Bernal-Martínez L, De la Cruz-Ríos P, Viedma R, Gago S, Ortega-Madueño S, Alcazar-Fuoli L, Buitrago M J
Mycology Reference Laboratory, National Center of Microbiology, Instituto de Salud Carlos III Majadahonda, 28222 Madrid, Spain.
CIBERINFEC, ISCIII-CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, 28029 Madrid, Spain.
J Fungi (Basel). 2025 Jun 12;11(6):448. doi: 10.3390/jof11060448.
Diagnosis of histoplasmosis is challenging. A rapid, sensitive, and specific method is essential. Serum is a non-invasive and easy sample to obtain in any hospital. The diagnostic accuracy of different techniques that use serum has been evaluated. Forty-one serum samples from patients with proven or probable histoplasmosis were analyzed. Different diagnostic techniques based on the detection of antibodies (ID Fungal Antibody System), antigens (Histoplasma GM EIA and Platelia Aspergillus Ag), and DNA ("in-house" real-time PCR (RT-PCR) were tested and compared. Additionally, the quantification of cytokines and biomarkers related to histoplasmosis was performed. Global results from 27 samples in which all the tests were performed showed that the sensitivity of the Histoplasma GM EIA kit was 87.5% in patients with disseminated infection and HIV as an underlying disease; in immunocompetent (IC) patients, it was 54.5%. The detection of spp. with the ID Fungal Antibody System was positive in 90.9% of IC and in 62.5% of HIV patients. The Platelia-Asp kit had a low performance in both groups of patients (37.5% in HIV and 9% in non-HIV), and, finally, RT-PCR was better in immunosuppressed patients (44% in HIV vs. 27% in non-HIV). The combination of diagnostic techniques increased the detection of Histoplasma infection in inmunosupressed patients. Overall, patient groups infected with H. capsulatum (Hc) showed higher IL-8, IL-6, IL-1β, TNF-α, and IL-18 median values compared to non-Hc-infected controls. The effectiveness of diagnostic techniques on serum samples is highly influenced by the patient's clinical presentation and underlying condition. Consequently, a thorough assessment of the patient's clinical presentation and disease phenotype is crucial in selecting the most suitable diagnostic method.
组织胞浆菌病的诊断具有挑战性。一种快速、灵敏且特异的方法至关重要。血清是一种在任何医院都能非侵入性且轻松获取的样本。已对使用血清的不同技术的诊断准确性进行了评估。分析了41份来自确诊或疑似组织胞浆菌病患者的血清样本。测试并比较了基于抗体检测（ID真菌抗体系统）、抗原检测（组织胞浆菌GM酶免疫测定和普立泰阿曲霉抗原检测）以及DNA检测（“内部”实时聚合酶链反应（RT-PCR））的不同诊断技术。此外，还对与组织胞浆菌病相关的细胞因子和生物标志物进行了定量分析。对27份进行了所有检测的样本的综合结果显示，在患有播散性感染且以HIV为基础疾病的患者中，组织胞浆菌GM酶免疫测定试剂盒的灵敏度为87.5%；在免疫功能正常（IC）的患者中，灵敏度为54.5%。使用ID真菌抗体系统检测荚膜组织胞浆菌在90.9%的IC患者和62.5%的HIV患者中呈阳性。普立泰阿曲霉试剂盒在两组患者中的表现都较差（HIV患者中为37.5%，非HIV患者中为9%），最后，RT-PCR在免疫抑制患者中表现更好（HIV患者中为44%，非HIV患者中为27%）。诊断技术的联合应用提高了免疫抑制患者中组织胞浆菌感染的检测率。总体而言，与未感染荚膜组织胞浆菌（Hc）的对照组相比，感染Hc的患者组的白细胞介素-8（IL-8）、白细胞介素-6（IL-6）、白细胞介素-1β、肿瘤坏死因子-α（TNF-α）和白细胞介素-18的中位数更高。诊断技术对血清样本的有效性受患者临床表现和基础疾病的影响很大。因此，在选择最合适的诊断方法时，对患者的临床表现和疾病表型进行全面评估至关重要。
