Vergidis P, Walker R C, Kaul D R, Kauffman C A, Freifeld A G, Slagle D C, Kressel A B, Wheat L J
Department of Medicine and William J. von Liebig Transplant Center, Mayo Clinic, Rochester, MN 55905, USA.
Transpl Infect Dis. 2012 Apr;14(2):213-7. doi: 10.1111/j.1399-3062.2011.00675.x. Epub 2011 Sep 26.
Post-transplantation histoplasmosis may be acquired via inhalation, may result from endogenous reactivation, or may be derived from the allograft. The Histoplasma and Aspergillus enzyme-linked immunoassays are increasingly being relied upon for rapid diagnosis of fungal infections, especially in immunocompromised patients. We describe 4 cases of solid organ transplant recipients who had histoplasmosis and a falsely positive Aspergillus galactomannan (GM) obtained from the serum or bronchoalveolar lavage (BAL) fluid. We also report our experience, testing for Histoplasma antigen (Ag) in specimens positive for Aspergillus GM. From January 2007 through December 2010, of 2432 unique patients who had positive Aspergillus GM tests, 514 (21%) were tested for Histoplasma Ag, and 27 were found to be positive. Most specimens that tested positive for both Aspergillus and Histoplasma were obtained by BAL. False-positive tests for Aspergillus GM can occur in immunosuppressed patients who have histoplasmosis, and may obscure the correct diagnosis.
移植后组织胞浆菌病可通过吸入获得，可能由内源性再激活引起，也可能源自同种异体移植。组织胞浆菌和曲霉酶联免疫测定越来越多地被用于真菌感染的快速诊断，尤其是在免疫功能低下的患者中。我们描述了4例实体器官移植受者，他们患有组织胞浆菌病，且血清或支气管肺泡灌洗（BAL）液中的曲霉半乳甘露聚糖（GM）检测呈假阳性。我们还报告了我们在曲霉GM检测阳性的标本中检测组织胞浆菌抗原（Ag）的经验。从2007年1月到2010年12月，在2432例曲霉GM检测呈阳性的独特患者中，514例（21%）接受了组织胞浆菌Ag检测，其中27例呈阳性。大多数曲霉和组织胞浆菌检测均呈阳性的标本是通过BAL获得的。患有组织胞浆菌病的免疫抑制患者可能会出现曲霉GM检测假阳性，这可能会掩盖正确诊断。
