Trends in Microbiology
Current diagnosis of histoplasmosis
Section snippets
Fungal culture
Diagnosis by isolation of the organism from cultures provides the strongest evidence for infection with Histoplasma capsulatum, but has certain limitations. First, cultures are negative in most patients with mild forms of histoplasmosis, limiting its use for diagnosis in mild cases. Cultures are positive primarily in patients with disseminated or chronic pulmonary histoplasmosis, but even in these cases cultures can be falsely negative in about 20% of disseminated cases 2, 3, 4 and 50% of
Antigen test development
During active infection, antigens are released into the tissues and enter body fluids adjacent to the sites of infection, including blood, urine, alveolar lavage fluid and cerebrospinal fluid (CSF), providing a basis for rapid diagnosis by antigen detection. Accuracy is imperative for tests that are to be used in patient management; an inaccurate test could lead to critical mistakes. A brief description of the work that yielded the antigen test might provide an insight into the approach to
Asymptomatic infection
Asymptomatic infections are usually identified on the basis of discoveries: hilar lymphadenopathy, pulmonary nodules, calcified granulomas in the spleen or liver found by radiographic studies, or granulomas containing structures resembling H. capsulatum as an incidental finding in tissues that have been removed surgically. Asymptomatic cases might also be identified by serologic screening as part of pre-transplant evaluation or epidemiological investigation.
The main significance of these
Conclusion
Although the diagnostic approach to histoplasmosis is well described and the tests are reasonably accurate, recognized deficiencies justify ongoing research. Excellent quality control is essential to achieve the accuracy reported in this review, and not all clinical laboratories achieve this high level of excellence. New tests must be validated before they are used for patient care, otherwise serious mistakes in patient management will occur.
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