학술논문
Diagnostic accuracy cohort study and clinical value of the Histoplasma urine antigen (ALPHA Histoplasma EIA) for disseminated histoplasmosis among HIV infected patients: A multicenter study.
Document Type
article
Author
Pedro Torres-González; María Dolores Niembro-Ortega; Areli Martínez-Gamboa; Víctor Hugo Ahumada-Topete; Jaime Andrade-Villanueva; Javier Araujo-Meléndez; Alberto Chaparro-Sánchez; Brenda Crabtree-Ramírez; Sofia Cruz-Martínez; Armando Gamboa-Domínguez; Oscar I Flores-Barrientos; Jesús Enrique Gaytán-Martínez; Luz Alicia González-Hernández; Christian Hernández-León; Víctor Hugo Lozano-Fernandez; Marisol Manríquez-Reyes; Martin Magaña-Aquino; Pedro Martínez-Ayala; Juan Pablo Ramírez-Hinojosa; Andrea Rangel-Cordero; Norma Erendira Rivera-Martínez; Edgardo Reyes-Gutiérrez; Gustavo Reyes-Terán; Patricia Rodríguez-Zulueta; Jesús Ruíz-Quiñones; Janeth Santiago-Cruz; Nancy Guadalupe Velázquez-Zavala; José Sifuentes-Osornio; Alfredo Ponce de León
Source
PLoS Neglected Tropical Diseases, Vol 12, Iss 11, p e0006872 (2018)
Subject
Language
English
ISSN
1935-2727
1935-2735
1935-2735
Abstract
BACKGROUND:The Histoplasma urine antigen (HUAg) is the preferred method to diagnose progressive disseminated histoplasmosis (PDH) in HIV patients. In 2007, IMMY ALPHA Histoplasma EIA was approved for clinical for on-site use, and therefore useful for regions outside the United States. However, ALPHA-HUAg is considered inferior to the MVista-HUAg which is only available on referral. We aim to evaluate the diagnostic accuracy of ALPHA-HUAg. METHODOLOGY/PRINCIPAL FINDINGS:We conducted a multicenter, prospective, diagnostic test study in two secondary and eight tertiary-care facilities in Mexico. We included HIV patient with PDH suspicion and evaluated ALPHA-HUAg diagnostic accuracy using as reference standard the Histoplasma capsulatum growth on blood, bone marrow, and tissue cultures or compatible histopathologic exam (PDH-proven). We evaluated the results of 288 patients, 29.5% (85/288; 95% confidence interval [CI], 24.3-35.1) had PDH. The sensitivity of ALPHA-HUAg was 67.1% (95% CI, 56-76.8%) and the specificity was 97.5% (95% CI, 94.3%-99.1%). The positive likelihood ratio was 27.2 (95% CI; 11.6-74.4). In 10.5% of the PDH-proven patients, a co-existing opportunistic infection was diagnosed, mostly disseminated Mycobacterium avium complex infection. CONCLUSIONS/SIGNIFICANCE:We observed a high specificity but low sensitivity of IMMY-HUAg. The test may be useful to start early antifungals, but a culture-based approach is necessary since co-infections are frequent and a negative IMMY-HUAg result does not rule out PDH.