A Multicenter Evaluation of Tests for Diagnosis of Histoplasmosis
Open accessAbstract
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 = 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.
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MRSA accounts for approximately 5% of culture-positive infections among critically ill patients, and may be decreasing according to some reports.
“MRSA accounts for approximately 5% of culturepositive infections among critically ill patients (133), and may be decreasing according to some reports (134, 135).”
From Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021. (2021) · cites this paper as [133]
The Results passages under Disseminated Histoplasmosis report culture positivity and disease severity in patients with histoplasmosis, not the proportion of culture-positive infections caused by MRSA in critically ill patients. A search for MRSA, the approximately 5% figure, and a decreasing trend found no passage addressing the claim. (LLM, conf=0.76)
Experimental — accuracy not yet measuredThe incidence of MRSA varies by region (ranging from ~2% in Western Europe to 10% in North America) and by patient-related characteristics.
“The incidence of MRSA varies, however, by region (ranging from ~2% in Western Europe to 10% in North America) and by patient-related characteristics (133, 136, 137).”
From Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021. (2021) · cites this paper as [133]
The Results and Disseminated Histoplasmosis sections report Histoplasma antigen-test findings, including differences by patients’ immune status, not MRSA incidence. Searches for MRSA, the Western Europe–North America comparison, and the 2%–10% range found no passage addressing the claim; the cited paper therefore cannot verify it. (LLM, conf=0.78)
Experimental — accuracy not yet measuredIn a recent large international point prevalence study, viruses were documented in less than 4% of infections.
“In a recent large international point prevalence study, viruses were documented in less than 4% of infections (133).”
From Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021. (2021) · cites this paper as [133]
The Patients section describes 218 evaluable histoplasmosis cases at US centers, and the Discussion addresses the sensitivity of diagnostic tests for histoplasmosis. Searches for an international point-prevalence study and for viral infections or a figure below 4% found no passage addressing the claim; page numbers were unavailable in our copy. (LLM, conf=0.77)
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- Authors
- Hage, C. A., Ribes, J. A., Wengenack, N. L., Baddour, L. M., Assi, M., McKinsey, D. S., Hammoud, K., Alapat, D., Babady, N. E., Parker, M., Fuller, D., Noor, A., Davis, T. E., Rodgers, M., Connolly, P. A., El Haddad, B., & Wheat, L. J.
- Affiliations
- Richard L. Roudebush VA Medical Center (US)
- University of Kentucky (US)
- Mayo Clinic (US)
- University of Kansas (US)
- Memorial Sloan Kettering Cancer Center (US)
- Indiana University Indianapolis (US)
- ORCID
- Venue
- Clinical Infectious Diseases
- Publisher
- Oxford University Press (OUP)
- Published
- 2011-08-02
- Volume
- 53
- Issue
- 5
- Pages
- 448-454
- ISSN
- 1058-4838 (ISSN-L)
- 1537-6591
- OpenAlex
- W2110538662
- Cited by
- 393
- References
- 0
- Citations by year
- 2026: 18 · 2025: 23 · 2024: 24 · 2023: 26 · 2022: 26 · 2021: 31 · 2020: 35 · 2019: 31 · 2018: 26 · 2017: 30 · 2016: 21 · 2015: 29 · 2014: 28 · 2013: 27 · 2012: 13
- FWCI
- 17.11
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- cc-by-nc
- Locations
- Clinical Infectious Diseases (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Epidemiology › Fungal Infections and Studies
- Health Sciences › Medicine › Infectious Diseases › Antifungal resistance and susceptibility
- Health Sciences › Medicine › Physiology › Histiocytic Disorders and Treatments
- Keywords
- histoplasmosis, Histoplasma antigen, enzyme immunoassay, antigenuria, antigenemia, diagnostic sensitivity, immunocompromised patients, AIDS, disseminated histoplasmosis, acute histoplasmosis, chronic pulmonary histoplasmosis, blastomycosis, cross-reactivity
- MeSH terms
- Antibodies, Fungal, Antigens, Fungal, Cross Reactions, Histoplasma, Histoplasmosis, Humans, Immunoenzyme Techniques, Lung Diseases, Fungal, Sensitivity and Specificity, Cohort Studies, Case-Control Studies, Mycological Typing Techniques, Immunocompromised Host
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