title: A multicenter evaluation of tests for diagnosis of histoplasmosis.
abstract: 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.
authors.affiliation: Pulmonary-Critical Care Medicine, Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis, Indiana 46202, USA. chage@iupui.edu
authors.forename: Chadi A
authors.initials: CA
authors.lastname: Hage
authors.forename: Julie A
authors.initials: JA
authors.lastname: Ribes
authors.forename: Nancy L
authors.initials: NL
authors.lastname: Wengenack
authors.forename: Larry M
authors.initials: LM
authors.lastname: Baddour
authors.forename: Maha
authors.initials: M
authors.lastname: Assi
authors.forename: David S
authors.initials: DS
authors.lastname: McKinsey
authors.forename: Kassem
authors.initials: K
authors.lastname: Hammoud
authors.forename: Daisy
authors.initials: D
authors.lastname: Alapat
authors.forename: N Esther
authors.initials: NE
authors.lastname: Babady
authors.forename: Michelle
authors.initials: M
authors.lastname: Parker
authors.forename: DeAnna
authors.initials: D
authors.lastname: Fuller
authors.forename: Aliya
authors.initials: A
authors.lastname: Noor
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Davis
authors.forename: Mark
authors.initials: M
authors.lastname: Rodgers
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Connolly
authors.forename: Boutros
authors.initials: B
authors.lastname: El Haddad
authors.forename: L Joseph
authors.initials: LJ
authors.lastname: Wheat
mesh_terms: D000908:Antibodies, Fungal; D000946:Antigens, Fungal / Q000097:blood* / Q000652:urine*; D016022:Case-Control Studies; D015331:Cohort Studies; D003429:Cross Reactions; D006658:Histoplasma / Q000276:immunology* / Q000302:isolation & purification; D006660:Histoplasmosis / Q000175:diagnosis* / Q000473:pathology; D006801:Humans; D016867:Immunocompromised Host; D007124:Immunoenzyme Techniques / Q000379:methods* / Q000592:standards; D008172:Lung Diseases, Fungal / Q000175:diagnosis / Q000382:microbiology; D016533:Mycological Typing Techniques; D012680:Sensitivity and Specificity
chemical_list: D000908:Antibodies, Fungal; D000946:Antigens, Fungal