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Communication

Prevalence of Histoplasma Antigenuria among Outpatient Cohort with Advanced HIV in Kampala, Uganda

by
Preethiya Sekar
1,†,
Elizabeth Nalintya
1,†,
Richard Kwizera
1,
Claudine Mukashyaka
1,
Godfrey Niyonzima
1,
Loryndah Olive Namakula
1,
Patricia Nerima
1,
Ann Fieberg
2,
Biyue Dai
2,
Jayne Ellis
3,
David R. Boulware
2,
David B. Meya
1,
Nathan C. Bahr
4 and
Radha Rajasingham
2,*
1
Infectious Diseases Institute, Makerere University, Kampala P.O. Box 22418, Uganda
2
Division of Infectious Diseases and International Medicine, Department of Medicine, University of Minnesota, Minneapolis, MN 55455, USA
3
Clinical Research Department, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
4
Division of Infectious Diseases, University of Kansas, Kansas City, KS 66160, USA
*
Author to whom correspondence should be addressed.
†
These authors contributed equally to this work.
J. Fungi 2023, 9(7), 757; https://doi.org/10.3390/jof9070757
Submission received: 25 May 2023 / Revised: 12 July 2023 / Accepted: 13 July 2023 / Published: 18 July 2023
(This article belongs to the Special Issue Histoplasma and Histoplasmosis 2023)
Review Reports Versions Notes

Abstract

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 < 100 cells/mcL was 2.5% (4/158). Three of the four participants with a positive 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.
Keywords: histoplasmosis; prevalence; opportunistic infection; advanced HIV disease histoplasmosis; prevalence; opportunistic infection; advanced HIV disease

Share and Cite

MDPI and ACS Style

Sekar, P.; Nalintya, E.; Kwizera, R.; Mukashyaka, C.; Niyonzima, G.; Namakula, L.O.; Nerima, P.; Fieberg, A.; Dai, B.; Ellis, J.; et al. Prevalence of Histoplasma Antigenuria among Outpatient Cohort with Advanced HIV in Kampala, Uganda. J. Fungi 2023, 9, 757. https://doi.org/10.3390/jof9070757

AMA Style

Sekar P, Nalintya E, Kwizera R, Mukashyaka C, Niyonzima G, Namakula LO, Nerima P, Fieberg A, Dai B, Ellis J, et al. Prevalence of Histoplasma Antigenuria among Outpatient Cohort with Advanced HIV in Kampala, Uganda. Journal of Fungi. 2023; 9(7):757. https://doi.org/10.3390/jof9070757

Chicago/Turabian Style

Sekar, Preethiya, Elizabeth Nalintya, Richard Kwizera, Claudine Mukashyaka, Godfrey Niyonzima, Loryndah Olive Namakula, Patricia Nerima, Ann Fieberg, Biyue Dai, Jayne Ellis, and et al. 2023. "Prevalence of Histoplasma Antigenuria among Outpatient Cohort with Advanced HIV in Kampala, Uganda" Journal of Fungi 9, no. 7: 757. https://doi.org/10.3390/jof9070757

APA Style

Sekar, P., Nalintya, E., Kwizera, R., Mukashyaka, C., Niyonzima, G., Namakula, L. O., Nerima, P., Fieberg, A., Dai, B., Ellis, J., Boulware, D. R., Meya, D. B., Bahr, N. C., & Rajasingham, R. (2023). Prevalence of Histoplasma Antigenuria among Outpatient Cohort with Advanced HIV in Kampala, Uganda. Journal of Fungi, 9(7), 757. https://doi.org/10.3390/jof9070757

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