Diagnosis of disseminated histoplasmosis by detection of Histoplasma capsulatum antigen in serum and urine specimens.
Diagnosis of disseminated histoplasmosis by detection of Histoplasma capsulatum antigen in serum and urine specimens.
复制标题
通过检测血清和尿液标本中的荚膜组织胞浆菌抗原来诊断播散性组织胞浆菌病。
DOI：
10.1056/nejm198601093140205
复制
发表时间：
1986
期刊：
影响因子：
--
通讯作者：
R. Tewari
中科院分区：
文献类型：
--
作者：
L. Wheat;R. Kohler;R. Tewari
通过血清学检测是否存在抗体来诊断荚膜组织胞浆菌感染，由于假阳性和假阴性结果的高发生率以及患者具有正常免疫反应的要求而受到限制。我们开发了一种放射免疫测定法，用于检测尿液和血清样本中的荚膜螺杆菌抗原。在 16 名患者发生的 22 次播散性组织胞浆菌病发作中，有 20 次出现抗原尿；在 32 名自限性感染患者中，有 6 名出现抗原尿；在 32 名空洞组织胞浆菌病患者中，有 2 名出现抗原尿；在 8 名由荚膜梭菌引起的结节样疾病患者中，有 4 名出现抗原尿。 41 次样本重新检测中，有 38 次（93%）可重复检测到尿液中的抗原。在 22 次播散性组织胞浆菌病发作中的 11 次血清中也检测到了荚膜梭菌抗原，在抗原尿患者的其他类型组织胞浆菌病发作的 12 次中均未检测到，在 33 名缺乏尿抗原的组织胞浆菌病患者中也未检测到 1 例，在 50 名对照者中也未检测到。开始抗真菌治疗后，抗原血症和抗原尿减少，并且在复发的患者中复发。我们的结论是，这种荚膜螺杆菌抗原的放射免疫测定法代表了一种快速诊断播散性组织胞浆菌病的有用新方法。
The diagnosis of Histoplasma capsulatum infection by serologic testing for the presence of antibodies is limited by a high rate of false positive and false negative results and by the requirement that the patient have a normal immune response. We have developed a radioimmunoassay for the detection of H. capsulatum antigen in urine and serum specimens. Antigenuria was noted in 20 of 22 episodes of disseminated histoplasmosis that occurred in 16 patients, in 6 of 32 patients with self-limited infection, in 2 of 32 patients with cavitary histoplasmosis, and in 4 of 8 patients with a sarcoid-like illness caused by H. capsulatum. The detection of antigen in urine was reproducible in 38 of 41 (93 percent) retests of specimens. H. capsulatum antigen was also detected in the serum during 11 of the 22 episodes of disseminated histoplasmosis, in none of the 12 episodes of other types of histoplasmosis in patients with antigenuria, in 1 of the 33 patients with histoplasmosis who lacked the urinary antigen, and in none of the 50 controls. Antigenemia and antigenuria decreased after initiation of antifungal therapy and recurred in patients who had a relapse. We conclude that this radioimmunoassay for H. capsulatum antigen represents a useful new method for the rapid diagnosis of disseminated histoplasmosis.