Ganho de experiência em ensaios laboratoriais de detecção de antígeno urinário no reconhecimento de Histoplasma capsulatum: retrato de uma unidade de referência em Goiás

Abstract

INTRODUCTION: Histoplasmosis is a fungal disease, endemic on the American continent. This condition is associated with high mortality, mainly affecting people living with HIV/AIDS (PLHA). In Brazil, the investigation of Histoplasmosis begins late, as it is a neglected disease and still has the limitations of diagnostic laboratory tests. OBJECTIVE: To compare laboratory tests performed by classical methods and with antigen detection in the recognition of Histoplasmosis in PLWHA admitted to the State Hospital for Tropical Diseases Dr. Anuar Auad (HDT), Goiânia, Goiás. METHODOLOGY: This was a retrospective cohort study (2017-2021) involving a population sample of 197 patients living with HIV/AIDS diagnosed with Histoplasmosis in an Infectious Diseases reference center in the city of Goiânia, Goiás. All patients were previously selected by specialist doctors when passing through the outpatient clinics and wards, infections are confirmed through consultation of medical records and laboratory diagnostic tests. Univariate and multivariate analysis was performed using the BioEstat® and SPSS® (Statistical Package for the Social Sciences) programs to calculate the Odds Ratio, with a 95% Confidence Interval and significance level considering p ≤ 0.05. RESULTS AND DISCUSSION: The average CD4+ lymphocyte count and viral load of PLWHA at the time of diagnosis of Histoplasmosis were, respectively, 51.7 cells/mm³ and 1,210,539.4 copies/ml. The fungus test in peripheral blood showed low sensitivity (17.80%). Blood culture represented the test with the highest sensitivity (89.18%), but with an average time to result of 25.70 days. Antigen detection showed sensitivity and specificity of 86.36% and 54.28% respectively for antigenuria and 61.53% and 45% for antigenemia. Serology presented low sensitivity data (51.25%) in our sample, even with high specificity, 86.67%. Patients diagnosed with HIV and Histoplasmosis concomitantly at the onset of advanced AIDS had a higher risk of death OR=5.9844, 95% CI (3.2500-11.0174), p=<0.0001 than patients who were known to be HIV and had Histoplasmosis as an opportunistic disease in subsequent hospitalizations. CONCLUSION: It is concluded that antigenuria, as it is fast and has high sensitivity, is the method of choice to confirm an early diagnosis of Histoplasmosis, impacting the reduction of Public Health spending and reducing morbidity and mortality.