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Original Research: LUNG INFECTION |

Diagnosis of Histoplasmosis by Antigen Detection in BAL Fluid

Chadi A. Hage, MD, FCCP; Thomas E. Davis, MD; Deanna Fuller, MS; Lindsey Egan, BS; John R. Witt, III, MA; L. Joseph Wheat, MD; Kenneth S. Knox, MD, FCCP
Author and Funding Information

From the Department of Medicine, Roudebush VA Medical Center (Dr Hage), the Department of Pathology and Laboratory Medicine (Dr Davis, Ms Fuller), Indiana University; MiraVista Diagnostics and MiraBella Technologies (Ms Egan, Mr Witt, Dr Wheat), Indianapolis, IN; and the University of Arizona-Southern Arizona VA HealthCare System (Dr Knox), Tucson, AZ.

Correspondence to: Chadi A. Hage, MD, Assistant Professor of Medicine, Pulmonary-Critical Care and Infectious Diseases, Indiana University School of Medicine, Roudebush VA Medical Center, 1481 W 10th St, 111P-IU, Indianapolis, IN 46202; e-mail: chage@iupui.edu


Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestpubs.org/site/misc/reprints.xhtml).


© 2010 American College of Chest Physicians


Chest. 2010;137(3):623-628. doi:10.1378/chest.09-1702
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Background:  Detection of antigen in BAL is useful for diagnosis of histoplasmosis. The MVista Histoplasma antigen enzyme immunoassay has been modified to permit quantification. The purpose of this study is to compare the sensitivity of the quantitative antigen detection assay with cytopathology and culture of BAL specimens.

Methods:  BAL from patients with histoplasmosis who were evaluated at the Indiana University Medical Center and controls without histoplasmosis were studied. BAL fluid was tested in the quantitative Histoplasma antigen assay.

Results:  Antigen was detected in the BAL in 93.5% of patients with histoplasmosis, 80% with blastomycosis, and 0% of controls with nonfungal infections. Antigen was detected in the urine of 79% and serum in 65% of patients with histoplasmosis. Cytopathology was positive in 48% and culture in 48% of patients with histoplasmosis, and 40% and 60% of patients with blastomycosis, respectively. Serology was positive in 65%. Combining BAL antigen detection and BAL cytopathology, both methods for rapid diagnosis, the sensitivity was 96.8% in histoplasmosis and 80% in blastomycosis.

Conclusions:  Detection of antigen in BAL complements antigen detection in serum and urine as an objective diagnostic test for histoplasmosis.

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