title: Progressive disseminated histoplasmosis: a systematic review on the performance of non-culture-based diagnostic tests.
abstract: The diagnosis of progressive disseminated histoplasmosis is often a challenge to clinicians, especially due to the low sensitivity and long turnaround time of the classic diagnostic methods. In recent years, studies involving a variety of non-culture-based diagnostic tests have been published in the literature. We performed a systematic review by selecting studies evaluating non-culture-based diagnostic methods for progressive disseminated histoplasmosis. We searched for articles evaluating detection of antibody, antigens, as well as DNA-based diagnostic methods. A comprehensive PUBMED, Web of Science, and Cochrane Library search was performed between the years 1956 and 2016. Case reports, review articles, non-human models and series involving less than 10 patients were excluded. We found 278 articles and after initial review 18 articles were included: (12) involved antigen detection methods, (4) molecular methods, and (2) antibody detection methods. Here we demonstrate that the pursuit of new technologies is ultimately required for the early and accurate diagnosis of disseminated histoplasmosis. In particular, urinary antigen detection was the most accurate tool when compared with other diagnostic techniques.
authors.affiliation: Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil; Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brazil.
authors.forename: Diego R
authors.initials: DR
authors.lastname: Falci
authors.affiliation: Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brazil.
authors.forename: Elias R
authors.initials: ER
authors.lastname: Hoffmann
authors.affiliation: Irmandade Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, Brazil.
authors.forename: Diego D
authors.initials: DD
authors.lastname: Paskulin
authors.affiliation: Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brazil; Irmandade Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, Brazil. Electronic address: pasqualotto@santacasa.tche.br.
authors.forename: Alessandro C
authors.initials: AC
authors.lastname: Pasqualotto
mesh_terms: D006660:Histoplasmosis / Q000175:diagnosis*; D006801:Humans; D007124:Immunoenzyme Techniques / Q000379:methods*; D016133:Polymerase Chain Reaction / Q000379:methods; D012680:Sensitivity and Specificity; D012698:Serologic Tests / Q000379:methods*
keywords: Diagnostic tests; Disseminated histoplasmosis; Enzyme immunoassay; Non-culture