scholarly journals 934. Diagnostic Utility of Blood (1- >3)-β-D-Glucan Testing in Patients with HIV in Arkansas

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S500-S500
Author(s):  
Gayathri Krishnan ◽  
Lana Hasan ◽  
Michael Saccente
Keyword(s):  
Respiratory Symptoms ◽  
Histoplasma Capsulatum ◽  
Fungal Infections ◽  
Pneumocystis Jirovecii Pneumonia ◽  
Antigen Assay ◽  
Common Diagnosis ◽  
Sterile Site ◽  
Progressive Disseminated Histoplasmosis ◽  
Reliable Marker ◽  
Respiratory Complaints

Abstract Background Blood (1- > 3)-β-D-Glucan (BDG) is a sensitive marker for Pneumocystis jirovecii pneumonia (PJP) in patients with AIDS (PWA). However, other fungal infections, including progressive disseminated histoplasmosis (PDH), cause high levels of BDG. At our hospital, PDH is a common diagnosis in PWA with fever and respiratory complaints, making it difficult to differentiate PJP from PDH based on clinical features alone. The objective of this study was to assess BDG as a diagnostic test for PJP in Arkansas where histoplasmosis is endemic. Methods We performed a retrospective review of patients with confirmed PJP and confirmed PDH who had BDG testing between 2014-2020. Positive cytological or histological evidence of P. jirovecii in bronchoalveolar lavage (BAL) or lung biopsy, or positive PCR on sputum or BAL confirmed PJP. Identification of Histoplasma capsulatum in culture of blood or other normally sterile site, histology showing typical yeast forms, or a positive urine H. capsulatum antigen assay (MiraVista Diagnostics) confirmed PDH. The Fungitell Assay determined BDG levels as follows: negative, < 60 pg/mL; indeterminate, 60-79 pg/mL, and positive > 80 pg/mL. Values below 31 pg/mL and those above 500 pg/mL were censored at 30 and 500, respectively. Respiratory symptoms were defined as the presence of cough, shortness of breath, or dyspnea on exertion. Results 53 episodes of PDH occurred in 46 patients. 42 were accompanied by a BDG result. Of these, 38 (90%) were positive; 3 (7%) were negative; and 1 (2%) was indeterminate. 44 (83%) of the PDH episodes were associated with respiratory symptoms. 36 of these had a BDG result. 34 (94%) were positive; 1 (3%) was negative; and 1 (3%) was indeterminate. 44 episodes of PJP occurred in 40 patients. All had a BDG result. 43 (98%) were positive.10 (23%) episodes of PJP were accompanied by a concomitant infection. The mean BDG level was significantly higher in the PJP group compared to those with PDH and respiratory symptoms (P=.002). However, values overlapped substantially, and BDG positivity was not significantly more frequent in the PJP group (P=.586). Box-and-Whisker Display of (1->3)-β-D-Glucan Results Conclusion In Arkansas, BDG positivity is not a reliable marker of PJP because it cannot distinguish between PJP and PDH. Attributing an elevated BDG to PJP without additional evaluation risks misdiagnosis. Disclosures All Authors: No reported disclosures

scholarly journals 837. Performance of Blood (1- >3)-β-D-Glucan in People with AIDS Presenting with Respiratory Symptoms

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S510-S511
Author(s):  
Lana Hasan ◽  
Gayathri Krishnan ◽  
Michael Saccente
Keyword(s):  
Bronchoalveolar Lavage ◽  
Diagnostic Test ◽  
Test Performance ◽  
Respiratory Symptoms ◽  
Fungal Infections ◽  
Pneumocystis Jirovecii ◽  
Cape Cod ◽  
Pneumocystis Jirovecii Pneumonia ◽  
Non Invasive ◽  
Progressive Disseminated Histoplasmosis

Abstract Background The gold standard for diagnosis of Pneumocystis jirovecii pneumonia (PCP) is direct visualization of the microorganism in respiratory samples, usually obtained via bronchoalveolar lavage (BAL). Blood β-D-glucan (BDG) is used as a non-invasive adjunctive diagnostic test for PCP, but specificity is only modest, in part because other opportunistic fungal infections cause high BDG. We previously showed BDG-positivity in 94% of people with AIDS (PWA), progressive disseminated histoplasmosis (PDH), and respiratory symptoms in our hospital. In this study, we aim to assess the performance of BDG as a diagnostic test for PCP in PWA who have respiratory symptoms. Methods We retrospectively identified PWA who had a BDG result between 2014 and 2019. AIDS was defined as past or current absolute CD4 count < 200 cells/µL, or a past or current AIDS-defining condition. Positive cytological or histological evidence of P. jirovecii in bronchoalveolar lavage (BAL) fluid or lung biopsy, or positive Pneumocystis PCR on sputum or BAL confirmed PCP. The Fungitell Assay (Associates of Cape Cod, East Falmouth, MA) determined BDG levels as follows: negative, < 60 pg/mL; indeterminate, 60-79 pg/mL, and positive, ≥ 80 pg/mL. Values < 31 pg/mL and those >500 pg/mL were censored at 30 pg/mL and 500 pg/mL, respectively. Respiratory symptoms were defined as cough, dyspnea, chest pain, or hypoxia. We compared BDG results for participants with proven PCP and participants without proven PCP. Results We identified 260 PWA with a BDG result, of whom 183 had at least one respiratory symptom. 84 (45.9%) of these participants had a positive BDG. BDG results among participants with and without PCP are shown in Table 1. Of the 44 participants with a positive BDG who did not have PCP, 29 (65.9%) had PDH. Other diagnoses included cryptococcosis and candidemia. The test performance of BDG for the diagnosis of PCP is shown in Table 2. Exclusion of participants with PDH increased the specificity of BDG for PCP to 86.4%. Table 1. Results of (1->3)-β-D-glucan Testing by Pneumocystis jirovecii Pneumonia Diagnosis Among Participants with AIDS and Respiratory Symptoms Table 2. Test Performance of (1->3)-β-D-glucan for the Diagnosis of Pneumocystis jirovecii Pneumonia* Conclusion At our center where histoplasmosis is endemic, a positive BDG should not be attributed to PCP among PWA with respiratory symptoms because of low specificity and low positive predictive value. However, a negative BDG can exclude PCP in this population. Disclosures All Authors: No reported disclosures

scholarly journals Detection of Histoplasma capsulatum Antigen in Panamanian Patients with Disseminated Histoplasmosis and AIDS

2008 ◽  
Vol 15 (4) ◽  
pp. 681-683 ◽  
Author(s):  
Maria Eugenia Gutierrez ◽  
Alfredo Canton ◽  
Patricia Connolly ◽  
Robert Zarnowski ◽  
L. Joseph Wheat
Keyword(s):  
United States ◽  
Latin American ◽  
Histoplasma Capsulatum ◽  
Severe Disease ◽  
Nuclear Gene ◽  
The United States ◽  
Antigen Detection ◽  
Disseminated Histoplasmosis ◽  
Antigen Assay ◽  
Progressive Disseminated Histoplasmosis

ABSTRACT Histoplasmosis is a common endemic mycosis in the Americas, often causing severe disease in patients with AIDS. Antigen detection has become an important method for rapid diagnosis of histoplasmosis in the United States but not in Central or South America. Isolates from patients in the United States are predominantly found to be class 2 isolates when typed using the nuclear gene YPS3, while isolates from Latin America are predominantly typed as class 5 or class 6. Whether infection with these Latin American genotypes produces positive results in the Histoplasma antigen assay has not been reported. In this study, we have compared the sensitivity of antigen detection for AIDS patients from Panama who had progressive disseminated histoplasmosis to that for those in the United States. Antigenuria was detected in the MVista Histoplasma antigen enzyme immunoassay (EIA) in 95.2% of Panamanian cases versus 100% of U.S. cases. Antigenemia was detected in 94.7% of the Panamanian cases versus 92% of the U.S. cases. Two clinical isolates from Panama were typed using YPS3 and were found to be restriction fragment length polymorphism class 6. We conclude that the MVista Histoplasma antigen EIA is a sensitive method for diagnosis of histoplasmosis in Panama.

scholarly journals 274. Impact of Fungal Serologies in the Management of Veteran Patients with Suspected Endemic Mycoses

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S151-S151
Author(s):  
Eloy E Ordaya ◽  
Dimitri M Drekonja
Keyword(s):  
Respiratory Symptoms ◽  
Histoplasma Capsulatum ◽  
Positive Serology ◽  
Dimorphic Fungi ◽  
Fungal Exposure ◽  
Serologic Testing ◽  
Common Diagnosis ◽  
Va Health Care System ◽  
Endemic Mycoses ◽  
The Impact

Abstract Background Endemic mycoses are caused by the dimorphic fungi Histoplasma capsulatum, Blastomyces dermatitidis, and Coccidiodes species. Histoplasmosis and blastomycosis are endemic in Minnesota, with travel to coccidioidomycosis endemic areas being common. Diagnosis is challenging, in part due to confusion regarding laboratory testing. In our institution, we have observed that fungal serologies are often ordered when such infections are suspected, but results rarely seem to affect management. We reviewed the impact of serologic testing on the management of a Midwest veteran population. Methods Retrospective, observational study of patients with any serologic testing for endemic mycoses performed from January2014 to December 2018 at the Minneapolis VA Health Care System. To focus evaluation on the utility of serologic testing, we excluded patients with fungal antigen testing. Results Of 127 patients tested, 62 (49%) had only serologic testing. Patients were predominantly males (95%) with a median age of 66 years (range 27–93). Nineteen (31%) were tested in the hospital and had a median stay of 8 days (range 1–48). Median Charlson score was 4 (range 0–12). Travel to an endemic area for coccidioidomycosis was frequent (27/62: 44%), with Arizona being the most common destination (20/27: 74%). Median illness duration was 30 days (range 1–720). Respiratory symptoms predominated (43/62: 69%), followed by nonspecific (6/62: 10%), neurologic (5/62: 8%), and musculoskeletal (2/62: 3%) symptoms. Five (8%) were asymptomatic. Abnormal imaging was common, with 27/62 (44%) patients having an abnormal chest radiograph (consolidation 15%, nodules 11%, and interstitial pattern 8%), and 44/62 (71%) having abnormal CT findings (nodules 55%, ground glass opacities 18%, and consolidation 15%). Six patients (10%) had positive serology, but antifungals were started only in one case. Fungal serology results impacted management in 19/43 (44%) patients seen in clinic, but in 0/19 tested as inpatients (P < 0.001). The most common action (16/19: 84%) was to cease diagnostic workup (table). Conclusion Fungal serologies can be useful in patients evaluated in clinic who present with respiratory symptoms, abnormal imaging, and potential fungal exposure. Testing in hospitalized patients appears to offer little benefit. Disclosures All authors: No reported disclosures.

Comparison of Blood (1->3)-β-D-Glucan Levels in AIDS-Related Pneumocystis jirovecii Pneumonia and AIDS-Related Progressive Disseminated Histoplasmosis

2021 ◽  
Author(s):  
Michael Saccente ◽  
Gayathri Krishnan
Keyword(s):  
Retrospective Study ◽  
Respiratory Symptoms ◽  
Pneumocystis Jirovecii ◽  
Pneumocystis Jirovecii Pneumonia ◽  
Disseminated Histoplasmosis ◽  
Progressive Disseminated Histoplasmosis ◽  
Glucan B

Abstract In this retrospective study, (1-&gt;3)-β-D-glucan (B-glucan) was an unreliable marker for AIDS-related Pneumocystis jirovecii pneumonia (PCP) because a high percentage of participants with progressive disseminated histoplasmosis and respiratory symptoms had a positive B-glucan result. Where histoplasmosis is common attributing B-glucan positivity to PCP without further testing risks misdiagnosis.

scholarly journals Achalasia Cardia: A Mimicker of Pulmonary Tuberculosis in a High-Burden Setting

2020 ◽  
Author(s):  
Pratibha Sharma ◽  
Ranganath T. Ganga
Keyword(s):  
South Africa ◽  
Adverse Effects ◽  
Respiratory Symptoms ◽  
Antitubercular Drugs ◽  
Achalasia Cardia ◽  
High Burden ◽  
Antitubercular Treatment ◽  
Common Diagnosis ◽  
National Tuberculosis ◽  
Long Time

AbstractBRICS (Brazil, Russia, India, China, and South Africa) countries account for more than two-thirds of the global tuberculosis burden. Tuberculosis is a common diagnosis in patients presenting with chronic respiratory symptoms in these high-burden countries, which results in other diseases being missed easily. The national tuberculosis elimination program encourages to start antitubercular treatment on a clinical basis even without any confirmatory evidence. This has resulted in missing many nontuberculosis cases and unnecessarily exposing to adverse effects of antitubercular drugs. Here we report one such instance where achalasia cardia was missed for a long time.

scholarly journals Test performance of blood beta-glucan for Pneumocystis jirovecii pneumonia in patients with AIDS and respiratory symptoms

AIDS ◽  
2013 ◽  
Vol 27 (6) ◽  
pp. 967-972 ◽  
Author(s):  
Brian R. Wood ◽  
Lauren Komarow ◽  
Andrew R. Zolopa ◽  
Malcolm A. Finkelman ◽  
William G. Powderly ◽  
...  
Keyword(s):  
Test Performance ◽  
Respiratory Symptoms ◽  
Pneumocystis Jirovecii ◽  
Pneumocystis Jirovecii Pneumonia ◽  
Beta Glucan

scholarly journals Bats, Fever and Adenopathy – What Is the Link?

2013 ◽  
Vol 24 (1) ◽  
pp. 35-37 ◽  
Author(s):  
Joshua J Manolakos ◽  
Mohan Cooray ◽  
Ameen Patel ◽  
Shariq Haider
Keyword(s):  
Costa Rica ◽  
Environmental Exposure ◽  
Salvage Therapy ◽  
Histoplasma Capsulatum ◽  
Treatment Options ◽  
Diagnostic Approach ◽  
Disseminated Histoplasmosis ◽  
Progressive Disseminated Histoplasmosis

A case of travel-related, subacute, progressive disseminated histoplasmosis in a nonimmunocompromised individual is described. The present case highlights the environmental exposure toHistoplasma capsulatumin Costa Rica, the diagnostic approach and treatment options, as well as new alternatives for salvage therapy for histoplasmosis infection.

scholarly journals Coronavirus disease-19 Pandemic-Induced Panic Disorder

2021 ◽  
Vol 9 (T3) ◽  
pp. 237-239
Author(s):  
Muhammad Surya Husada ◽  
Mustafa M. Amin ◽  
Munawir Saragih
Keyword(s):  
Infectious Disease ◽  
Case Report ◽  
Panic Disorder ◽  
Panic Attack ◽  
Respiratory Symptoms ◽  
Panic Attacks ◽  
Psychosocial Burden ◽  
Her Family ◽  
Common Diagnosis ◽  
The Individual

Background: COVID-19 is a newly emerging infectious disease which is found to be caused by SARS-2. COVID-19 pandemic has spread worldwide causing a rapidly increasing number of mental disorders cases, primarily anxiety disorder. Since majority of panic disorder patients are present with great anxiety in response to their physical or respiratory symptoms, support and encouragement from psychiatrist or therapist are fundamental to alleviate the severity of the symptoms. Case Report: We reported a case of COVID-19 induced panic disorder in a woman, 52 years old, batak tribe who started to experience multiple panic attacks since one of her family members was confirmed to be Covid-10 positive. Conclusion: In general, panic disorder is a common diagnosis, but this case appeared to be interesting as it is induced by COVID-19 pandemic. As in this case, the individual who experienced multiple panic attack is not even a COVID-19 patient but has one of her family member affected by the virus. A wide body of evidence has shown that this pandemic massively contributes to worsening of psychosocial burden in nationwide.

Noncandidal Fungal Infections

2018 ◽  
Author(s):  
Brett A Melnikoff ◽  
René P Myers
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Fungal Infections ◽  
Ventricular Assist Devices ◽  
Surgical Patient ◽  
Transplant Recipients ◽  
Biopsy Material ◽  
Ventricular Assist ◽  
The Past ◽  
Progressive Disseminated Histoplasmosis

Fungal infections remain an important cause of morbidity and mortality in surgical settings, with critically ill patients, transplant recipients, and sick neonates all especially vulnerable. Over the past few decades, technological and scientific advancements have improved physicians’ ability to sustain life in critically ill patients; developments in chemotherapeutics and immune-based therapies have yielded increased survival for many cancer patients; organ transplantation has evolved dramatically; and the use of invasive therapies (eg, ventricular assist devices) has increased markedly. With these changes has come an increase in the incidence of serious fungal infections, including the less common but potentially fatal noncandidal infections caused by Aspergillus and the Zygomycetes Mucor and Rhizopus. This review outlines an approach to the workup and management of the nonneutropenic surgical patient with a suspected noncandidal infection (aspergillosis and zygomycosis). Figures show biopsy samples from an elderly man with chronic progressive disseminated histoplasmosis and thick-walled, broad-based budding yeasts typical for Blastomyces dermatitidis on biopsy material. This review contains 2 figures and 47 references Key words: aspergillosis, aspergillosis prophylaxis, blastomycosis, Cryptococcus, histoplasmosis, noncandidal fungal infections  

Amphotericin B Formulation Confusion and Mortality in an HIV-Seropositive Patient

2007 ◽  
Vol 42 (6) ◽  
pp. 532-536 ◽  
Author(s):  
Jeffrey S. Stroup ◽  
Johnny R. Stephens ◽  
Damon L. Baker ◽  
Madhuri Lad
Keyword(s):  
Amphotericin B ◽  
Histoplasma Capsulatum ◽  
Fungal Infections ◽  
Hiv Positive ◽  
Seropositive Patient ◽  
New Agents ◽  
Liposomal Formulations ◽  
Immunodeficiency Virus ◽  
Cryptococcus Spp ◽  
Hiv Seropositive

Amphotericin B (AmB) is commonly used in patients with a human immunodeficiency virus (HIV)-positive diagnosis for the treatment of disseminated fungal infections such as Histoplasma spp. or Cryptococcus spp. Newer liposomal formulations of AmB have been introduced to the market to avoid the toxic effects of the traditional agent. With the introduction of these new agents, there is a risk of confusion between the agents in regards to dosing, which may lead to toxicity. We report the case of an HIV-seropositive patient who inadvertently received five times the dose of AmB deoxycholate for disseminated Histoplasma capsulatum and died.

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