Histoplasma Urinary Antigen Testing Obviates the Need for Coincident Serum Antigen Testing

Abstract Objectives Serum and urine antigen (SAg, UAg) detection are common tests for Histoplasma capsulatum. UAg detection is more widely used and reportedly has a higher sensitivity. We investigated whether SAg detection contributes meaningfully to the initial evaluation of patients with suspected...

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Bibliographic Details
Published in:American journal of clinical pathology 2018-03, Vol.149 (4), p.362-368
Main Authors: Libert, Diane, Procop, Gary W, Ansari, Mohammad Q
Format: Article
Language:English
Subjects:
Adult
Aged
Antigens
Antigens, Fungal - blood
Antigens, Fungal - urine
Biomarkers - blood
Biomarkers - urine
False Negative Reactions
False Positive Reactions
Female
Histoplasma - immunology
Histoplasma - isolation & purification
Histoplasmosis
Histoplasmosis - blood
Histoplasmosis - diagnosis
Histoplasmosis - urine
Humans
Male
Medical records
Middle Aged
Retrospective Studies
Sensitivity and Specificity
Urine
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Summary:Abstract Objectives Serum and urine antigen (SAg, UAg) detection are common tests for Histoplasma capsulatum. UAg detection is more widely used and reportedly has a higher sensitivity. We investigated whether SAg detection contributes meaningfully to the initial evaluation of patients with suspected histoplasmosis. Methods We reviewed 20,285 UAg and 1,426 SAg tests ordered from 1997 to 2016 and analyzed paired UAg and SAg tests completed on the same patient within 1 week. We determined the positivity rate for each test. Results Of 601 paired specimens, 542 were concurrent negatives and 48 were concurrent positives (98% agreement). Medical records were available for eight of 11 pairs with discrepant results. UAg was falsely positive in six instances, truly positive once, and falsely negative once. Conclusions These findings support using a single antigen detection test, rather than both UAg and SAg, as an initial screen for suspected histoplasmosis. This aligns with the current practice of most physicians.
ISSN:0002-9173
1943-7722
DOI:10.1093/ajcp/aqx169