Infectious Diseases, Apollo Hospitals, Chennai, India.
Microbiology, Apollo Hospitals, Chennai, India.
Mycoses. 2019 Jun;62(6):502-507. doi: 10.1111/myc.12902. Epub 2019 Mar 21.
Many patients with histoplasmosis are treated with anti-tubercular therapy (ATT) in tuberculosis endemic regions as diagnosis of histoplasmosis requires invasive sampling. We sought to study the utility of urinary Histoplasma antigen detection test.
Case records of patients with a diagnosis of histoplasmosis prior to (Period A) and after (Period B) introduction of urinary Histoplasma antigen detection test were analysed in this single centre retrospective study.
Thirty-seven patients (18 in Period A, and 19 patients in Period B) were studied. There was nearly a threefold increase in diagnoses (from 0.39 cases to 1.18 cases per month) after the introduction of antigen test. Nine patients (24.3%) were immunocompromised (6 had HIV infection and 3 were on steroids), and 28 (75.6%) were immunocompetent. Empirical ATT had been given to 10 patients prior to histoplasmosis diagnosis. Invasive tissue sampling was required in only two patients in Period B to confirm the diagnosis. Immunocompromised patients were younger, were more likely to have skin and mucosal findings, anaemia and leucopenia as compared to immune-competent patients.
This study emphasises that histoplasmosis cases may be missed and patients may receive ATT unnecessarily. Histoplasma antigen increased the diagnostic yield by almost threefold in our study.
在结核病流行地区，许多患有组织胞浆菌病的患者接受抗结核治疗（ATT），因为组织胞浆菌病的诊断需要进行有创性采样。我们旨在研究尿组织胞浆菌抗原检测试验的实用性。
在这项单中心回顾性研究中，分析了在引入尿组织胞浆菌抗原检测试验之前（A 期）和之后（B 期）诊断为组织胞浆菌病的患者的病历。
研究了 37 名患者（A 期 18 例，B 期 19 例）。抗原检测试验引入后，诊断数量几乎增加了三倍（从每月 0.39 例增加到 1.18 例）。9 名患者（24.3%）免疫功能低下（6 名感染 HIV，3 名正在服用类固醇），28 名患者（75.6%）免疫功能正常。在组织胞浆菌病诊断之前，有 10 名患者接受了经验性 ATT。B 期仅需对 2 名患者进行有创性组织采样以确认诊断。与免疫功能正常的患者相比，免疫功能低下的患者更年轻，更有可能出现皮肤和黏膜表现、贫血和白细胞减少。
本研究强调可能会漏诊组织胞浆菌病病例，并且患者可能会不必要地接受 ATT。在我们的研究中，组织胞浆菌抗原将诊断率提高了近三倍。
