title: A complementary tool for management of disseminated Histoplasma capsulatum var. capsulatum infections in AIDS patients.
abstract: In South America, disseminated histoplasmosis due to Histoplasma capsulatum var. capsulatum (H. capsulatum), is a severe and frequent opportunistic infection in AIDS patients. In areas outside the USA where specific-Histoplasma antigen detection is not available, the diagnosis is difficult. With the galactomannan antigen (GM) detection, a test commonly used for invasive aspergillosis diagnosis, there is a cross-reactivity with H. capsulatum that can be helpful for the diagnosis of histoplasmosis. The aim of this study was to evaluate the GM detection for the diagnosis of disseminated histoplasmosis in AIDS patients. The performance of the GM detection was evaluated with serum collected in French Guiana where H. capsulatum is highly endemic. Sera from AIDS patients with disseminated histoplasmosis occurring from 2002 to 2009 and from control HIV-positive patients without histoplasmosis were tested with the GM detection and Histoplasma-specific antibody detection (IEP). In 39 AIDS patients with proven disseminated histoplasmosis, the sensitivity of the Histoplasma IEP was only 35.9% and was linked to the TCD4+ lymphocyte level. For the GM detection, the sensitivity (Se) was 76.9% and specificity (Sp) was 100% with the recommended threshold for aspergillosis diagnosis (0.5). The test was more efficient with a threshold of 0.4 (Se: 0.82 [95% CI: 0.66-0.92], Sp: 1.00 [95% CI: 0.86-1.00], LR+: >10, LR-: 0.18). This study confirms that the GM detection can be a surrogate marker for the diagnosis of disseminated histoplasmosis in AIDS patients in endemic areas where Histoplasma EIA is not available.
authors.affiliation: Service de Parasitologie-Mycologie, Centre Hospitalier Universitaire de Toulouse, Toulouse, France; INSERM UMR1043/CNRS UMR5282/Université de Toulouse UPS, Centre de Physiopathologie de Toulouse Purpan (CPTP), Toulouse F-31300, France. Electronic address: iriart.x@chu-toulouse.fr.
authors.forename: Xavier
authors.initials: X
authors.lastname: Iriart
authors.affiliation: Laboratoire Hospitalier et Universitaire Parasitologie Mycologie, Centre Hospitalier de Cayenne, BP 6006, 97300 Cayenne, French Guiana.
authors.forename: Denis
authors.initials: D
authors.lastname: Blanchet
authors.affiliation: INSERM UMR1043/CNRS UMR5282/Université de Toulouse UPS, Centre de Physiopathologie de Toulouse Purpan (CPTP), Toulouse F-31300, France.
authors.forename: Sandie
authors.initials: S
authors.lastname: Menard
authors.affiliation: Service de Parasitologie-Mycologie, Centre Hospitalier Universitaire de Toulouse, Toulouse, France; INSERM UMR1043/CNRS UMR5282/Université de Toulouse UPS, Centre de Physiopathologie de Toulouse Purpan (CPTP), Toulouse F-31300, France.
authors.forename: Rose-Anne
authors.initials: RA
authors.lastname: Lavergne
authors.affiliation: Service de Parasitologie-Mycologie, Centre Hospitalier Universitaire de Toulouse, Toulouse, France.
authors.forename: Pamela
authors.initials: P
authors.lastname: Chauvin
authors.affiliation: CIC-EC Antilles-Guyane, CIE 802 Inserm, Centre Hospitalier de Cayenne, BP 6006, 97300 Cayenne, French Guiana.
authors.forename: Antoine
authors.initials: A
authors.lastname: Adenis
authors.affiliation: Service de Parasitologie-Mycologie, Centre Hospitalier Universitaire de Toulouse, Toulouse, France.
authors.forename: Sophie
authors.initials: S
authors.lastname: Cassaing
authors.affiliation: Service de Parasitologie-Mycologie, Centre Hospitalier Universitaire de Toulouse, Toulouse, France.
authors.forename: Judith
authors.initials: J
authors.lastname: Fillaux
authors.affiliation: Service de Parasitologie-Mycologie, Centre Hospitalier Universitaire de Toulouse, Toulouse, France.
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Magnaval
authors.affiliation: Laboratoire Hospitalier et Universitaire Parasitologie Mycologie, Centre Hospitalier de Cayenne, BP 6006, 97300 Cayenne, French Guiana; Equipe EA 3593 Épidémiologie des Parasitoses et Mycoses Tropicales, Université Antilles Guyane, Campus Saint Denis, Cayenne, French Guiana.
authors.forename: Magalie
authors.initials: M
authors.lastname: Demar
authors.affiliation: Laboratoire Hospitalier et Universitaire Parasitologie Mycologie, Centre Hospitalier de Cayenne, BP 6006, 97300 Cayenne, French Guiana; Equipe EA 3593 Épidémiologie des Parasitoses et Mycoses Tropicales, Université Antilles Guyane, Campus Saint Denis, Cayenne, French Guiana.
authors.forename: Bernard
authors.initials: B
authors.lastname: Carme
authors.affiliation: Service de Parasitologie-Mycologie, Centre Hospitalier Universitaire de Toulouse, Toulouse, France.
authors.forename: Marie-Hélène
authors.initials: MH
authors.lastname: Bessieres
authors.affiliation: Service de dermatologie, Centre Hospitalier de Cayenne, BP 6006, 97300 Cayenne, French Guiana; Equipe EA 3593 Épidémiologie des Parasitoses et Mycoses Tropicales, Université Antilles Guyane, Campus Saint Denis, Cayenne, French Guiana.
authors.forename: Pierre
authors.initials: P
authors.lastname: Couppie
authors.affiliation: CIC-EC Antilles-Guyane, CIE 802 Inserm, Centre Hospitalier de Cayenne, BP 6006, 97300 Cayenne, French Guiana; Equipe EA 3593 Épidémiologie des Parasitoses et Mycoses Tropicales, Université Antilles Guyane, Campus Saint Denis, Cayenne, French Guiana.
authors.forename: Mathieu
authors.initials: M
authors.lastname: Nacher
authors.affiliation: Service de Parasitologie-Mycologie, Centre Hospitalier Universitaire de Toulouse, Toulouse, France; INSERM UMR1043/CNRS UMR5282/Université de Toulouse UPS, Centre de Physiopathologie de Toulouse Purpan (CPTP), Toulouse F-31300, France.
authors.forename: Antoine
authors.initials: A
authors.lastname: Berry
authors.affiliation: Laboratoire Hospitalier et Universitaire Parasitologie Mycologie, Centre Hospitalier de Cayenne, BP 6006, 97300 Cayenne, French Guiana; Equipe EA 3593 Épidémiologie des Parasitoses et Mycoses Tropicales, Université Antilles Guyane, Campus Saint Denis, Cayenne, French Guiana. Electronic address: christine.aznar1@wanadoo.fr.
authors.forename: Christine
authors.initials: C
authors.lastname: Aznar
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis* / Q000188:drug therapy* / Q000382:microbiology; D000163:Acquired Immunodeficiency Syndrome / Q000150:complications*; D000328:Adult; D000908:Antibodies, Fungal / Q000097:blood; D015331:Cohort Studies; D005260:Female; D005616:French Guiana; D005690:Galactose / Q000031:analogs & derivatives; D006658:Histoplasma / Q000302:isolation & purification*; D006660:Histoplasmosis / Q000175:diagnosis* / Q000188:drug therapy* / Q000382:microbiology; D006801:Humans; D008297:Male; D008351:Mannans / Q000097:blood*; D008875:Middle Aged; D012680:Sensitivity and Specificity; D013020:South America
chemical_list: D000908:Antibodies, Fungal; D008351:Mannans; C012990:galactomannan; D005690:Galactose
keywords: AIDS; Antibody; Cross-reactivity; Diagnosis; Galactomannan; Histoplasma capsulatum; Histoplasmosis; Platelia