부산대학교 도서관

Background: Histoplasma capsulatum exposure is rarely suspected in Indonesia. Pulmonary histoplasmosis can occur simultaneously with pulmonary tuberculosis (TB) or as an alternative diagnosis in clinically-diagnosed TB patients with no microbiological evidence of TB. This study aimed to determine the seroprevalence of anti-H. capsulatum IgG antibody among pulmonary TB patients. Methodology: This was a sub-study of 306 participants from a prospective cohort pulmonary TB study conducted at seven TB referral hospitals in Indonesia. The study population was presumptive pulmonary TB adult patients who underwent microbiological TB examinations and were categorized as drug-sensitive (DS), drug-resistant (DR), and clinically-diagnosed TB. Anti-H. capsulatum IgG antibody levels at baseline were measured using MVista Histoplasma Ab enzyme immunoassays. Data were summarized using descriptive statistics. Bivariate and multivariate logistic regression analysis were performed to assess factors associated with anti-H. capsulatum IgG antibody positive result. Results: 12.7% (39/306) of pulmonary TB patients were positive for anti-H. capsulatum IgG antibodies (DR-TB patients (15.9%, 18/114), DS-TB (13.0%, 15/115), and clinically-diagnosed TB (7.8%, 6/77)). The median unit value of anti-H. capsulatum IgG antibody for all positive samples was 15.7 (IQR 10.2–28.9) EU. This median unit value was higher in clinically-diagnosed TB patients compared to DS-TB or DR-TB patients (38.1 (IQR 25.6–46.6) EU, 19.7 (IQR 12.3–28.9) EU, and 10.9 (IQR 9.2–15.4), respectively). There were 10 patients (3.3%) with anti-H. capsulatum IgG antibody levels above 30 EU. Factors associated with the anti-H. capsulatum IgG antibody positive result were malignancies (OR 4.88, 95% CI 1.09–21.69, p = 0.037) and cavitary lesions (OR 2.27, 95% CI 1.09–4.70, p = 0.028). Conclusions: Our results provide evidence of exposure to H. capsulatum among pulmonary TB patients in Indonesia. Further studies are needed to provide a comprehensive picture of this fungal disease in other populations and regions to enhance awareness among clinicians and public health officials. Author summary: Histoplasma capsulatum exposure is rarely suspected in Indonesia, even though this fungal presence in the country has been reported since the 1930s. Pulmonary manifestations of histoplasmosis, especially chronic pulmonary histoplasmosis (CPH), resemble pulmonary tuberculosis (TB). It may be misdiagnosed as or be a co-infection with pulmonary TB. Since Indonesia is the second-highest TB-burdened country worldwide, it is imperative to capture histoplasmosis data among pulmonary TB patients. Our study provides evidence of H. capsulatum exposure by measuring anti-H. capsulatum IgG antibodies in both bacteriologically confirmed and clinically-diagnosed pulmonary TB patients at seven TB referral hospitals in Indonesia. We found 12.7% (39/306) of pulmonary TB patients were positive for anti-H. capsulatum IgG antibodies. We had a high suspicion of pulmonary histoplasmosis diagnosis in 10 of the 39 patients (six bacteriologically confirmed and four clinically-diagnosed TB) who were immunocompromised due to high IgG assay values (>30 EU). The utilization of other modalities, such as the Histoplasma antigen test, may support a histoplasmosis diagnosis. In our study, malignancies and cavitary lesions were associated with anti-H. capsulatum IgG antibody positive results. Our results bring much-needed preliminary data to guide policymakers regarding fungal infection in pulmonary TB patients and support further research on histoplasmosis in Indonesia. [ABSTRACT FROM AUTHOR]