Urine antigen detection of blastomycosis in pediatric patients

Section of Pediatric Infectious Diseases, Department of Pediatrics, University of Chicago, Chicago, IL 61637, USA.
The Pediatric Infectious Disease Journal (Impact Factor: 2.72). 12/2006; 25(11):1076-8. DOI: 10.1097/01.inf.0000241144.89426.2a
Source: PubMed


Blastomycosis is an uncommonly recognized disease in pediatric patients. We describe 4 cases of pediatric blastomycosis that presented to our children's hospital, 2 with isolated pulmonary blastomycosis and 2 with disseminated blastomycosis. Because of variable clinical presentations and morbidity if treatment is delayed, physicians must maintain a high index of suspicion and obtain appropriate diagnostic tests promptly. For the first time, we report the effect of therapy on Blastomyces antigen clearance. In our experience, the urine antigen detection for B. dermatitidis is useful for diagnosis and follow up during therapy.

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    • "The urine antigen test for blastomycosis has high sensitivity (92%) for the detection of the blastomycosis and excellent specificity (>98%) in patients without fungal infections, but is highly cross-reactive in those with histoplasmosis, paracoccidioidomycosis, and Penicilliosis marneffei [6]. Urine antigen detection of blastomycosis has recently been shown to be useful for followup during therapy of blastomycosis in pediatric patients, including the present adolescent patient prior to the pregnancy [7]. The effect of pregnancy on urine antigen for diagnosis of blastomycosis is not known, but our case illustrates that levels of antigen in the urine will persist if antifungal therapy is stopped or not taken consistently. "
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    ABSTRACT: Although disseminated blastomycosis is a rare complication in pregnancy, delay in diagnosis and treatment can be fatal. We investigate the use of the Blastomyces urine antigen in diagnosis following disease progression in the intrapartum, postpartum, and neonatal periods. We describe a case of disseminated blastomycosis in a pregnant adolescent and review the pertinent literature regarding treatment and monitoring blastomycosis in pregnancy and the neonatal periods. This is the first reported case in which the Blastomyces urine antigen is utilized as a method of following disease activity during pregnancy confirming absence of clinically evident disease in a neonate. Urine antigen detection for blastomycosis can be useful for following progression of disease in patients with disseminated blastomycosis in both the intrapartum and postpartum periods.
    Infectious Diseases in Obstetrics and Gynecology 02/2007; 2007(2):89059. DOI:10.1155/2007/89059
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    ABSTRACT: Background: Early diagnosis and treatment are associated with an improved prognosis in blastomycosis. The diagnosis of blastomycosis may be missed by cytology, histopathology, culture, or serology. An enzyme immunoassay (EIA) for detection of Blastomyces dermatitidis galactomannan antigen in body fluids has been used for rapid diagnosis of blastomycosis in humans. Hypothesis: Measurement of Blastomyces antigen in urine or serum by the MVista Blastomyces antigen EIA is more sensitive than measurement of anti-Blastomyces antibodies for diagnosis of blastomycosis in dogs. Methods: Serum and urine samples from 46 dogs with confirmed blastomycosis were tested for Blastomyces antigen and serum was tested for anti-Blastomyces antibodies. Results: The sensitivity for the detection of antigen in urine was 93.5% and it was 87.0% in serum. The sensitivity of antibody detection by agar gel immunodiffusion (AGID) was 17.4% and it was 76.1% by EIA. Antigen and antibody decreased during itraconazole treatment. Conclusions and Clinical Importance: Antigen detection is a more sensitive test for diagnosis of blastomycosis than antibody testing by AGID, the only commercially available method. Antigen concentrations decreased with treatment.
  • Current Fungal Infection Reports 12/2008; 2(4):189-193. DOI:10.1007/s12281-008-0027-x
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