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Laboratory diagnosis of histoplasmosis: update 2000
1Division of Infectious Diseases, Indiana University School of Medicine, Richard L. Roudebush Department of Veterans' Affairs Hospital, Histoplasmosis Reference Laboratory, Indianapolis, IN 46202-28790, USA. lwheat@iupui.edu
Abstract:
Histoplasmosis is a common infection in endemic regions of North and Latin America, causing a broad spectrum of clinical findings. Although acute pulmonary infection, chronic pulmonary, and progressive disseminated histoplasmosis are the most commonly recognized clinical manifestations, pericarditis, rheumatologic syndromes, esophageal compression, and sarcoid-like manifestations are well-recognized complications of histoplasmosis. Although excellent laboratory methods for diagnosis are available, diagnosis in many cases is missed or delayed because histoplasmosis is not considered in the differential. Physicians must be aware of the clinical syndromes and take advantage of epidemiologic clues. Furthermore, clinicians must be familiar with the uses and limitations of a battery of serologic and mycologic tests. Cultures, fungal stains, antigen detection, and serologic tests for antibodies are useful for diagnosis of histoplasmosis. All are reasonably specific and can serve as the basis for diagnosis in patients with compatible clinical findings. Each has certain limitations that must be recognized if they are to be used correctly. The approach to diagnosis of histoplasmosis will be reviewed.
Insights
Histoplasmosis, a common fungal infection in the Americas, presents diverse clinical issues. Early consideration of histoplasmosis and understanding diagnostic tests are crucial for timely and accurate diagnosis.
Area of Science:
- Mycology
- Infectious Diseases
- Clinical Medicine
Background:
- Histoplasmosis is a prevalent fungal infection in North and Latin America.
- It manifests with a wide range of clinical presentations, including pulmonary and disseminated forms.
- Recognized complications include pericarditis, rheumatologic syndromes, and sarcoid-like reactions.
Purpose of the Study:
- To review the clinical syndromes associated with histoplasmosis.
- To emphasize the importance of considering histoplasmosis in differential diagnoses.
- To discuss the utility and limitations of diagnostic tests for histoplasmosis.
Main Methods:
- Review of clinical manifestations and complications of histoplasmosis.
- Evaluation of diagnostic approaches, including serologic and mycologic tests.
- Discussion of epidemiological clues and clinical syndromes.
Main Results:
- Diagnosis is often delayed because histoplasmosis is overlooked.
- Available laboratory methods, including cultures, antigen detection, and serology, are useful but have limitations.
- Awareness of clinical syndromes and diagnostic test performance is key.
Conclusions:
- Physicians need to consider histoplasmosis in endemic areas.
- Familiarity with diagnostic test characteristics is essential for correct interpretation.
- A systematic approach integrating clinical suspicion and laboratory findings improves diagnosis.