologic treatment. Treatment options Options for therapy for Histoplasmosis include ketoconazole, itraconazole, fluconazole, amphotericin B (Fungizone; Bristol-Meyer Squibb, Princeton, NJ), liposomal amphotericin B (AmBisome; Fujisawa, Deerfield, IL), amphotericin B colloidal suspension (ABCD, or Amphotec; Seques, Menlo Park, CA), and amphotericin B lipid complex (ABLC, or Abelcet; Liposome, Princeton, NJ).
Chadi A. Hage - One of the best experts on this subject based on the ideXlab platform.
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Clinical Perspectives in the Diagnosis and Management of Histoplasmosis.
Clinics in chest medicine, 2017Co-Authors: Marwan M. Azar, Chadi A. HageAbstract:With increasing numbers of travelers and immunocompromised patients, Histoplasmosis, caused by the dimorphic fungus Histoplasma capsulatum, has become a disease of national extent. The clinical spectrum of Histoplasmosis is very wide, in terms of disease cadence, onset, distribution, and severity. A multipronged approach is recommended for diagnosis. Manifestations that are always treated include moderate to severe acute pulmonary Histoplasmosis, disseminated disease, and Histoplasmosis in immunocompromised individuals. Amphotericin B is the drug of choice for moderate to severe and disseminated presentations, whereas itraconazole is appropriate for mild disease and as step-down therapy.
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A Multicenter Evaluation of Tests for Diagnosis of Histoplasmosis
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2011Co-Authors: Chadi A. Hage, Julie A. Ribes, Nancy L. Wengenack, Larry M. Baddour, Maha Assi, David S. Mckinsey, Kassem Hammoud, Daisy Alapat, N. Esther Babady, Michelle ParkerAbstract:Background. The sensitivity of the MVista 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 6 patients 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 5 130) and in healthy subjects (n 5 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.
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Diagnosis of Histoplasmosis by Antigen Detection in BAL Fluid
Chest, 2009Co-Authors: Chadi A. Hage, L. Joseph Wheat, Thomas E. Davis, Deanna Fuller, Lindsey Egan, John Witt, Kenneth S. KnoxAbstract:Background Detection of antigen in BAL is useful for diagnosis of Histoplasmosis. The MVista Histoplasma antigen enzyme immunoassay has been modified to permit quantification. The purpose of this study is to compare the sensitivity of the quantitative antigen detection assay with cytopathology and culture of BAL specimens. Methods BAL from patients with Histoplasmosis who were evaluated at the Indiana University Medical Center and controls without Histoplasmosis were studied. BAL fluid was tested in the quantitative Histoplasma antigen assay. Results Antigen was detected in the BAL in 93.5% of patients with Histoplasmosis, 80% with blastomycosis, and 0% of controls with nonfungal infections. Antigen was detected in the urine of 79% and serum in 65% of patients with Histoplasmosis. Cytopathology was positive in 48% and culture in 48% of patients with Histoplasmosis, and 40% and 60% of patients with blastomycosis, respectively. Serology was positive in 65%. Combining BAL antigen detection and BAL cytopathology, both methods for rapid diagnosis, the sensitivity was 96.8% in Histoplasmosis and 80% in blastomycosis. Conclusions Detection of antigen in BAL complements antigen detection in serum and urine as an objective diagnostic test for Histoplasmosis.
