Passos Angela Noronha, Kohara Valdelene Sayuri, de Freitas Roseli Santos, Vicentini Adriana Pardini
Laboratório de Imunodiagnóstico das Micoses Centro de Imunologia Instituto Adolfo Lutz São PauloSP Brazil Laboratório de Imunodiagnóstico das Micoses, Centro de Imunologia, Instituto Adolfo Lutz, São Paulo, SP, Brazil. ; Programa de Pós-Graduação em Ciências Coordenadoria de Controle de Doenças Secretaria de Estado da Saúde de São Paulo São PauloSP Brazil Programa de Pós-Graduação em Ciências, Coordenadoria de Controle de Doenças, Secretaria de Estado da Saúde de São Paulo, São Paulo, SP, Brazil.
Laboratório de Imunodiagnóstico das Micoses Centro de Imunologia Instituto Adolfo Lutz São PauloSP Brazil Laboratório de Imunodiagnóstico das Micoses, Centro de Imunologia, Instituto Adolfo Lutz, São Paulo, SP, Brazil.
Braz J Microbiol. 2015 Mar 4;45(4):1357-61. doi: 10.1590/s1517-83822014000400028. eCollection 2014.
Several reports showed outbreaks of histoplasmosis acquired while bat-inhabited caves were visited by tourists, miners or researchers. We evaluated the performance of double immunodifusion (DI) and immunoblotting (IB) assays, employed for the histoplasmosis outbreak elucidation occurred in Vale do Paraíba, São Paulo. The existence of epidemiologic link, four patients with clinical signs suggestive of histoplasmosis and mycological confirmation has made that all 35 individuals involved to the cave visit were subjected to serological evaluation. By DI, we observed reactivity against H. capsulatum antigen in a single serum examined nearly 20 days after exposure to fungal propagules. On the other hand, IB showed reactivity against H and M fractions in 50% of samples evaluated. The analysis of the second sample batch, collected two months after the exposure showed that 96.7% were reactive by DI with antibodies titers ranging from 1 to 16 and 100% of reactivity against H and M fractions, by IB, suggesting an acute infection. The analysis of the overall agreement between the methods showed to be reasonable (κ = 0.37). This study confirms the importance and efficacy of more sensitive methodologies, such as IB assay, to early elucidation of disease, especially in cases of patients without mycological information.
几份报告显示，游客、矿工或研究人员在参观蝙蝠栖息的洞穴时会感染组织胞浆菌病。我们评估了双免疫扩散（DI）和免疫印迹（IB）检测在圣保罗帕拉伊巴河谷发生的组织胞浆菌病疫情调查中的表现。由于存在流行病学关联，4名有组织胞浆菌病临床症状且经真菌学确诊的患者，使得所有35名参与洞穴参观的人员都接受了血清学评估。通过DI检测，我们在一名接触真菌繁殖体近20天后检测的血清中观察到了针对荚膜组织胞浆菌抗原的反应性。另一方面，IB检测在50%的评估样本中显示出针对H和M组分的反应性。对暴露后两个月采集的第二批样本进行分析，结果显示，96.7%的样本通过DI检测呈反应性，抗体滴度为1至16，100%的样本通过IB检测对H和M组分呈反应性，提示为急性感染。对两种方法总体一致性的分析显示结果合理（κ = 0.37）。本研究证实了更敏感的方法（如IB检测）对于早期明确疾病的重要性和有效性，尤其是在没有真菌学信息的患者中。
