Diagnostic accuracy cohort study and clinical value of the Histoplasma urine antigen (ALPHA Histoplasma EIA) for disseminated histoplasmosis among HIV infected patients: A multicenter study.
Autor: | Torres-González P; Department of Infectious Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpan, Mexico City, Mexico., Niembro-Ortega MD; Department of Infectious Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpan, Mexico City, Mexico., Martínez-Gamboa A; Department of Infectious Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpan, Mexico City, Mexico., Ahumada-Topete VH; Centro de Investigación en Enfermedades Infecciosas, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Tlalpan, Mexico City, Mexico., Andrade-Villanueva J; HIV Unit, Hospital Civil de Guadalajara 'Fray Antonio Alcalde', Guadalajara, Jalisco, Mexico., Araujo-Meléndez J; Department of Internal Medicine, Hospital Central Dr. Ignacio Morones Prieto, San Luis Potosí, San Luis Potosí, Mexico., Chaparro-Sánchez A; Adult Infectious Diseases Department, Hospital de Infectología del Centro Médico Nacional 'La Raza', Instituto Mexicano del Seguro Social, Atzcapotzalco, Mexico City, Mexico., Crabtree-Ramírez B; Department of Infectious Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpan, Mexico City, Mexico., Cruz-Martínez S; Department of Infectious Diseases, Hospital Regional de Alta Especialidad de Oaxaca, HRAEO, San Bartolo Coyotepec, Oaxaca, Mexico., Gamboa-Domínguez A; Department of Pathology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubiran, Tlalpan, Mexico City, Mexico., Flores-Barrientos OI; Intensive Care Unit, Department of Internal Medicine, Hospital 'Dr. Juan Graham Casasus', Villahermosa, Tabasco, Mexico., Gaytán-Martínez JE; Adult Infectious Diseases Department, Hospital de Infectología del Centro Médico Nacional 'La Raza', Instituto Mexicano del Seguro Social, Atzcapotzalco, Mexico City, Mexico., González-Hernández LA; HIV Unit, Hospital Civil de Guadalajara 'Fray Antonio Alcalde', Guadalajara, Jalisco, Mexico., Hernández-León C; Area of Infectious Diseases, Department of Internal Medicine, Hospital General de Puebla 'Dr. Eduardo Vazquez Navarro', Puebla, Puebla, Mexico., Lozano-Fernandez VH; Centro de Investigación en Enfermedades Infecciosas, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Tlalpan, Mexico City, Mexico., Manríquez-Reyes M; Department of Internal Medicine, Hospital de Alta Especialidad de Veracruz, Veracruz, Veracruz, Mexico., Magaña-Aquino M; Department of Internal Medicine, Hospital Central Dr. Ignacio Morones Prieto, San Luis Potosí, San Luis Potosí, Mexico., Martínez-Ayala P; HIV Unit, Hospital Civil de Guadalajara 'Fray Antonio Alcalde', Guadalajara, Jalisco, Mexico., Ramírez-Hinojosa JP; Infectious Diseases Department, Hospital General Dr. Manuel Gea González, Tlalpan, Mexico City, Mexico., Rangel-Cordero A; Department of Infectious Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpan, Mexico City, Mexico., Rivera-Martínez NE; Department of Infectious Diseases, Hospital Regional de Alta Especialidad de Oaxaca, HRAEO, San Bartolo Coyotepec, Oaxaca, Mexico., Reyes-Gutiérrez E; Department of Pathology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubiran, Tlalpan, Mexico City, Mexico., Reyes-Terán G; Centro de Investigación en Enfermedades Infecciosas, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Tlalpan, Mexico City, Mexico., Rodríguez-Zulueta P; Infectious Diseases Department, Hospital General Dr. Manuel Gea González, Tlalpan, Mexico City, Mexico., Ruíz-Quiñones J; Intensive Care Unit, Department of Internal Medicine, Hospital 'Dr. Juan Graham Casasus', Villahermosa, Tabasco, Mexico., Santiago-Cruz J; Department of Infectious Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpan, Mexico City, Mexico., Velázquez-Zavala NG; Department of Infectious Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpan, Mexico City, Mexico., Sifuentes-Osornio J; Department of Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpan, Mexico City, Mexico., Ponce de León A; Department of Infectious Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpan, Mexico City, Mexico. |
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Jazyk: | angličtina |
Zdroj: | PLoS neglected tropical diseases [PLoS Negl Trop Dis] 2018 Nov 05; Vol. 12 (11), pp. e0006872. Date of Electronic Publication: 2018 Nov 05 (Print Publication: 2018). |
DOI: | 10.1371/journal.pntd.0006872 |
Abstrakt: | Background: The Histoplasma urine antigen (HUAg) is the preferred method to diagnose progressive disseminated histoplasmosis (PDH) in HIV patients. In 2007, IMMY ALPHA Histoplasma EIA was approved for clinical for on-site use, and therefore useful for regions outside the United States. However, ALPHA-HUAg is considered inferior to the MVista-HUAg which is only available on referral. We aim to evaluate the diagnostic accuracy of ALPHA-HUAg. Methodology/principal Findings: We conducted a multicenter, prospective, diagnostic test study in two secondary and eight tertiary-care facilities in Mexico. We included HIV patient with PDH suspicion and evaluated ALPHA-HUAg diagnostic accuracy using as reference standard the Histoplasma capsulatum growth on blood, bone marrow, and tissue cultures or compatible histopathologic exam (PDH-proven). We evaluated the results of 288 patients, 29.5% (85/288; 95% confidence interval [CI], 24.3-35.1) had PDH. The sensitivity of ALPHA-HUAg was 67.1% (95% CI, 56-76.8%) and the specificity was 97.5% (95% CI, 94.3%-99.1%). The positive likelihood ratio was 27.2 (95% CI; 11.6-74.4). In 10.5% of the PDH-proven patients, a co-existing opportunistic infection was diagnosed, mostly disseminated Mycobacterium avium complex infection. Conclusions/significance: We observed a high specificity but low sensitivity of IMMY-HUAg. The test may be useful to start early antifungals, but a culture-based approach is necessary since co-infections are frequent and a negative IMMY-HUAg result does not rule out PDH. Competing Interests: The authors have declared that no competing interests exist. |
Databáze: | MEDLINE |
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