Cryptococcal and Histoplasma Antigen Screening among People with Human Immunodeficiency Virus in Ghana and Comparative Analysis of OIDx Histoplasma Lateral Flow Assay and IMMY Histoplasma Enzyme Immunoassay

Bright K. Ocansey*, Benjamin Otoo, Isabella Asamoah, Vincent Ganu, Kofi P. Berko, Oluwakemi Oladele, Emmanuella A. Amankwa, Bismark Opoku-Asare, Martin Agyei, Lawrence George, Fleischer C.N. Kotey, Chris Kosmidis, Peter Puplampu, Japheth A. Opintan, David W. Denning

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Cryptococcal meningitis (CM) and disseminated histoplasmosis (DH) are common in people with human immunodeficiency virus (PWH) and diagnosed by detecting cryptococcal antigen (CrAg) and Histoplasma antigen (HistoAg), respectively. In Ghana, CM and DH are rarely suspected by clinicians due to limited epidemiological data. Methods: This study was conducted among PWH in Ghana who are unwell. Sociodemographic and clinical data were collected by questionnaire. Serum and/or urine were screened for CrAg and HistoAg, using IMMY CrAg lateral flow assay (LFA) and IMMY Histoplasma enzyme immunoassay (EIA) kits, respectively, regardless of symptoms. Samples run with IMMY Histoplasma EIA were simultaneously run with Optimum Imaging Diagnostics (OIDx) Histoplasma LFA. Laboratory investigations were conducted by the research team, and diagnosis incorporating clinical assessment, screening, and confirmatory testing results and treatment decisions were made by the clinical team. Treatment and outcome information on CM and DH patients were evaluated. Results: Overall, 150 participants were recruited. There were 73% (n = 109) females, and the age range was 18-62 years. The prevalence rates of CrAg and HistoAg were 2.7% (4 of 150) and 4.7% (5 of 107), respectively. The OIDx Histoplasma LFA showed a high concordance (98.4%) with the IMMY Histoplasma EIA. All antigen-positive cases by standard tests were diagnosed with CM and DH. Antifungal treatment was given in 5 patients and follow-up revealed 2 deaths and 3 recoveries. Conclusions: Histoplasmosis among PWH may be more common than previously anticipated and may be more frequent than cryptococcosis in Ghana. The performance of the OIDx Histoplasma LFA should be further explored.

Original languageEnglish
Article numberofac277
JournalOpen Forum Infectious Diseases
Volume9
Issue number7
Early online date3 Jun 2022
DOIs
Publication statusPublished - 1 Jul 2022

Keywords

  • antigen tests
  • cryptococcosis
  • Ghana
  • histoplasmosis
  • people with HIV

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