Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 10 de 10
Filtrar
1.
Arch Pathol Lab Med ; 118(12): 1205-8, 1994 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-7979915

RESUMEN

In this study we examine the sensitivity of Histoplasma capsulatum var capsulatum antigen detection for the diagnosis of histoplasmosis. This was a retrospective review of the sensitivity of antigen detection in patients who were diagnosed as having self-limited, chronic pulmonary, or disseminated histoplasmosis during an outbreak in Indianapolis, Ind. All patients had clinical and laboratory evidence of histoplasmosis, and specimens of urine or serum that were obtained from the patients were tested for H capsulatum var capsulatum antigen. Of the 195 patients who were studied, the following forms of the infection were found: disseminated (n = 108), self-limited (n = 70), chronic pulmonary (n = 14), and asymptomatic (n = 3). Antigen was detected in 92%, 21%, and 39% of the patients with the disseminated, chronic pulmonary, and self-limited forms of histoplasmosis, respectively. Tests for the antigen are most useful in patients with clinical findings of disseminated infection. Antigen detection also may be useful in those patients with more severe pulmonary involvement, especially during the first month of illness when serologic tests for antibodies may be negative.


Asunto(s)
Antígenos Fúngicos/análisis , Brotes de Enfermedades , Histoplasma/aislamiento & purificación , Histoplasmosis/diagnóstico , Infecciones Oportunistas Relacionadas con el SIDA/diagnóstico , Infecciones Oportunistas Relacionadas con el SIDA/epidemiología , Adolescente , Adulto , Anciano , Niño , Preescolar , Femenino , Histoplasmosis/epidemiología , Humanos , Indiana/epidemiología , Lactante , Enfermedades Pulmonares Fúngicas/diagnóstico , Enfermedades Pulmonares Fúngicas/epidemiología , Masculino , Persona de Mediana Edad , Infecciones Oportunistas/diagnóstico , Infecciones Oportunistas/epidemiología , Estudios Retrospectivos , Sensibilidad y Especificidad
2.
Pediatr Infect Dis J ; 13(9): 801-5, 1994 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-7808850

RESUMEN

Progressive disseminated histoplasmosis is often fatal without treatment and requires rapid and accurate laboratory diagnosis. Radioimmunoassay for Histoplasma capsulatum var. capsulatum antigen has been established as a sensitive and accurate diagnostic technique for disseminated histoplasmosis in adults; this study examines the radioimmunoassay in children. The clinical and laboratory records of 26 patients 18 years old or younger in whom H. capsulatum antigen was detected in urine by radioimmunoassay and at least one other positive corroborative standard test were evaluated. Twenty-two (85%) had disseminated disease, and 4 (15%) had self-limited pulmonary disease. Positive corroborative tests included serologic tests in 17 of 22 (77%) patients tested, tissue stains in 5 of 9 (56%) and fungal cultures in 16 of 24 (67%). Patients with disseminated histoplasmosis had a greater degree of antigenuria than those with self-limited infection. In 20 patients with progressive disease treated with amphotericin B, antigen levels declined, and the decrease in antigenuria correlated with clinical improvement. The radioimmunoassay for H. capsulatum antigen in urine is an important test in the diagnosis of disseminated histoplasmosis and is useful for assessing the efficacy of treatment. The presence of urinary antigen is strong evidence for progressive disease that requires treatment.


Asunto(s)
Antígenos Fúngicos/análisis , Histoplasma/inmunología , Histoplasmosis/diagnóstico , Adolescente , Anfotericina B/uso terapéutico , Antígenos Fúngicos/orina , Niño , Preescolar , Pruebas de Fijación del Complemento , Histoplasma/aislamiento & purificación , Histoplasmosis/tratamiento farmacológico , Histoplasmosis/fisiopatología , Histoplasmosis/orina , Humanos , Lactante , Radioinmunoensayo/métodos , Estudios Retrospectivos , Pruebas Serológicas
3.
J Clin Lab Anal ; 8(1): 1-3, 1994.
Artículo en Inglés | MEDLINE | ID: mdl-8164105

RESUMEN

We sought to determine whether measurement of Histoplasma capsulatum var. capsulatum antigen concentration in tissues and blood provided a marker for antifungal effect of itraconazole in a nonlethal murine model of histoplasmosis. Treatment with itraconazole (Sporanox), in cyclodextrin, was evaluated in a pulmonary model of histoplasmosis. Mice infected with 4.0 x 10(7) yeast-phase organisms by endotracheal inoculation were treated with itraconazole, 1.5 mg twice daily by gavage, for 10 consecutive days, beginning on day 4 of infection. All mice were sacrificed on day 15 of infection. Blood, spleen, and lung tissues were removed for culture and quantification of antigen. Numbers of organisms were significantly lower in spleens from the treated group: 20.8 +/- 41.8 vs. 65.8 +/- 39.1 in the control group, P = 0.017. Numbers of organisms in lung were 9.6 +/- 27.3 colony forming units in treated versus 24.2 +/- 36.3 in control animals, P = 0.267. Antigen concentrations in spleen tissue and serum were lower in treated versus control mice: spleen, 1.8 +/- .6 units in treated versus 11.0 +/- 2.3 in controls, P < 0.001; serum, 0.8 +/- 0.2 units in treated versus 2.2 +/- 1.0 units in controls, P < 0.001. Lung antigen concentrations were similar in the two groups, 19.2 +/- 1.4 units in treated compared to 17.9 +/- 3.0 units in control mice, P = 0.142. The cyclodextrin formulation of itraconazole (Sporanox) demonstrated antifungal activity in experimental histoplasmosis. Antigen detection was a useful marker for antifungal effect.


Asunto(s)
Antígenos Fúngicos/metabolismo , Histoplasma/inmunología , Histoplasmosis/tratamiento farmacológico , Histoplasmosis/inmunología , Itraconazol/uso terapéutico , Animales , Antígenos Fúngicos/sangre , Antígenos Fúngicos/inmunología , Biomarcadores , Histoplasmosis/sangre , Pulmón/inmunología , Ratones , Pruebas de Sensibilidad Microbiana , Radioinmunoensayo , Bazo/inmunología
4.
Ann Intern Med ; 118(8): 610-6, 1993 Apr 15.
Artículo en Inglés | MEDLINE | ID: mdl-8383934

RESUMEN

OBJECTIVE: To assess the efficacy and safety of itraconazole in preventing relapse of histoplasmosis after induction therapy with amphotericin B in patients with the acquired immunodeficiency syndrome (AIDS) and disseminated histoplasmosis. DESIGN: A prospective, multicenter, open-label clinical trial, with follow-up for at least 52 weeks. SETTING: Tertiary care hospitals participating in a clinical investigation sponsored by the National Institutes of Allergy and Infectious Diseases (AIDS Clinical Trial Group and Mycoses Study Group). PATIENTS: Forty-two patients with AIDS who had successfully completed induction therapy for disseminated histoplasmosis amphotericin B, at least 15 mg/kg body weight given over 4 to 12 weeks. INTERVENTIONS: Itraconazole, 200 mg given orally twice daily. MAIN OUTCOME MEASURES: Response to therapy, specifically prevention of histoplasmosis relapse, was the main outcome measure. Secondary end points were survival and the effect of therapy on Histoplasma capsulatum variety capsulatum antigen levels in urine and serum. Plasma itraconazole concentrations were measured to document drug absorption and compliance with therapy. RESULTS: The median follow-up was 109 weeks, and median survival was 98 weeks. Two relapses occurred (5%; 95% CI, 0.5% to 16%), one in a patient withdrawn from the study 18 weeks earlier and one in a patient who did not comply with the study therapy. Patients with elevated antigen levels at study entry showed clearance of antigen from urine and serum; urine specimens became negative in 43% of patients (CI, 26% to 59%), and serum specimens became negative in 75% of patients (CI, 56% to 94%). Only one patient discontinued treatment because of itraconazole toxicity (hypokalemia). CONCLUSIONS: Itraconazole, 200 mg twice daily, is safe and effective in preventing relapse of disseminated histoplasmosis in patients with AIDS. Antigen clearance from blood and urine correlates with clinical efficacy.


Asunto(s)
Infecciones Oportunistas Relacionadas con el SIDA/tratamiento farmacológico , Antifúngicos/uso terapéutico , Histoplasmosis/tratamiento farmacológico , Cetoconazol/análogos & derivados , Adolescente , Adulto , Anfotericina B/uso terapéutico , Antifúngicos/efectos adversos , Antifúngicos/sangre , Antígenos Fúngicos/metabolismo , Femenino , Histoplasma/inmunología , Humanos , Itraconazol , Cetoconazol/efectos adversos , Cetoconazol/sangre , Cetoconazol/uso terapéutico , Masculino , Persona de Mediana Edad , Cooperación del Paciente , Estudios Prospectivos , Recurrencia
5.
Am Rev Respir Dis ; 145(6): 1421-4, 1992 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-1596012

RESUMEN

Diagnosis of histoplasmosis in patients with Acquired Immunodeficiency Syndrome (AIDS) may be established by detection of the organism in lung tissue or bronchoalveolar lavage fluid. In this report we have evaluated the utility of Histoplasma capsulatum polysaccharide antigen (HPA) detection in bronchoalveolar lavage fluid for diagnosis of histoplasmosis. HPA was detected in bronchoalveolar lavage fluid of 19 of 27 cases (70.3%). Of 122 controls with a variety of underlying diseases, HPA was detected in none. Eight of the negative specimens from patients with histoplasmosis were retested after fivefold concentration, and HPA was detected in five. Fivefold concentration of 10 control samples had no effect on HPA level. H. capsulatum was seen by methenamine silver or Giemsa stain in 19 of the 27 (70.3%) and isolated by culture in 24 of 27 (88.9%) cases. Twenty-four of 26 (92.3%) cases had positive cultures from extrapulmonary sites as well. HPA was detected in the urine of 25 (92.6%) and the serum of 23 (88.5%) of the 26 cases. We conclude that HPA detection offers a rapid method for identification of pulmonary histoplasmosis in patients with AIDS and could be a helpful addition to the battery of tests performed on bronchoalveolar lavage fluids in areas where histoplasmosis is endemic.


Asunto(s)
Síndrome de Inmunodeficiencia Adquirida/complicaciones , Antígenos Fúngicos/análisis , Líquido del Lavado Bronquioalveolar/inmunología , Histoplasmosis/complicaciones , Enfermedades Pulmonares Fúngicas/complicaciones , Infecciones Oportunistas/complicaciones , Histoplasmosis/diagnóstico , Humanos , Enfermedades Pulmonares Fúngicas/diagnóstico , Infecciones Oportunistas/diagnóstico
6.
Am J Med ; 92(2): 153-60, 1992 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-1543199

RESUMEN

PURPOSE: The purpose of this study was to establish the effect of induction and maintenance treatment with amphotericin B on levels of Histoplasma capsulatum var. capsulatum polysaccharide antigen (HPA) in the urine and blood of patients with acquired immunodeficiency syndrome (AIDS) and disseminated histoplasmosis. PATIENTS AND METHODS: This was a retrospective study of the effect of amphotericin B treatment on levels of HPA in the urine or serum from 70 patients with AIDS and disseminated histoplasmosis. All patients received initial intensive induction treatment with amphotericin B, and a subset continued to receive amphotericin B at less frequent intervals for maintenance therapy to prevent relapse. Treatment regimens varied in intensity and duration and specimens were obtained at irregular intervals. Urine and serum specimens were stored and retested for HPA in the same radioimmunoassay. RESULTS: HPA levels in serum decreased by at least 2 units during induction therapy in all 19 (100%) patients with initial levels of greater than or equal to 2.6 units and reverted to negative in 40.9% of those with initial levels of greater than or equal to 1.0 unit. HPA in urine decreased by at least 2 units in 84.8% and reverted to negative in 17.3% of patients. During induction treatment, HPA cleared more rapidly from serum than from urine. During maintenance treatment, HPA levels in serum decreased by at least 2 units in 100% and became negative in 66.7%. HPA in urine decreased by at least 2 units in 54.5% and reverted to negative in 20.0%. Rates of clearance of HPA from the serum and urine were similar, 0.01 unit/week compared with -0.04 unit/week, respectively, but less than rates during induction treatment. CONCLUSIONS: Successful therapy of histoplasmosis with amphotericin B is associated with reduction of HPA in body fluids. Periodic measurement of HPA levels offers a method for monitoring the response to therapy and for comparing new treatments for histoplasmosis.


Asunto(s)
Síndrome de Inmunodeficiencia Adquirida/complicaciones , Anfotericina B/farmacología , Antígenos Fúngicos/efectos de los fármacos , Histoplasma/inmunología , Histoplasmosis/tratamiento farmacológico , Anfotericina B/uso terapéutico , Antígenos Fúngicos/metabolismo , Histoplasmosis/etiología , Histoplasmosis/inmunología , Humanos , Análisis de los Mínimos Cuadrados , Polisacáridos/metabolismo , Estudios Retrospectivos
7.
Ann Intern Med ; 115(12): 936-41, 1991 Dec 15.
Artículo en Inglés | MEDLINE | ID: mdl-1952490

RESUMEN

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%; CI, 0.03% to 6.6%) obtained on 56 occasions (1.8%; CI, 0.04% to 9.6%) from controls (specificity, 98.2%; CI, 90.4% to 99.96%). In three cases of relapse, antigen levels increased before clinical 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%; CI, 10.9% to 69.2%) but in 0 of 9 control patients (CI, 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.


Asunto(s)
Síndrome de Inmunodeficiencia Adquirida/complicaciones , Antígenos Fúngicos/análisis , Histoplasma/inmunología , Histoplasmosis/diagnóstico , Pruebas de Fijación del Complemento , Congelación , Histoplasmosis/etiología , Humanos , Polisacáridos/análisis , Valor Predictivo de las Pruebas , Recurrencia , Estudios Retrospectivos
8.
J Clin Lab Anal ; 5(2): 121-6, 1991.
Artículo en Inglés | MEDLINE | ID: mdl-2023057

RESUMEN

We sought to determine if Histoplasma capsulatum polysaccharide antigen (HPA) levels correlate with the extent of infection in murine of histoplasmosis. Separate groups of mice were inoculated intratracheally with varying numbers of H. capsulatum yeast cells. After 1 week, HPA levels and fungal burden (quantitative culture of lung and spleen and histopathologic stain of lung) were determined in lung and spleen, and HPA levels in serum. HPA levels, cultures and histopathological stain results of lung and spleen tissue showed a direct correlation with increasing inoculum size. HPA levels in serum also correlated with the size of inoculum. H. capsulatum antigen in lung correlated with silver stain scores of lung tissue, (R = 0.948, P less than 0.001) and with quantitative culture scores of lung, (R = 0.929, P less than 0.001). HPA levels in spleen tissue also correlated with spleen culture scores, (R = 0.724, P less than 0.001). These results indicate that determination of HPA level in serum and tissue may be a useful test in evaluating the severity of diseases as well as efficacy of antifungal therapy in histoplasmosis.


Asunto(s)
Antígenos Fúngicos/análisis , Histoplasma/inmunología , Histoplasmosis/inmunología , Animales , Femenino , Histoplasmosis/diagnóstico , Histoplasmosis/microbiología , Pulmón/inmunología , Pulmón/microbiología , Ratones , Polisacáridos/inmunología
9.
Medicine (Baltimore) ; 69(6): 361-74, 1990 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-2233233

RESUMEN

Histoplasmosis is a serious opportunistic infection in patients with AIDS, often representing the first manifestation of the syndrome. Most infections occurring within the endemic region are caused by exogenous exposure, while those occurring in nonendemic areas may represent endogenous reactivation of latent foci of infection or exogenous exposure to microfoci located within those nonendemic regions. However, prospective investigations are needed to prove the mode of acquisition. The infection usually begins in the lungs even though the chest roentgenogram may be normal. Clinical findings are nonspecific; most patients present with symptoms of fever and weight loss of at least 1 month's duration. When untreated, many cases eventually develop severe clinical manifestations resembling septicemia. Chest roentgenograms, when abnormal, show interstitial or reticulonodular infiltrates. Many cases have been initially misdiagnosed as disseminated mycobacterial infection or Pneumocystis carinii pneumonia. Patients are often concurrently infected with other opportunistic pathogens, supporting the need for a careful search for co-infections. Useful diagnostic tests include serologic tests for anti-H. capsulatum antibodies and HPA, silver stains of tissue sections or body fluids, and cultures using fungal media from blood, bone marrow, bronchoalveolar lavage fluid, and other tissues or body fluids suspected to be infected on clinical grounds. Treatment with amphotericin B is highly effective, reversing the clinical manifestations of infection in at least 80% of cases. However, nearly all patients relapse within 1 year after completing courses of amphotericin B of 35 mg/kg or more, supporting the use of maintenance treatment to prevent recurrence. Relapse rates are lower (9 to 19%) in patients receiving maintenance therapy with amphotericin B given at doses of about 50 mg weekly or biweekly than with ketoconazole (50-60%), but controlled trials comparing different maintenance regimens have not been conducted. Until results of such trials become available, our current approach is to administer an induction phase of 15 mg/kg of amphotericin B given over 4 to 6 weeks, followed by maintenance therapy with 50 to 100 mg of amphotericin B given once or twice weekly, or biweekly. If results of a prospective National Institutes of Allergy and Infectious Disease study of itraconazole maintenance therapy document its effectiveness, alternatives to amphotericin B may be reasonable.


Asunto(s)
Síndrome de Inmunodeficiencia Adquirida/complicaciones , Histoplasmosis/complicaciones , Anfotericina B/uso terapéutico , Diagnóstico Diferencial , Histoplasmosis/diagnóstico , Histoplasmosis/tratamiento farmacológico , Histoplasmosis/patología , Humanos , Neumonía por Pneumocystis/diagnóstico
10.
Am J Med ; 87(4): 396-400, 1989 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-2801730

RESUMEN

PURPOSE: Disseminated histoplasmosis is a serious and often rapidly progressive, opportunistic infection in patients with acquired immunodeficiency syndrome (AIDS), supporting the importance of rapid diagnostic tests. We investigated Histoplasma capsulatum polysaccharide antigen (HPA) detection, a promising new method for rapid diagnosis of histoplasmosis. PATIENTS AND METHODS: Sixty-one cases of disseminated histoplasmosis in patients with AIDS form the basis of this report. Control cases were patients with AIDS who had other opportunistic infections and whose cultures were negative for H. capsulatum. A slightly modified radioimmunoassay procedure was used to measure the levels of HPA in urine and blood specimens. RESULTS: High levels of HPA were detected in the urine of 59 of 61 (96.7%) and the blood of 37 of 47 (78.7%) patients with AIDS complicated by disseminated histoplasmosis. Treatment with amphotericin B reduced levels of HPA in the urine in 19 of 21 (90.5%) and the serum of all 10 patients tested. HPA levels increased in the urine in all eight and in the serum in all five patients with culture-proven relapse. CONCLUSION: In conclusion, HPA detection offers a rapid method for diagnosing disseminated histoplasmosis. Additional experience is required to establish the role of this test in monitoring the effects of treatment and in identifying relapse in patients with AIDS.


Asunto(s)
Síndrome de Inmunodeficiencia Adquirida/complicaciones , Antígenos Fúngicos/análisis , Histoplasma/inmunología , Histoplasmosis/diagnóstico , Infecciones Oportunistas/diagnóstico , Anfotericina B/uso terapéutico , Antígenos Fúngicos/orina , Sangre , Histoplasmosis/complicaciones , Histoplasmosis/tratamiento farmacológico , Humanos , Infecciones Oportunistas/complicaciones , Infecciones Oportunistas/tratamiento farmacológico , Polisacáridos/inmunología , Radioinmunoensayo , Recurrencia
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA