Prevalence of <i>Histoplasma</i> Antigenuria among Outpatient Cohort with Advanced HIV in Kampala, Uganda
In sub-Saharan Africa, an estimated 25% of people with HIV present with advanced HIV and are at high risk of opportunistic infections. Whereas histoplasmosis has occasionally been seen in Uganda, the understanding of the local risk of acute infection is limited. We sought to determine the prevalence...
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MDPI AG
2023-07-01
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| Series: | Journal of Fungi |
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| Online Access: | https://www.mdpi.com/2309-608X/9/7/757 |
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| author | Preethiya Sekar Elizabeth Nalintya Richard Kwizera Claudine Mukashyaka Godfrey Niyonzima Loryndah Olive Namakula Patricia Nerima Ann Fieberg Biyue Dai Jayne Ellis David R. Boulware David B. Meya Nathan C. Bahr Radha Rajasingham |
| author_facet | Preethiya Sekar Elizabeth Nalintya Richard Kwizera Claudine Mukashyaka Godfrey Niyonzima Loryndah Olive Namakula Patricia Nerima Ann Fieberg Biyue Dai Jayne Ellis David R. Boulware David B. Meya Nathan C. Bahr Radha Rajasingham |
| author_sort | Preethiya Sekar |
| collection | DOAJ |
| description | In sub-Saharan Africa, an estimated 25% of people with HIV present with advanced HIV and are at high risk of opportunistic infections. Whereas histoplasmosis has occasionally been seen in Uganda, the understanding of the local risk of acute infection is limited. We sought to determine the prevalence of <i>Histoplasma</i> antigenuria using an enzyme immunoassay (EIA, clarus <i>Histoplasma</i> GM EIA, IMMY; Norman, OK, USA) in a cohort of outpatients with advanced HIV disease in Kampala, Uganda. Among the persons with positive urine <i>Histoplasma</i> antigen tests, we assessed their clinical presentation and outcomes. The EIA was run on stored urine samples as per the manufacturer’s instructions. Specimens ≥1 EIA units were considered positive. Among the 388 tested urine samples, 4 (1.2%) were positive for <i>Histoplasma</i> antigen. The histoplasmosis prevalence among participants with a CD4 < 100 cells/mcL was 2.5% (4/158). Three of the four participants with a positive <i>Histoplasma</i> antigen test reported systemic symptoms consistent with histoplasmosis. All four participants had a positive urine lipoarabinomannan test and were treated for tuberculosis. By the four-week follow-up visit, all participants were clinically improved, alive, and in care without antifungal therapy. In advanced HIV, the clinical presentations of tuberculosis and histoplasmosis overlap. The value of histoplasmosis screening and pre-emptive treatment is an area of future research. |
| first_indexed | 2024-03-11T00:55:34Z |
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| issn | 2309-608X |
| language | English |
| last_indexed | 2024-03-11T00:55:34Z |
| publishDate | 2023-07-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Fungi |
| spelling | doaj.art-4419e79500574044aaa41b0bb1f60c3c2023-11-18T20:02:00ZengMDPI AGJournal of Fungi2309-608X2023-07-019775710.3390/jof9070757Prevalence of <i>Histoplasma</i> Antigenuria among Outpatient Cohort with Advanced HIV in Kampala, UgandaPreethiya Sekar0Elizabeth Nalintya1Richard Kwizera2Claudine Mukashyaka3Godfrey Niyonzima4Loryndah Olive Namakula5Patricia Nerima6Ann Fieberg7Biyue Dai8Jayne Ellis9David R. Boulware10David B. Meya11Nathan C. Bahr12Radha Rajasingham13Infectious Diseases Institute, Makerere University, Kampala P.O. Box 22418, UgandaInfectious Diseases Institute, Makerere University, Kampala P.O. Box 22418, UgandaInfectious Diseases Institute, Makerere University, Kampala P.O. Box 22418, UgandaInfectious Diseases Institute, Makerere University, Kampala P.O. Box 22418, UgandaInfectious Diseases Institute, Makerere University, Kampala P.O. Box 22418, UgandaInfectious Diseases Institute, Makerere University, Kampala P.O. Box 22418, UgandaInfectious Diseases Institute, Makerere University, Kampala P.O. Box 22418, UgandaDivision of Infectious Diseases and International Medicine, Department of Medicine, University of Minnesota, Minneapolis, MN 55455, USADivision of Infectious Diseases and International Medicine, Department of Medicine, University of Minnesota, Minneapolis, MN 55455, USAClinical Research Department, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UKDivision of Infectious Diseases and International Medicine, Department of Medicine, University of Minnesota, Minneapolis, MN 55455, USAInfectious Diseases Institute, Makerere University, Kampala P.O. Box 22418, UgandaDivision of Infectious Diseases, University of Kansas, Kansas City, KS 66160, USADivision of Infectious Diseases and International Medicine, Department of Medicine, University of Minnesota, Minneapolis, MN 55455, USAIn sub-Saharan Africa, an estimated 25% of people with HIV present with advanced HIV and are at high risk of opportunistic infections. Whereas histoplasmosis has occasionally been seen in Uganda, the understanding of the local risk of acute infection is limited. We sought to determine the prevalence of <i>Histoplasma</i> antigenuria using an enzyme immunoassay (EIA, clarus <i>Histoplasma</i> GM EIA, IMMY; Norman, OK, USA) in a cohort of outpatients with advanced HIV disease in Kampala, Uganda. Among the persons with positive urine <i>Histoplasma</i> antigen tests, we assessed their clinical presentation and outcomes. The EIA was run on stored urine samples as per the manufacturer’s instructions. Specimens ≥1 EIA units were considered positive. Among the 388 tested urine samples, 4 (1.2%) were positive for <i>Histoplasma</i> antigen. The histoplasmosis prevalence among participants with a CD4 < 100 cells/mcL was 2.5% (4/158). Three of the four participants with a positive <i>Histoplasma</i> antigen test reported systemic symptoms consistent with histoplasmosis. All four participants had a positive urine lipoarabinomannan test and were treated for tuberculosis. By the four-week follow-up visit, all participants were clinically improved, alive, and in care without antifungal therapy. In advanced HIV, the clinical presentations of tuberculosis and histoplasmosis overlap. The value of histoplasmosis screening and pre-emptive treatment is an area of future research.https://www.mdpi.com/2309-608X/9/7/757histoplasmosisprevalenceopportunistic infectionadvanced HIV disease |
| spellingShingle | Preethiya Sekar Elizabeth Nalintya Richard Kwizera Claudine Mukashyaka Godfrey Niyonzima Loryndah Olive Namakula Patricia Nerima Ann Fieberg Biyue Dai Jayne Ellis David R. Boulware David B. Meya Nathan C. Bahr Radha Rajasingham Prevalence of <i>Histoplasma</i> Antigenuria among Outpatient Cohort with Advanced HIV in Kampala, Uganda Journal of Fungi histoplasmosis prevalence opportunistic infection advanced HIV disease |
| title | Prevalence of <i>Histoplasma</i> Antigenuria among Outpatient Cohort with Advanced HIV in Kampala, Uganda |
| title_full | Prevalence of <i>Histoplasma</i> Antigenuria among Outpatient Cohort with Advanced HIV in Kampala, Uganda |
| title_fullStr | Prevalence of <i>Histoplasma</i> Antigenuria among Outpatient Cohort with Advanced HIV in Kampala, Uganda |
| title_full_unstemmed | Prevalence of <i>Histoplasma</i> Antigenuria among Outpatient Cohort with Advanced HIV in Kampala, Uganda |
| title_short | Prevalence of <i>Histoplasma</i> Antigenuria among Outpatient Cohort with Advanced HIV in Kampala, Uganda |
| title_sort | prevalence of i histoplasma i antigenuria among outpatient cohort with advanced hiv in kampala uganda |
| topic | histoplasmosis prevalence opportunistic infection advanced HIV disease |
| url | https://www.mdpi.com/2309-608X/9/7/757 |
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