Serviço de Atenção de Pacientes Internados, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, Brazil.
Laboratório de Pesquisa Clínica em Dermatologia Infecciosa, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, Brazil.
PLoS Negl Trop Dis. 2024 Aug 29;18(8):e0012472. doi: 10.1371/journal.pntd.0012472. eCollection 2024 Aug.
Paracoccidioidomycosis (PCM) and histoplasmosis are endemic fungal diseases in South America. Both can lead to lung involvement with fungal dissemination progressing to systemic and severe clinical manifestations, especially in immunosuppressed hosts. As the population of immunosuppressed individuals has been rising, a higher occurrence of fungal infections is predicted in this setting. This poses challenges regarding the differential diagnosis due to overlapping clinical and laboratorial findings, hampering the management of cases.
In this study, the authors discuss the occurrence of a false-positive Histoplasma urinary antigen detection in a kidney transplant recipient with acute PCM. Given the scarce information about this subject, a review on literature data is provided.
A comprehensive literature search was conducted to investigate previous studies that found cross-reactivity between Histoplasma urinary antigen assays in human patients with confirmed diagnosis of PCM. Additionally, an update of PCM in transplant recipients is provided.
The included studies reported 120 samples from patients with PCM tested for Histoplasma antigen, presenting an overall cross-reactivity of 51.67% and 17 cases of PCM in transplant recipients. CONCLUSIONS: The galactomannan urinary antigen developed to diagnose histoplasmosis can cross react with PCM, which may represent a concern in countries where both mycoses overlap.
球孢子菌病（PCM）和组织胞浆菌病是南美的地方性真菌病。两者都可导致肺部受累，真菌传播进展为全身和严重的临床表现，特别是在免疫抑制宿主中。由于免疫抑制个体的数量不断增加，预计在这种情况下会出现更高的真菌感染发生率。由于临床表现和实验室发现重叠，这给鉴别诊断带来了挑战，从而影响了病例的管理。
在这项研究中，作者讨论了一位急性 PCM 的肾移植受者中假阳性组织胞浆菌尿抗原检测的发生。鉴于该主题的信息有限，提供了对文献数据的回顾。
进行了全面的文献检索，以调查以前的研究，这些研究发现人类确诊 PCM 患者的组织胞浆菌尿抗原检测存在交叉反应。此外，还提供了关于移植受者中 PCM 的最新信息。
纳入的研究报告了 120 例来自 PCM 患者的样本进行了组织胞浆菌抗原检测，总体交叉反应率为 51.67%，在移植受者中有 17 例 PCM。结论：开发用于诊断组织胞浆菌病的半乳糖甘露聚糖尿抗原可能与 PCM 发生交叉反应，这在两种真菌感染重叠的国家可能是一个问题。
