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Short Report: Serum Aspergillus Galactomannan for the Management of Disseminated Histoplasmosis in AIDS

Service des Maladies Infectieuses et Tropicales, Centre d'Infectiologie Necker - Pasteur, Paris, France.
The American journal of tropical medicine and hygiene (Impact Factor: 2.74). 08/2012; 87(2):303-5. DOI: 10.4269/ajtmh.2012.12-0119
Source: PubMed

ABSTRACT Disseminated histoplasmosis is an emerging infection in patients with cellular immune deficiency in non-endemic countries, caused by the migration from endemic regions and the development of travels. Diagnosis can be challenging in this context because rapid diagnostic tools such as Histoplasma antigen detection or appropriate molecular tools are generally unavailable, serology is often negative in immunosuppressed patients, and isolation of the fungus from cultures often takes several weeks. Here, we report the contribution of galactomannan serum detection for the management of an HIV-infected patient with disseminated histoplasmosis.

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    • ". The cross-reactivity of Aspergillus GM assay has been observed in the management of a patient with histoplasmosis and some authors have suggested the Aspergillus GM assay may have utility as an adjunctive test for the diagnosis of histoplasmosis when other non-invasive tests are unavailable [20] [21]. Table 1 enlists reported evidence of cross-reactivity of Platelias Aspergillus GM assay in immunocompromised patients with culture-proven histoplasmosis . "
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    ABSTRACT: The diagnosis of histoplasmosis due to Histoplasma capsulatum var capsulatum is based on a direct examination identifying encapsulated yeast with narrow-based budding. Galactomannan antigenemia facilitates diagnosis, as well as the monitoring of patients receiving treatment. The case of a HIV-positive patient from Congo-Brazzaville with a disseminated form of African histoplasmosis highlighted the positive galactomannan antigen in this disease due to Histoplasma capsulatum var duboisii. Galactomannan antigenemia remained high with a very slow decrease during antifungal therapy and slow regression of clinical lesions. African histoplasmosis is a rare disease that is difficult to diagnose and rarely described in immunocompromised patients, in whom differential diagnosis can be common. This observation underlines the importance of the galactomannan antigen assay in patients who have travelled to endemic areas. As in the case of Histoplasma capsulatum var capsulatum, the positivity of the Aspergillus galactomannan antigen is very useful in the diagnosis and monitoring of African histoplasmosis.
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