Disseminated histoplasmosis (DH) is endemic in Latin America and the Caribbean where diagnostic tools are restricted. We carried-out a 1-year prospective cohort study at a referral hospital in São Paulo, Brazil. Participants had > or =18 years old, were hospitalized due to any indication and had CD4+ < 200 cells/µl. A urine commercial monoclonal Histoplasma galactomannan enzyme-linked immunosorbent assay (IMMY, Norman, OK, USA) and ‘in house’ Histoplasma blood nested PCR were performed in all cases. Probable/proven DH cases were defined according to international guidelines. Conventional mycological methods were available in routine conditions to investigate suspected DH cases. Treatment of participants followed the institutional routine. One-hundred six participants were included. Median age (interquartile range [IQR]) was 39.5 years (30.0–47.3) and 80 individuals (75.5%) were males. Median (IQR) CD4 cell count was 26.5 (9.4–89.3) cells/mm3. DH was diagnosed in 8/106 patients (7.5%). Antigen assay and/or PCR were positive in 4.7% (5/106) of patients. The antigen assay and/or PCR identified 37.5% (3/8) of DH cases, which had not been diagnosed with conventional mycological methods, but had clinical manifestations compatible with HD. In conclusion, the use of Histoplasma urine antigen and Histoplasma blood PCR guided by CD4 status contributed to the diagnosis of DH in hospitalized individuals. These assays were complementary to conventional mycologic methods and are urgently needed in our setting. Lay Summary In this prospective cohort study carried-out in a referral center in São Paulo, Brazil, we found a high frequency of AIDS-related disseminated histoplasmosis (8/106, 7.5%). We used urine antigen test and blood PCR assay to improve the diagnosis of this opportunistic disease.

中文翻译：

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联合尿抗原和血液聚合酶链反应诊断晚期 HIV 住院患者播散性组织胞浆菌病

播散性组织胞浆菌病 (DH) 在拉丁美洲和加勒比地区流行，诊断工具受到限制。我们在巴西圣保罗的一家转诊医院开展了一项为期 1 年的前瞻性队列研究。参与者有 > 或 = 18 岁，因任何适应症住院且 CD4+ < 200 个细胞/微升。在所有病例中都进行了尿液商业化单克隆组织胞浆菌半乳甘露聚糖酶联免疫吸附试验（IMMY，Norman，OK，USA）和“内部”组织胞浆菌血巢式 PCR。根据国际指南定义可能/已证实的 DH 病例。常规的真菌学方法可用于调查疑似 DH 病例。参与者的治疗遵循机构常规。包括一百六名参与者。中位年龄（四分位距 [IQR]）为 39 岁。5 岁 (30.0–47.3) 和 80 人 (75.5%) 是男性。中位数 (IQR) CD4 细胞计数为 26.5 (9.4–89.3) 个细胞/mm3。8/106 名患者 (7.5%) 被诊断为 DH。4.7% (5/106) 的患者抗原检测和/或 PCR 呈阳性。抗原测定和/或 PCR 鉴定了 37.5% (3/8) 的 DH 病例，这些病例未被常规真菌学方法诊断，但临床表现与 HD 相符。总之，在 CD4 状态指导下使用组织胞浆菌尿抗原和组织胞浆菌血液 PCR 有助于诊断住院个体的 DH。这些检测是对传统真菌学方法的补充，在我们的环境中是迫切需要的。总结 在巴西圣保罗的转诊中心进行的这项前瞻性队列研究中，我们发现与艾滋病相关的播散性组织胞浆菌病的发生率很高（8/106，7.5%）。我们使用尿抗原检测和血液 PCR 检测来改善这种机会性疾病的诊断。