Histoplasmosis relapse in patients with AIDS: Detection using Histoplasma capsulatum variety capsulatum antigen levels

L. Joseph Wheat, Patricia Connolly-Stringfield, Robinette Blair, Kathleen Connolly, Todd Garringer, Barry Katz

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Abstract

Objective: To assess the accuracy of Histoplasma capsulatum variety capsulatum polysaccharide antigen testing for the identification of histoplasmosis relapse in patients with the acquired immunodeficiency syndrome (AIDS). Design: A retrospective study using stored specimens. Setting: A referral center and several private hospitals. Patients: Twenty episodes of histoplasmosis relapse were evaluated in 17 patients with AIDS from November 1987 to August 1990. Controls included 30 patients with AIDS and histoplasmosis who did not have a relapse during maintenance therapy and who were initially tested during the same week as the patients with relapse. A second control group included seven patients with AIDS and histoplasmosis who were evaluated for relapse on 23 occasions; relapse, however, was excluded on each occasion. Measurements: To avoid interassay variability, specimens were tested for H.c. var. capsulatum polysaccharide antigen with the same radioimmunoassay. Main Outcome Measure: The change in the H.c. var. capsulatum polysaccharide antigen level during successful as opposed to unsuccessful maintenance therapy for the prevention of histoplasmosis relapse. Main Results: For the 20 episodes of relapse (17 patients), H.c. var. capsulatum antigen levels increased by at least 2 radioimmunoassay units in 12 of 14 serum specimens tested (85.7%; 95% Cl, 57.2% to 98.2%) and in 17 of 18 urine specimens tested (94.4%; Cl, 72.7% to 99.9%). Antigen levels increased in the urine or serum in 1 of 83 specimens (1.2%; Cl, 0.03% to 6.6%) obtained on 56 occasions (1.8%; Cl, 0.04% to 9.6%) from controls (specificity, 98.2%; Cl, 90.4% to 99.96%). In three cases of relapse, antigen levels increased before clinical relapse was suspected. Complement fixation titers increased by at least 2 dilutions in 4 of 11 cases (36.4%; Cl, 10.9% to 69.2%) but in 0 of 9 control patients (Cl, 0% to 28.3%). Conclusion: An increase in H.c. var. capsulatum polysaccharide antigen levels of 2 units or more strongly suggests histoplasmosis relapse. The presence of increasing titers of anti-H.c. var. capsulatum antibodies by complement fixation is less accurate for the diagnosis of relapse.

Original languageEnglish
Pages (from-to)936-941
Number of pages6
JournalAnnals of Internal Medicine
Volume115
Issue number12
StatePublished - Dec 15 1991

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Histoplasma
Histoplasmosis
Acquired Immunodeficiency Syndrome
Antigens
Recurrence
Polysaccharides
Radioimmunoassay
Urine
Private Hospitals
Secondary Prevention
Serum
Referral and Consultation
Retrospective Studies

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Wheat, L. J., Connolly-Stringfield, P., Blair, R., Connolly, K., Garringer, T., & Katz, B. (1991). Histoplasmosis relapse in patients with AIDS: Detection using Histoplasma capsulatum variety capsulatum antigen levels. Annals of Internal Medicine, 115(12), 936-941.

Histoplasmosis relapse in patients with AIDS : Detection using Histoplasma capsulatum variety capsulatum antigen levels. / Wheat, L. Joseph; Connolly-Stringfield, Patricia; Blair, Robinette; Connolly, Kathleen; Garringer, Todd; Katz, Barry.

In: Annals of Internal Medicine, Vol. 115, No. 12, 15.12.1991, p. 936-941.

Research output: Contribution to journalArticle

Wheat, LJ, Connolly-Stringfield, P, Blair, R, Connolly, K, Garringer, T & Katz, B 1991, 'Histoplasmosis relapse in patients with AIDS: Detection using Histoplasma capsulatum variety capsulatum antigen levels', Annals of Internal Medicine, vol. 115, no. 12, pp. 936-941.
Wheat, L. Joseph ; Connolly-Stringfield, Patricia ; Blair, Robinette ; Connolly, Kathleen ; Garringer, Todd ; Katz, Barry. / Histoplasmosis relapse in patients with AIDS : Detection using Histoplasma capsulatum variety capsulatum antigen levels. In: Annals of Internal Medicine. 1991 ; Vol. 115, No. 12. pp. 936-941.
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abstract = "Objective: To assess the accuracy of Histoplasma capsulatum variety capsulatum polysaccharide antigen testing for the identification of histoplasmosis relapse in patients with the acquired immunodeficiency syndrome (AIDS). Design: A retrospective study using stored specimens. Setting: A referral center and several private hospitals. Patients: Twenty episodes of histoplasmosis relapse were evaluated in 17 patients with AIDS from November 1987 to August 1990. Controls included 30 patients with AIDS and histoplasmosis who did not have a relapse during maintenance therapy and who were initially tested during the same week as the patients with relapse. A second control group included seven patients with AIDS and histoplasmosis who were evaluated for relapse on 23 occasions; relapse, however, was excluded on each occasion. Measurements: To avoid interassay variability, specimens were tested for H.c. var. capsulatum polysaccharide antigen with the same radioimmunoassay. Main Outcome Measure: The change in the H.c. var. capsulatum polysaccharide antigen level during successful as opposed to unsuccessful maintenance therapy for the prevention of histoplasmosis relapse. Main Results: For the 20 episodes of relapse (17 patients), H.c. var. capsulatum antigen levels increased by at least 2 radioimmunoassay units in 12 of 14 serum specimens tested (85.7{\%}; 95{\%} Cl, 57.2{\%} to 98.2{\%}) and in 17 of 18 urine specimens tested (94.4{\%}; Cl, 72.7{\%} to 99.9{\%}). Antigen levels increased in the urine or serum in 1 of 83 specimens (1.2{\%}; Cl, 0.03{\%} to 6.6{\%}) obtained on 56 occasions (1.8{\%}; Cl, 0.04{\%} to 9.6{\%}) from controls (specificity, 98.2{\%}; Cl, 90.4{\%} to 99.96{\%}). In three cases of relapse, antigen levels increased before clinical relapse was suspected. Complement fixation titers increased by at least 2 dilutions in 4 of 11 cases (36.4{\%}; Cl, 10.9{\%} to 69.2{\%}) but in 0 of 9 control patients (Cl, 0{\%} to 28.3{\%}). Conclusion: An increase in H.c. var. capsulatum polysaccharide antigen levels of 2 units or more strongly suggests histoplasmosis relapse. The presence of increasing titers of anti-H.c. var. capsulatum antibodies by complement fixation is less accurate for the diagnosis of relapse.",
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AU - Garringer, Todd

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N2 - Objective: To assess the accuracy of Histoplasma capsulatum variety capsulatum polysaccharide antigen testing for the identification of histoplasmosis relapse in patients with the acquired immunodeficiency syndrome (AIDS). Design: A retrospective study using stored specimens. Setting: A referral center and several private hospitals. Patients: Twenty episodes of histoplasmosis relapse were evaluated in 17 patients with AIDS from November 1987 to August 1990. Controls included 30 patients with AIDS and histoplasmosis who did not have a relapse during maintenance therapy and who were initially tested during the same week as the patients with relapse. A second control group included seven patients with AIDS and histoplasmosis who were evaluated for relapse on 23 occasions; relapse, however, was excluded on each occasion. Measurements: To avoid interassay variability, specimens were tested for H.c. var. capsulatum polysaccharide antigen with the same radioimmunoassay. Main Outcome Measure: The change in the H.c. var. capsulatum polysaccharide antigen level during successful as opposed to unsuccessful maintenance therapy for the prevention of histoplasmosis relapse. Main Results: For the 20 episodes of relapse (17 patients), H.c. var. capsulatum antigen levels increased by at least 2 radioimmunoassay units in 12 of 14 serum specimens tested (85.7%; 95% Cl, 57.2% to 98.2%) and in 17 of 18 urine specimens tested (94.4%; Cl, 72.7% to 99.9%). Antigen levels increased in the urine or serum in 1 of 83 specimens (1.2%; Cl, 0.03% to 6.6%) obtained on 56 occasions (1.8%; Cl, 0.04% to 9.6%) from controls (specificity, 98.2%; Cl, 90.4% to 99.96%). In three cases of relapse, antigen levels increased before clinical relapse was suspected. Complement fixation titers increased by at least 2 dilutions in 4 of 11 cases (36.4%; Cl, 10.9% to 69.2%) but in 0 of 9 control patients (Cl, 0% to 28.3%). Conclusion: An increase in H.c. var. capsulatum polysaccharide antigen levels of 2 units or more strongly suggests histoplasmosis relapse. The presence of increasing titers of anti-H.c. var. capsulatum antibodies by complement fixation is less accurate for the diagnosis of relapse.

AB - Objective: To assess the accuracy of Histoplasma capsulatum variety capsulatum polysaccharide antigen testing for the identification of histoplasmosis relapse in patients with the acquired immunodeficiency syndrome (AIDS). Design: A retrospective study using stored specimens. Setting: A referral center and several private hospitals. Patients: Twenty episodes of histoplasmosis relapse were evaluated in 17 patients with AIDS from November 1987 to August 1990. Controls included 30 patients with AIDS and histoplasmosis who did not have a relapse during maintenance therapy and who were initially tested during the same week as the patients with relapse. A second control group included seven patients with AIDS and histoplasmosis who were evaluated for relapse on 23 occasions; relapse, however, was excluded on each occasion. Measurements: To avoid interassay variability, specimens were tested for H.c. var. capsulatum polysaccharide antigen with the same radioimmunoassay. Main Outcome Measure: The change in the H.c. var. capsulatum polysaccharide antigen level during successful as opposed to unsuccessful maintenance therapy for the prevention of histoplasmosis relapse. Main Results: For the 20 episodes of relapse (17 patients), H.c. var. capsulatum antigen levels increased by at least 2 radioimmunoassay units in 12 of 14 serum specimens tested (85.7%; 95% Cl, 57.2% to 98.2%) and in 17 of 18 urine specimens tested (94.4%; Cl, 72.7% to 99.9%). Antigen levels increased in the urine or serum in 1 of 83 specimens (1.2%; Cl, 0.03% to 6.6%) obtained on 56 occasions (1.8%; Cl, 0.04% to 9.6%) from controls (specificity, 98.2%; Cl, 90.4% to 99.96%). In three cases of relapse, antigen levels increased before clinical relapse was suspected. Complement fixation titers increased by at least 2 dilutions in 4 of 11 cases (36.4%; Cl, 10.9% to 69.2%) but in 0 of 9 control patients (Cl, 0% to 28.3%). Conclusion: An increase in H.c. var. capsulatum polysaccharide antigen levels of 2 units or more strongly suggests histoplasmosis relapse. The presence of increasing titers of anti-H.c. var. capsulatum antibodies by complement fixation is less accurate for the diagnosis of relapse.

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