Abstract
Histoplasmosis is an emerging fungal disease, with global distribution. The disseminated form of the disease is a more severe infection, generally associated with AIDS. Classic diagnostic methods for histoplasmosis consist of microscopy, culture, and histopathology. More recently, the importance of Histoplasma antigen detection has dominated the literature on histoplasmosis diagnosis, but the relevance of molecular assays has not been as much studied. Here we describe the results of a systematic literature review focusing on studies that mainly compared immunological techniques (Histoplasma urine antigen detection) with molecular tests for the diagnosis of histoplasmosis. In addition to the review of comparative studies using such diagnostic techniques, the literature on polymerase chain reaction (PCR) tests in patients with disseminated histoplasmosis is also summarized. Two studies reported the comparison between immunological and molecular methods applied simultaneously for the diagnosis of disseminated histoplasmosis. PCR demonstrates a satisfactory performance assisting in the detection of Histoplasma spp. DNA in clinical samples.
Highlights
Histoplasmosis is a global emerging fungal disease, with most cases reported in the American continent
We summarize below the the use of molecular tests with Histoplasma antigen detection, in patients with Disseminated histoplasmosis (DH)
We summarize evidence regarding the use of molecular tests for the diagnosis of histoplasmosis
Summary
Histoplasmosis is a global emerging fungal disease, with most cases reported in the American continent. The disease is the most common cause for hospitalization and death among the endemic mycoses in the U.S [1,2]. In Brazil, 3530 patients were diagnosed with histoplasmosis between the years 1939 and 2018, which is likely to be underestimated. Histoplasmosis is endemic in all Brazilian regions, in the Northeast, Central-West, Southeast, and South [3]. Disseminated histoplasmosis (DH)–the more severe and common form of the disease–generally occurs in AIDS patients, in addition to immunocompromised person on treatment with steroids, presenting with severe neutropenia as a result of cancer chemotherapy, as well as recipients of hematopoietic stem cell and solid organ transplantation [2,3]
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