Table 2.
Characteristics of patients’ specimens with results discrepant between culture/diagnosis and the MVD Histoplasma urinary Ag LFA and EIA.
| # | Patient Diagnosis | LFA Result | EIA Result (ng/mL) | Laboratory Diagnosis | Comments |
|---|---|---|---|---|---|
| Discrepant results against fungal negative culture | |||||
| 1 | PCM | + | ALQ (+) | PCM proven by culture | Positive Paracoccidioides serology, HIV negative |
| 2 | PCM | + | 5.7 (+) | PCM proven by culture. | Positive Paracoccidioides serology, HIV negative |
| 3 | Cryptococcosis | + | − | Culture/microscopy in CSF and lymph node. (+) Ag by latex in CSF | Negative fungal serology, 4 CD4 cells/mm3, (−) Histoplasma culture, |
| 4 | Cryptococcosis | − | 0.88 (+) | Cryptococcosis proven by culture/microscopy in lung tissue | Negative fungal serology, (−) Histoplasma culture, |
| 5 | Tuberculosis | − | 2.4 (+) | Tuberculosis proven by positive AFB smear | Negative fungal serology, 186 CD4 cells/mm3, (−) Histoplasma culture |
| 6 | Tuberculosis | − | 1.9 (+) | Tuberculosis proven by culture and/microscopy in BAL | Negative fungal serology, 44 CD4 cells/mm3, (−) Histoplasma culture |
| 7 | Tuberculosis | − | 1.2 (+) | Tuberculosis proven by positive AFB smear | Negative fungal serology, 241 CD4 cells/mm3, (−) Histoplasma culture |
| 8 | Tuberculosis | − | 0.8 (+) | Tuberculosis proven by culture/microscopy in BAL | Negative fungal serology, (−) Histoplasma culture, (−) by four of five Histoplasma Ag assays |
| 9 | Tuberculosis | − | 0.4 (+) | Tuberculosis proven by blood culture | Negative fungal serology, (−) Histoplasma culture, Patient deceased |
| 10 | Tuberculosis | − | BLQ (+) | Tuberculosis proven by culture and/microscopy in sputum and lymph node | Negative fungal serology, (−) Histoplasma culture |
| 11 | Tuberculosis | − | BLQ (+) | Tuberculosis proven by culture and/microscopy in sputum | Negative fungal serology, 242 CD4 cells/mm3, (−) Histoplasma culture |
| 12 | PjP | − | 0.7 (+) | PjP proven by special staining | Negative fungal serology, 15 CD4 cells/mm3, (−) Histoplasma culture |
| 13 | PjP | − | BLQ (+) | PjP proven by special staining | Negative fungal serology, (−) Histoplasma culture, |
| 14 | Toxoplasmosis | − | BLQ (+) | Toxoplasma proven by serology | Negative fungal serology, (−) Histoplasma culture, patient on TB treatment |
| 15 | Non-HIV | − | 1.5 (+) | Asymptomatic; resident of region endemic for histoplasmosis | Negative fungal serology |
| 16 | Non-HIV | − | 0.4 (+) | Asymptomatic; resident of region endemic for histoplasmosis | Negative fungal serology |
| 17 | Non-HIV | − | 0.3 (+) | Asymptomatic; resident of region endemic for histoplasmosis | Negative fungal serology |
| 18 | Non-HIV | − | 0.3 (+) | Asymptomatic; resident of region endemic for histoplasmosis | Negative fungal serology |
| False negative | |||||
| 19 | DH | − | − | DH proven by culture | (+) Histoplasma culture in peritoneum, negative fungal serology, 570 CD4 cells/mm3, HIV viral load < 40 copies, |
(+) positive result; (−) negative result; (#) number; (Ag) antigen; (AFB) acid-fast bacillus; (CSF) cerebrospinal fluid; (BAL) bronchoalveolar lavage; (DH) disseminated histoplasmosis; (PCM) paracoccidioidomycosis; (PjP) Pneumocystis pneumonia. All infectious diseases were co-infections with HIV in these patient cohorts. MVD EIA result interpretation: (BLQ) below limit of quantification; (ALQ) above limit of quantification.