Implementation of rapid diagnostics assays for detection of histoplasmosis and cryptococcosis in central american people living with HIV

Implementation of rapid diagnostics assays for detection of histoplasmosis and cryptococcosis in central american people living with HIV

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 hig...

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Published in:Mycoses Vol. 64; no. 11; pp. 1396 - 1401
Main Authors: Caceres, Diego H., Arauz, Ana B., Flores, Carlos, Santiago, Erika, Montoya, Sandra, Saenz, Carlos, Torres‐Meneses, Felipe A., Peralta, Hortencia, Zuniga‐Moya, Julio Cesar, Lainez Arteaga, Isis Zohar, Garcia, Arturo, Abdo, Jose, Verweij, Paul E., Chiller, Tom M., Forno, Diana
Format: Journal Article
Language:English
Published: Germany Wiley Subscription Services, Inc 01-11-2021
Wiley-Blackwell
John Wiley and Sons Inc
Subjects:
AIDS
Antigens
Cerebrospinal fluid
Cryptococcosis
Cryptococcus
Diagnosis
Enzyme immunoassay
Histoplasma
Histoplasmosis
HIV
Human immunodeficiency virus
Laboratories
Original
Patients
Public health
Honduras
Panama
Nicaragua
Nicaragua
HIV
Histoplasma
Panama
Cryptococcus
AIDS
Honduras
histoplasmosis
cryptococcosis
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Summary: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.
Bibliography:Funding information
All authors report no potential conflicts of interest. This study was funded by the United States President's Emergency Plan for AIDS Relief (PEPFAR). The findings and conclusions in this article are those of the authors and do not necessarily represent the views of the CDC.
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USDOE
ISSN:0933-7407
1439-0507
DOI:10.1111/myc.13303