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

Journal Article · 23 May 2021 · Mycoses

DOI: https://doi.org/10.1111/myc.13303 · OSTI ID:1784455

Caceres, Diego H.  ^[1]; Arauz, Ana B.  ^[2]; Flores, Carlos ^[2]; Santiago, Erika ^[2]; Montoya, Sandra ^[3]; Saenz, Carlos ^[4]; Torres‐Meneses, Felipe A. ^[4]; Peralta, Hortencia ^[5]; Zuniga‐Moya, Julio Cesar ^[6]; Lainez Arteaga, Isis Zohar ^[6]; Garcia, Arturo ^[7]; Abdo, Jose  ^[7]; Verweij, Paul E.  ^[8]; Chiller, Tom M.  ^[9]; Forno, Diana ^[9]

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1. Centers for Disease Control and Prevention (CDC) Atlanta GA USA, Department of Medical Microbiology Radboud University Medical Center and Radboudumc‐CWZ Center of Expertise for Mycology Nijmegen The Netherlands
2. Hospital Santo Tomas Panama City Panama
3. Hospital Escuela Tegucigalpa Honduras
4. Centro Nacional de Diagnóstico y Referencia Managua Nicaragua
5. Hospital Escuela Antonio Lenin Fonseca Managua Nicaragua
6. Hospital Mario Catarino Rivas San Pedro de Sula Honduras
7. 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
8. Department of Medical Microbiology Radboud University Medical Center and Radboudumc‐CWZ Center of Expertise for Mycology Nijmegen The Netherlands
9. Centers for Disease Control and Prevention (CDC) Atlanta GA USA

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.

• Sponsoring Organization: USDOE
• OSTI ID: 1784455
• Journal Information: Mycoses, Journal Name: Mycoses Journal Issue: 11 Vol. 64; ISSN 0933-7407
• Publisher: Wiley-BlackwellCopyright Statement
• Country of Publication: Country unknown/Code not available
• Language: English