Trends in Microbiology
Volume 11, Issue 10, October 2003, Pages 488-494
Journal home page for Trends in Microbiology

Current diagnosis of histoplasmosis

https://doi.org/10.1016/j.tim.2003.08.007Get rights and content

Abstract

Histoplasmosis is a common infection endemic in many regions of America, Asia, India and Africa, with sporadic cases also occurring throughout the world. Although excellent laboratory methods for diagnosis are available, there are deficiencies that must be met by continued research. Clinicians and laboratory directors must be familiar with the uses and limitations of a battery of serologic and mycological tests to accurately diagnose histoplasmosis. Research is needed to reduce false-negative and false-positive results, and to improve the identification of the organism in tissues. Approaches to the diagnosis of histoplasmosis and areas that require further research will be reviewed.

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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