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Cerebrospinal fluid Histoplasma antibodies in central nervous system histoplasmosis
Abstract:
We have evaluated the Histoplasma antibody response in the cerebrospinal fluid (CSF) in nine patients with central nervous system histoplasmosis and 98 controls. While the CSF Histoplasma antibody response identified eight of the nine patients, CSF cultures were positive in only two. Of controls with histoplasmosis but without meningitis (13 patients), or without histoplasmosis (85 patients), elevated CSF antibodies were detected by complement fixation in seven, by IgG radioimmunoassay in 17, and by IgM radioimmunoassay in five. Measurement of the CSF Histoplasma antibody response appears useful for identifying meningitis in patients with histoplasmosis, although cross-reactions occur in half of patients with other forms of chronic fungal meningitis. Patients with these other infections can usually be identified by tests for CSF Coccidioides antibodies, or cryptococcal antigens.
Insights
Diagnosing central nervous system histoplasmosis is challenging. Cerebrospinal fluid (CSF) Histoplasma antibody testing is a valuable tool, identifying most patients, though cross-reactions with other fungal meningitis can occur.
Area of Science:
- Medical Mycology
- Infectious Diseases
- Neurology
Background:
- Central nervous system histoplasmosis is a severe fungal infection.
- Diagnosing this condition can be difficult, with low sensitivity of traditional methods like cerebrospinal fluid (CSF) cultures.
- Accurate and timely diagnosis is crucial for effective treatment.
Purpose of the Study:
- To evaluate the utility of measuring Histoplasma antibody response in CSF for diagnosing central nervous system histoplasmosis.
- To compare the diagnostic yield of CSF antibody testing with CSF cultures.
- To assess the specificity of CSF Histoplasma antibody testing by examining cross-reactions in other fungal meningitis cases.
Main Methods:
- Analysis of CSF samples from nine patients with central nervous system histoplasmosis and 98 controls.
- Detection of Histoplasma antibodies in CSF using complement fixation, IgG radioimmunoassay, and IgM radioimmunoassay.
- Comparison of antibody detection rates with CSF culture results.
- Evaluation of CSF samples from control groups, including those with other fungal meningitis.
Main Results:
- CSF Histoplasma antibody response identified 8 out of 9 patients with central nervous system histoplasmosis.
- CSF cultures were positive in only 2 of the 9 patients.
- Elevated CSF antibodies were detected in controls with other fungal meningitis, indicating potential cross-reactions.
- Complement fixation, IgG, and IgM radioimmunoassays showed varying sensitivities and specificities.
Conclusions:
- CSF Histoplasma antibody measurement is a valuable adjunctive test for diagnosing central nervous system histoplasmosis.
- This method offers higher sensitivity than CSF cultures for this specific diagnosis.
- Awareness of cross-reactions in other chronic fungal meningitis is important, and further testing (e.g., for Coccidioides antibodies, cryptococcal antigens) can help differentiate diagnoses.