DIAGNOSIS OF HISTOPLASMOSIS.
Endemic mycoses can be challenging to diagnose and accurate interpretation of laboratory data is important to ensure the most appropriate treatment for the patients. Although the definitive diagnosis of histoplasmosis (HP), one of the most frequent endemic mycoses in the world, is achieved by direct diagnosis performed by micro and/or macroscopic observation of Histoplasma capsulatum (H. capsulatum), serologic evidence of this fungal infection is important since the isolation of the etiologic agents is time-consuming and insensitive. A variety of immunoassays have been used to detect specific antibodies to H. capsulatum. The most applied technique for antibody detection is immunodiffusion with sensitivity between 70 to 100 % and specificity of 100%, depending on the clinical form. The complement fixation (CF) test, a methodology extensively used on the past, is less specific (60 to 90%). Detecting fungal antigens by immunoassays is valuable in immunocompromised individuals where such assays achieve positive predictive values of 96-98%. Most current tests in diagnostic laboratories still utilize unpurified antigenic complexes from either whole fungal cells or their culture filtrates. Emphasis has shifted, however, to clinical immunoassays using highly purified and well-characterized antigens including recombinant antigens. In this paper, we review the current conventional diagnostic tools, such as complement fixation and immunodiffusion, outline the development of novel diagnostic reagents and methods, and discuss their relative merits and disadvantages to the immunodiagnostic of this mycosis.
Guimarães
Allan Jefferson
AJ
Serviço de Micologia, Departamento de Micro-Imuno-Parasitologia, Instituto de Pesquisa Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil.
Nosanchuk
Joshua D
JD
Zancopé-Oliveira
Rosely Maria
RM
J Clin Microbiol. 1980 Mar;11(3):238-41
6155384
Infect Immun. 1979 Feb;23(2):479-85
422249
Mycoses. 1991 Mar-Apr;34(3-4):133-40
1749392
Miss Doct. 1952 Mar;29(10):256-7
14910411
J Clin Lab Anal. 1990;4(3):199-207
2352056
J Clin Microbiol. 1997 Oct;35(10):2618-22
9316918
FEMS Immunol Med Microbiol. 2005 Sep 1;45(3):443-9
16055317
Am Rev Respir Dis. 1978 May;117(5):929-56
655496
Sabouraudia. 1978 Dec;16(4):257-69
109929
J Iowa State Med Soc. 1955 Sep;45(9):463-8
13263698
Semin Respir Infect. 2001 Jun;16(2):131-40
11521245
J Lab Clin Med. 1956 Mar;47(3):499-502
13295711
Medicine (Baltimore). 1981 Jul;60(4):231-66
7017339
Pediatr Infect Dis J. 1994 Sep;13(9):801-5
7808850
J Med Vet Mycol. 1990;28(6):479-85
2093121
J Gen Microbiol. 1990 Feb;136(2):331-5
1691267
Semin Respir Infect. 1986 Mar;1(1):9-15
3317601
Annu Rev Microbiol. 1987;41:209-25
3318668
N Engl J Med. 1986 Jan 9;314(2):83-8
3941695
Arch Otolaryngol. 1985 Aug;111(8):558-60
4026672
Arch Ophthalmol. 2003 Nov;121(11):1551-5
14609910
Rev Asoc Argent Microbiol. 1976 May-Aug;8(2):68-73
63979
Med Clin (Barc). 1999 Jun 12;113(1):37-8
10422078
J Clin Microbiol. 1985 Dec;22(6):1066-7
4066919
Medicine (Baltimore). 1997 Sep;76(5):339-54
9352737
J Clin Microbiol. 1976 Aug;2(2):77-80
823169
Infect Immun. 1974 May;9(5):870-80
4137149
Clin Infect Dis. 1992 Mar;14 Suppl 1:S23-9
1562691
Can J Microbiol. 1960 Feb;6:65-70
13819437
Am Rev Respir Dis. 1965 Oct;92(4):640-1
5833842
Clin Infect Dis. 1992 Mar;14 Suppl 1:S60-7
1562697
Postgrad Med. 1956 Oct;20(4):349-64
13370403
J Clin Microbiol. 1990 Jan;28(1):59-64
2105336
Am J Public Health Nations Health. 1950 Apr;40(4):436-40
18017195
J Clin Microbiol. 1975 Mar;1(3):330-4
809475
Arch Pathol Lab Med. 1994 Dec;118(12):1205-8
7979915
J Clin Microbiol. 1978 Nov;8(5):558-65
103889
J Infect Dis. 1986 Feb;153(2):376-7
3944490
Am J Epidemiol. 1966 Jul;84(1):103-9
5944726
Diagn Cytopathol. 2002 Apr;26(4):243-6
11933270
Curr Top Med Mycol. 1996 Dec;7(1):7-18
9504056
Rev Iberoam Micol. 2004 Dec;21(4):198-201
15709801
Am J Med. 1992 Feb;92(2):153-60
1543199
Rev Iberoam Micol. 2005 Sep;22(3):141-6
16309348
J Infect Dis. 1997 Apr;175(4):905-14
9086148
J Clin Microbiol. 2001 Apr;39(4):1506-9
11283078
Rev Soc Bras Med Trop. 1990 Oct-Dec;23(4):213-5
2133587
Infect Immun. 1994 Jun;62(6):2375-8
8188361
Orv Hetil. 1956 Aug 26;97(35):964-7
13388299
Public Health Monogr. 1956;39:14-6
13370721
J Clin Microbiol. 2003 Feb;41(2):535-9
12574242
Infect Immun. 1987 Jun;55(6):1355-8
3032799
J Clin Microbiol. 1986 Mar;23(3):493-9
2420821
Public Health Monogr. 1956;39:237-9
13370763
Clin Diagn Lab Immunol. 1994 Sep;1(5):563-8
8556502
Clin Infect Dis. 1995 Oct;21(4):1054
8645813
South Med J. 1970 Jul;63(7):819-21
5427173
J Clin Microbiol. 1993 Feb;31(2):419-21
8432829
APMIS. 1996 Apr;104(4):241-58
8645463
J Clin Microbiol. 1991 Aug;29(8):1723-4
1761695
J Antimicrob Chemother. 2002 Feb;49 Suppl 1:11-9
11801576
J Clin Microbiol. 2003 Apr;41(4):1753-5
12682178
Clin Microbiol Rev. 1991 Oct;4(4):411-21
1747859
Rev Invest Clin. 1993 Mar-Apr;45(2):155-60
8337543
Appl Microbiol. 1972 Aug;24(2):191-7
5071648
J Clin Microbiol. 2004 Aug;42(8):3696-706
15297519
Ned Tijdschr Geneeskd. 2004 Mar 13;148(11):530-3
15054952
Am J Vet Res. 1982 Dec;43(12):2279-83
6819794
Science. 1972 Jan 21;175(4019):326
4651892
Trans R Soc Trop Med Hyg. 1990 May-Jun;84(3):425-8
1701936
Infect Dis Clin North Am. 2003 Mar;17(1):1-19, vii
12751258
Am Rev Respir Dis. 1992 Jun;145(6):1421-4
1596012
Transpl Infect Dis. 2004 Mar;6(1):23-7
15225223
Medicine (Baltimore). 1976 Nov;55(6):413-52
792626
Med Mycol. 2000;38 Suppl 1:139-45
11204139
Public Health Monogr. 1956;39:140-3
13370747
Infect Immun. 1995 Aug;63(8):3151-7
7622243
Sabouraudia. 1973 Nov;11(3):271-3
4128916
Am J Med. 1978 Jan;64(1):94-100
623139
J Clin Microbiol. 1976 Feb;3(2):157-60
1254713
Am Rev Respir Dis. 1969 Apr;99(4):Suppl:1-132
5767603
J Clin Microbiol. 1976 Mar;3(3):306-8
818111
J Clin Microbiol. 1986 Nov;24(5):905
3771780
J Clin Microbiol. 1991 Jan;29(1):96-8
1993772
Ann Microbiol (Paris). 1977 Feb-Mar;128(2):135-49
900693
Trans R Soc Trop Med Hyg. 1958 Sep;52(5):468-74
13592890
J Clin Microbiol. 1984 Sep;20(3):530-2
6436307
Chest. 1990 May;97(5):1244-5
2331921
Am Rev Respir Dis. 1961 Dec;84:845-9
13909377
Dermatol Int. 1966 Apr-Jun;5(2):69-71
5988597
Medicine (Baltimore). 1983 Sep;62(5):263-70
6312246
Rev Inst Med Trop Sao Paulo. 1990 Mar-Apr;32(2):116-20
2095627
Mycopathol Mycol Appl. 1971 Dec 6;45(3):221-30
4950673
Am Rev Respir Dis. 1979 Aug;120(2):441-9
89825
Pediatr Infect Dis J. 2003 Jun;22(6):545-52
12799512
Ann Intern Med. 1983 Apr;98(4):560-1
6838087
Diagn Microbiol Infect Dis. 2002 May;43(1):29-37
12052626
Public Health Monogr. 1956;39:129-31
13370745
Public Health Monogr. 1956;39:132-9
13370746
J Infect Dis. 1989 Oct;160(4):678-85
2794560
Med J Aust. 1976 Aug 14;2(7):243-8
994986
Ann Clin Lab Sci. 1973 May-Jun;3(3):194-200
4703526
Public Health Rep. 1970 Dec;85(12):1063-9
4991768
J Lab Clin Med. 1965 Nov;66(5):770-87
5844606
Infect Immun. 1999 Apr;67(4):1947-53
10085041
Proc Soc Exp Biol Med. 1958 Mar;97(3):700-3
13518380
Mycopathol Mycol Appl. 1965 Aug 10;26(2):257-63
5338149
Rev Inst Med Trop Sao Paulo. 1993 Mar-Apr;35(2):163-9
8284601
Sabouraudia. 1983 Mar;21(1):1-14
6342173
Mycopathologia. 1978 Nov 10;64(3):153-6
366428
Med Mycol. 2000;38 Suppl 1:147-59
11204140
Eur J Clin Microbiol Infect Dis. 2002 Nov;21(11):821-3
12461594
J Am Med Assoc. 1960 Jun 25;173:902-4
14440997
Medicine (Baltimore). 1990 Nov;69(6):361-74
2233233
J Clin Microbiol. 1999 Mar;37(3):675-80
9986830
Public Health Monogr. 1956;39:272-3
13370770
Clin Diagn Lab Immunol. 1999 Jan;6(1):20-3
9874658
Semin Respir Infect. 1986 Mar;1(1):16-21
3317595
Medicine (Baltimore). 1980 Jan;59(1):1-33
7356773
Eur J Clin Microbiol Infect Dis. 1989 May;8(5):480-90
2502413
Mycologia. 1975 Sep-Oct;67(5):980-90
1196334
J Lab Clin Med. 1956 Aug;48(2):255-63
13346192
Thorax. 1954 Sep;9(3):233-41
13205532
Arch Intern Med (Chic). 1950 Jun;85(6):893-9
15419863
Ann Intern Med. 1991 Dec 15;115(12):936-41
1952490
Am J Clin Pathol. 2002 Apr;117(4):597-603
11939735
Clin Infect Dis. 2005 Jul 15;41(2):170-6
15983912
Am J Med. 1989 Oct;87(4):396-400
2801730
J Clin Microbiol. 2002 May;40(5):1644-7
11980934
J Clin Microbiol. 2001 Jul;39(7):2640-1
11427583
Public Health Monogr. 1956;39:150-2
13370750
Am J Public Health Nations Health. 1952 Aug;42(8):930-5
14952597
J Med Microbiol. 2004 Jun;53(Pt 6):509-514
15150330
Clin Infect Dis. 1997 Jun;24(6):1169-71
9195077
Clin Infect Dis. 1994 Aug;19 Suppl 1:S19-27
7948567
J Bacteriol. 1967 Jan;93(1):40-6
6020413
Arch Intern Med. 1989 Feb;149(2):302-4
2916875
N Engl J Med. 1962 Apr 19;266:811-4
14467578
Am J Trop Med Hyg. 1971 Mar;20(2):288-319
5553267
Clin Diagn Lab Immunol. 1994 Jul;1(4):390-3
8556474
Mycopathol Mycol Appl. 1974 Oct 15;54(1):111-25
4279334
Chest. 1974 Aug;66(2):158-61
4604062
Mycoses. 1994 Sep-Oct;37(9-10):313-6
7746288
J Lab Clin Med. 1952 Jul;40(1):90-101
14938753
J Med Vet Mycol. 1993;31(1):29-41
7683335
Ann Thorac Surg. 1992 Dec;54(6):1053-7; discussion 1057-8
1449286
Microbiol Rev. 1989 Jun;53(2):186-209
2666842
Genitourin Med. 1992 Dec;68(6):409-12
1487266
Trends Microbiol. 2003 Oct;11(10):488-94
14557032
Clin Infect Dis. 1996 May;22 Suppl 2:S102-11
8722836
J Clin Microbiol. 1997 Sep;35(9):2252-5
9276396