Journal of Fungi (Jul 2023)

Prevalence of <i>Histoplasma</i> Antigenuria among Outpatient Cohort with Advanced HIV in Kampala, Uganda

  • 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

DOI
https://doi.org/10.3390/jof9070757
Journal volume & issue
Vol. 9, no. 7
p. 757

Abstract

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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 Histoplasma antigenuria using an enzyme immunoassay (EIA, clarus Histoplasma GM EIA, IMMY; Norman, OK, USA) in a cohort of outpatients with advanced HIV disease in Kampala, Uganda. Among the persons with positive urine Histoplasma 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 Histoplasma antigen. The histoplasmosis prevalence among participants with a CD4 Histoplasma 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.

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