Bahr Nathan C, Sarosi George A, Meya David B, Bohjanen Paul R, Richer Sarah M, Swartzentruber Samantha, Halupnick Ryan, Jarrett Deidre, Wheat L Joseph, Boulware David R
Infectious Diseases Institute, Makerere University, Kampala, Uganda Department of Medicine, University of Minnesota, Minneapolis, Minnesota Center for Infectious Disease & Microbiology Translational Research, University of Minnesota, Minneapolis, Minnesota
Department of Medicine, University of Minnesota, Minneapolis, Minnesota Department of Medicine, Minneapolis Veterans Affairs Medical Center, Minneapolis, Minnesota.
Med Mycol. 2016 Mar;54(3):295-300. doi: 10.1093/mmy/myv081. Epub 2015 Nov 2.
Histoplasmosis is endemic to the Midwestern United States, but cases have been reported nearly worldwide. A 1970 study found 3.8% skin test sensitivity to Histoplasma capsulatum in Uganda but no systemic study of histoplasmosis exposure has occurred since the onset of the human immunodeficiency virus (HIV) pandemic. This study investigated the seroprevalence of H. capsulatum and sought previously undetected cases of histoplasmosis in Kampala, Uganda. Serum, cerebrospinal fluid (CSF) and/or urine specimens were obtained from HIV-infected persons with suspected meningitis. Specimens were tested for H. capsulatum IgG and IgM by enzyme immune assay and Histoplasma antigen. 147 of the 257 subjects who were enrolled had cryptococcal meningitis. Overall, 1.3% (2/151) of subjects were serum Histoplasma IgG positive, and zero of 151 were IgM positive. Antigen was not detected in any serum (n = 57), urine (n = 37, or CSF (n = 63) samples. Both subjects with serum Histoplasma IgG positivity had cryptococcal meningitis. Histoplasma capsulatum IgG was detected at low levels in persons with HIV/AIDS in Kampala, Uganda. Histoplasmosis is not widespread in Uganda but microfoci do exist. There appears to be no cross-reactivity between Cryptococcus neoformans and Histoplasma antigen testing, and cryptococcosis appears to be at most, a rare cause of positive Histoplasma IgG.
组织胞浆菌病在美国中西部地区呈地方性流行，但几乎在世界各地均有病例报告。1970年的一项研究发现，乌干达有3.8%的人对荚膜组织胞浆菌皮肤试验呈阳性，但自人类免疫缺陷病毒（HIV）大流行以来，尚未对组织胞浆菌病暴露情况进行过系统性研究。本研究调查了荚膜组织胞浆菌的血清流行率，并在乌干达坎帕拉寻找此前未被发现的组织胞浆菌病病例。从疑似脑膜炎的HIV感染者中获取血清、脑脊液（CSF）和/或尿液标本。通过酶免疫测定法检测标本中的荚膜组织胞浆菌IgG和IgM以及组织胞浆菌抗原。纳入研究的257名受试者中，有147人患有隐球菌性脑膜炎。总体而言，1.3%（2/151）的受试者血清组织胞浆菌IgG呈阳性，151人中无人IgM呈阳性。在任何血清（n = 57）、尿液（n = 37）或脑脊液（n = 63）样本中均未检测到抗原。两名血清组织胞浆菌IgG呈阳性的受试者均患有隐球菌性脑膜炎。在乌干达坎帕拉的HIV/AIDS患者中，检测到低水平的荚膜组织胞浆菌IgG。组织胞浆菌病在乌干达并不广泛，但确实存在小范围发病情况。新型隐球菌与组织胞浆菌抗原检测之间似乎没有交叉反应，而且隐球菌病似乎至多是导致组织胞浆菌IgG呈阳性的罕见原因。
