title: Improved Diagnosis of Acute Pulmonary Histoplasmosis by Combining Antigen and Antibody Detection.
abstract: BACKGROUND
  Acute pulmonary histoplasmosis can be severe, especially following heavy inoculum exposure. Rapid diagnosis is critical and often possible by detection of antigen, but this test may be falsely negative in 17% of such cases. Antibody detection by enzyme immunoassay (EIA) may increase sensitivity and permit the measurement of immunoglobulin M (IgM) and immunoglobulin G (IgG) classes of antibodies separately.
  
  
  METHODS
  Microplates coated with Histoplasma antigen were used for testing of serum from patients with acute pulmonary histoplasmosis and controls in the MVista Histoplasma antibody EIA. Results for IgG and IgM were reported independently.
  
  
  RESULTS
  IgG antibodies were detected in 87.5%, IgM antibodies in 67.5%, and IgG and/or IgM antibodies in 88.8% of patients with acute pulmonary histoplasmosis in this assay, while immunodiffusion, complement fixation, and antigen testing showed sensitivities of 55.0%, 73.1%, and 67.5%, respectively (n = 80). Combining antigen and antibody detection increased the sensitivity to 96.3%.
  
  
  CONCLUSIONS
  The MVista Histoplasma antibody EIA offers increased sensitivity over current antibody tests while also allowing separate detection of IgG and IgM antibodies and complementing antigen detection. Combining antigen and EIA antibody testing provides an optimal method for diagnosis of acute pulmonary histoplasmosis.
authors.affiliation: MiraVista Diagnostics.
authors.forename: Sarah M
authors.initials: SM
authors.lastname: Richer
authors.affiliation: MiraVista Diagnostics.
authors.forename: Melinda L
authors.initials: ML
authors.lastname: Smedema
authors.affiliation: MiraVista Diagnostics.
authors.forename: Michelle M
authors.initials: MM
authors.lastname: Durkin
authors.affiliation: Richard M. Fairbanks School of Public Health, Indiana University-Purdue University.
authors.forename: Katie M
authors.initials: KM
authors.lastname: Herman
authors.affiliation: Thoracic Transplantation Program, Indiana University Health-Methodist Hospital.
authors.forename: Chadi A
authors.initials: CA
authors.lastname: Hage
authors.affiliation: Department of Pathology, Indiana University School of Medicine, Sidney & Lois Eskenazi Hospital, Indianapolis.
authors.forename: Deanna
authors.initials: D
authors.lastname: Fuller
authors.affiliation: MiraVista Diagnostics.
authors.forename: L Joseph
authors.initials: LJ
authors.lastname: Wheat
mesh_terms: D000208:Acute Disease; D000908:Antibodies, Fungal / Q000097:blood*; D000946:Antigens, Fungal / Q000097:blood*; D006658:Histoplasma / Q000276:immunology* / Q000302:isolation & purification; D006660:Histoplasmosis / Q000175:diagnosis* / Q000276:immunology / Q000382:microbiology; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D007075:Immunoglobulin M / Q000097:blood; D008172:Lung Diseases, Fungal / Q000175:diagnosis* / Q000276:immunology / Q000382:microbiology; D009172:Mycology / Q000379:methods*; D015203:Reproducibility of Results
chemical_list: D000908:Antibodies, Fungal; D000946:Antigens, Fungal; D007074:Immunoglobulin G; D007075:Immunoglobulin M
keywords: Histoplasma capsulatum; acute pulmonary histoplasmosis; serology