Ocansey Bright K, Otoo Benjamin, Asamoah Isabella, Ganu Vincent, Berko Kofi P, Oladele Oluwakemi, Amankwa Emmanuella A, Opoku-Asare Bismark, Agyei Martin, George Lawrence, Kotey Fleischer C N, Kosmidis Chris, Puplampu Peter, Opintan Japheth A, Denning David W
Division of Evolution, Infection and Genomics, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom.
Department of Bacteriology, Noguchi Memorial Institute of Medical Research, University of Ghana, Legon, Ghana.
Open Forum Infect Dis. 2022 Jun 3;9(7):ofac277. doi: 10.1093/ofid/ofac277. eCollection 2022 Jul.
Cryptococcal meningitis (CM) and disseminated histoplasmosis (DH) are common in people with human immunodeficiency virus (PWH) and diagnosed by detecting cryptococcal antigen (CrAg) and antigen (HistoAg), respectively. In Ghana, CM and DH are rarely suspected by clinicians due to limited epidemiological data.
This study was conducted among PWH in Ghana who are unwell. Sociodemographic and clinical data were collected by questionnaire. Serum and/or urine were screened for CrAg and HistoAg, using IMMY CrAg lateral flow assay (LFA) and IMMY enzyme immunoassay (EIA) kits, respectively, regardless of symptoms. Samples run with IMMY EIA were simultaneously run with Optimum Imaging Diagnostics (OIDx) LFA. Laboratory investigations were conducted by the research team, and diagnosis incorporating clinical assessment, screening, and confirmatory testing results and treatment decisions were made by the clinical team. Treatment and outcome information on CM and DH patients were evaluated.
Overall, 150 participants were recruited. There were 73% ( = 109) females, and the age range was 18-62 years. The prevalence rates of CrAg and HistoAg were 2.7% (4 of 150) and 4.7% (5 of 107), respectively. The OIDx LFA showed a high concordance (98.4%) with the IMMY EIA. All antigen-positive cases by standard tests were diagnosed with CM and DH. Antifungal treatment was given in 5 patients and follow-up revealed 2 deaths and 3 recoveries.
Histoplasmosis among PWH may be more common than previously anticipated and may be more frequent than cryptococcosis in Ghana. The performance of the OIDx LFA should be further explored.
隐球菌性脑膜炎（CM）和播散性组织胞浆菌病（DH）在人类免疫缺陷病毒感染者（PWH）中较为常见，分别通过检测隐球菌抗原（CrAg）和组织胞浆菌抗原（HistoAg）进行诊断。在加纳，由于流行病学数据有限，临床医生很少怀疑患有CM和DH。
本研究在加纳身体不适的PWH中进行。通过问卷调查收集社会人口学和临床数据。无论有无症状，分别使用IMMY CrAg侧向流动分析法（LFA）和IMMY酶免疫分析法（EIA）试剂盒对血清和/或尿液进行CrAg和HistoAg筛查。使用IMMY EIA检测的样本同时使用最佳影像诊断（OIDx）LFA进行检测。研究团队进行实验室检查，临床团队结合临床评估、筛查和确诊检测结果做出诊断及治疗决策。对CM和DH患者的治疗及转归信息进行评估。
总体而言，招募了150名参与者。女性占73%（n = 109），年龄范围为18至62岁。CrAg和HistoAg的患病率分别为2.7%（150例中有4例）和4.7%（107例中有5例）。OIDx LFA与IMMY EIA显示出高度一致性（98.4%）。所有标准检测抗原阳性的病例均被诊断为CM和DH。5例患者接受了抗真菌治疗，随访显示2例死亡，3例康复。
PWH中的组织胞浆菌病可能比之前预期的更常见，在加纳可能比隐球菌病更频繁。应进一步探索OIDx LFA的性能。
