Diego H Caceres1,2, Ana B Arauz3, Carlos Flores3, Erika Santiago3, Sandra Montoya4, Carlos Saenz5, Felipe A Torres-Meneses5, Hortencia Peralta6, Julio Cesar Zuniga-Moya7, Isis Zohar Lainez Arteaga7, Arturo Garcia8, Jose Abdo8, Paul E Verweij2, Tom M Chiller1, Diana Forno1. 1. Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA. 2. Department of Medical Microbiology, Radboud University Medical Center and Radboudumc-CWZ Center of Expertise for Mycology, Nijmegen, The Netherlands. 3. Hospital Santo Tomas, Panama City, Panama. 4. Hospital Escuela, Tegucigalpa, Honduras. 5. Centro Nacional de Diagnóstico y Referencia, Managua, Nicaragua. 6. Hospital Escuela Antonio Lenin Fonseca, Managua, Nicaragua. 7. Hospital Mario Catarino Rivas, San Pedro de Sula, Honduras. 8. LLC. HIV-TB Co-infection Surveillance Strategies for Program Planning in the Central American Region under PEPFAR, Formerly with University Research Co., Guatemala City, Guatemala.
Abstract
OBJECTIVES: Histoplasmosis and cryptococcosis are important public health problems in people living with HIV (PLHIV) in Central America. Conventional laboratory assays, based on microscopy and culture, are not optimal for the diagnosis of either disease. However, antigen (Ag) assays are rapid and highly accurate for the diagnosis of these infections. METHODS: Laboratory surveillance of PLHIV was carried out in four hospitals in Panama, Honduras and Nicaragua, between 2015 and 2019. Detection of Histoplasma antigens in urine was performed by enzyme immunoassay (EIA), and Cryptococcus antigen detection in sera and cerebrospinal fluid specimens was performed by lateral flow assay (LFA). RESULTS: A total of 4,453 PLHIV with clinical suspicion of histoplasmosis (n = 1,343) or cryptococcosis (n = 3,110; 2,721 sera and 389 CSF) were tested. Of 1,343 patients suspected of having histoplasmosis, 269 (20%) were Histoplasma Ag positive. Of 3,110 patients tested using the Cryptococcus Ag assay, 329 (11%) were positive. Honduras reported the highest positivity rates (32% for Histoplasma Ag, and 16% for Cryptococcus Ag); Panama reported the largest number of patients testing positive using the Histoplasma Ag assay (n = 201); and Nicaragua reported the largest number of patients testing positive using the Cryptococcus Ag assay (n = 170). CONCLUSION: Here, we show how the implementation of rapid diagnostics assays impacted case detection and was useful for the care of people with advanced HIV. Rapid and accurate diagnosis could reduce mortality associated with histoplasmosis and cryptococcosis in PLHIV.
OBJECTIVES: Histoplasmosis and cryptococcosis are important public health problems in people living with HIV (PLHIV) in Central America. Conventional laboratory assays, based on microscopy and culture, are not optimal for the diagnosis of either disease. However, antigen (Ag) assays are rapid and highly accurate for the diagnosis of these infections. METHODS: Laboratory surveillance of PLHIV was carried out in four hospitals in Panama, Honduras and Nicaragua, between 2015 and 2019. Detection of Histoplasma antigens in urine was performed by enzyme immunoassay (EIA), and Cryptococcus antigen detection in sera and cerebrospinal fluid specimens was performed by lateral flow assay (LFA). RESULTS: A total of 4,453 PLHIV with clinical suspicion of histoplasmosis (n = 1,343) or cryptococcosis (n = 3,110; 2,721 sera and 389 CSF) were tested. Of 1,343 patients suspected of having histoplasmosis, 269 (20%) were Histoplasma Ag positive. Of 3,110 patients tested using the Cryptococcus Ag assay, 329 (11%) were positive. Honduras reported the highest positivity rates (32% for Histoplasma Ag, and 16% for Cryptococcus Ag); Panama reported the largest number of patients testing positive using the Histoplasma Ag assay (n = 201); and Nicaragua reported the largest number of patients testing positive using the Cryptococcus Ag assay (n = 170). CONCLUSION: Here, we show how the implementation of rapid diagnostics assays impacted case detection and was useful for the care of people with advanced HIV. Rapid and accurate diagnosis could reduce mortality associated with histoplasmosis and cryptococcosis in PLHIV.
Authors: Bright K Ocansey; Benjamin Otoo; Isabella Asamoah; Vincent Ganu; Kofi P Berko; Oluwakemi Oladele; Emmanuella A Amankwa; Bismark Opoku-Asare; Martin Agyei; Lawrence George; Fleischer C N Kotey; Chris Kosmidis; Peter Puplampu; Japheth A Opintan; David W Denning Journal: Open Forum Infect Dis Date: 2022-06-03 Impact factor: 4.423
Authors: Wassim Abdallah; Thein Myint; Richard LaRue; Melissa Minderman; Suphansa Gunn; L Joseph Wheat; Chadi A Hage Journal: Open Forum Infect Dis Date: 2021-08-31 Impact factor: 3.835