Diagnosis of pulmonary histoplasmosis and blastomycosis by detection of antigen in bronchoalveolar lavage fluid using an improved second-generation enzyme-linked immunoassay.
Antigen detection is a useful adjunct for the diagnosis of histoplasmosis. The purpose of this study was to evaluate antigen detection in bronchoalveolar lavage (BAL) fluid using an improved second-generation Histoplasma antigen assay. Antigen was detected in 16 of 19 (84%) cases of histoplasmosis and 5 of 6 (83.3%) blastomycosis cases using the second-generation assay vs. 13 of 19 (68%) and 4 of 6 (66.7%), respectively, in the original assay. Ten-fold concentration permitted detection of antigen in an additional case of histoplasmosis and another with blastomycosis, for an overall sensitivity of 23 of 25 (92.0%). Specificity was 98.2% in both assays in controls with other pulmonary infections. These findings support the diagnostic utility of the second-generation assay in patients with pulmonary histoplasmosis and blastomycosis.
Hage
Chadi A
CA
Department of Medicine, Indiana University, 111P-IU, Indianapolis, IN 46202, USA. chage@iupui.edu
Davis
Thomas E
TE
Egan
Lindsey
L
Parker
Michelle
M
Fuller
Deanna
D
Lemonte
Ann M
AM
Durkin
Michelle
M
Connelly
Patricia
P
Joseph Wheat
L
L
Blue-Hnidy
Deborah
D
Knox
Kenneth S
KS
D000946:Antigens, Fungal / Q000032:analysis*; D001759:Blastomycosis / Q000175:diagnosis*; D001992:Bronchoalveolar Lavage Fluid / Q000276:immunology*; D016009:Chi-Square Distribution; D004797:Enzyme-Linked Immunosorbent Assay / Q000379:methods; D005260:Female; D006658:Histoplasma / Q000276:immunology; D006660:Histoplasmosis / Q000175:diagnosis*; D006801:Humans; D016867:Immunocompromised Host; D016031:Liver Transplantation; D008172:Lung Diseases, Fungal / Q000175:diagnosis*; D008875:Middle Aged; D018709:Statistics, Nonparametric
D000946:Antigens, Fungal