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. 2023 Sep 20;17(9):e0011575.
doi: 10.1371/journal.pntd.0011575. eCollection 2023 Sep.

The seroprevalence of anti-Histoplasma capsulatum IgG antibody among pulmonary tuberculosis patients in seven referral tuberculosis hospitals in Indonesia

Tutik Kusmiati  1 , Erlina Burhan  2 , Retna Indah Sugiyono  3 , Dona Arlinda  3 , Adhella Menur Naysilla  3 , Banteng Hanang Wibisono  4 , Riat El Khair  5 , Ni Wayan Candrawati  6 , Bintang Yinke Magdalena Sinaga  7 , Irawaty Djaharrudin  8 , Dewi Lokida  9 , Herman Kosasih  3 , Nugroho Harry Susanto  3 , Deni Pepy Butar Butar  3 , Robiatul Adawiyah  10 , Ayu Eka Fatril  10 , Muhammad Karyana  3 , David W Denning  11 , Retno Wahyuningsih  10   12
Affiliations

The seroprevalence of anti-Histoplasma capsulatum IgG antibody among pulmonary tuberculosis patients in seven referral tuberculosis hospitals in Indonesia

Tutik Kusmiati et al. PLoS Negl Trop Dis. .

Abstract

Background: Histoplasma capsulatum exposure is rarely suspected in Indonesia. Pulmonary histoplasmosis can occur simultaneously with pulmonary tuberculosis (TB) or as an alternative diagnosis in clinically-diagnosed TB patients with no microbiological evidence of TB. This study aimed to determine the seroprevalence of anti-H. capsulatum IgG antibody among pulmonary TB patients.

Methodology: This was a sub-study of 306 participants from a prospective cohort pulmonary TB study conducted at seven TB referral hospitals in Indonesia. The study population was presumptive pulmonary TB adult patients who underwent microbiological TB examinations and were categorized as drug-sensitive (DS), drug-resistant (DR), and clinically-diagnosed TB. Anti-H. capsulatum IgG antibody levels at baseline were measured using MVista Histoplasma Ab enzyme immunoassays. Data were summarized using descriptive statistics. Bivariate and multivariate logistic regression analysis were performed to assess factors associated with anti-H. capsulatum IgG antibody positive result.

Results: 12.7% (39/306) of pulmonary TB patients were positive for anti-H. capsulatum IgG antibodies (DR-TB patients (15.9%, 18/114), DS-TB (13.0%, 15/115), and clinically-diagnosed TB (7.8%, 6/77)). The median unit value of anti-H. capsulatum IgG antibody for all positive samples was 15.7 (IQR 10.2-28.9) EU. This median unit value was higher in clinically-diagnosed TB patients compared to DS-TB or DR-TB patients (38.1 (IQR 25.6-46.6) EU, 19.7 (IQR 12.3-28.9) EU, and 10.9 (IQR 9.2-15.4), respectively). There were 10 patients (3.3%) with anti-H. capsulatum IgG antibody levels above 30 EU. Factors associated with the anti-H. capsulatum IgG antibody positive result were malignancies (OR 4.88, 95% CI 1.09-21.69, p = 0.037) and cavitary lesions (OR 2.27, 95% CI 1.09-4.70, p = 0.028).

Conclusions: Our results provide evidence of exposure to H. capsulatum among pulmonary TB patients in Indonesia. Further studies are needed to provide a comprehensive picture of this fungal disease in other populations and regions to enhance awareness among clinicians and public health officials.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. The distribution of anti-H. capsulatum IgG antibody-positive serum specimens from pulmonary TB patients at seven TB referral hospitals in Indonesia.
The original map was obtained from an openly available source https://www.naturalearthdata.com/. The figure was developed with QGIS 3.32.1 and https://biorender.com/.
Fig 2
Fig 2. Anti-H. capsulatum IgG antibody results among DS-TB, DR-TB, and clinically-diagnosed pulmonary TB patients.
See this image and copyright information in PMC

References

    1. Diaz JH. Environmental and Wilderness-Related Risk Factors for Histoplasmosis: More Than Bats in Caves. Wilderness Environ Med. 2018;29(4):531–40. doi: 10.1016/j.wem.2018.06.008 . - DOI - PubMed
    1. Kauffman CA. Histoplasmosis: a clinical and laboratory update. Clin Microbiol Rev. 2007;20(1):115–32. doi: 10.1128/CMR.00027-06 . - DOI - PMC - PubMed
    1. Benedict K, Toda M, Jackson BR. Revising Conventional Wisdom About Histoplasmosis in the United States. Open Forum Infect Dis. 2021;8(7):ofab306. doi: 10.1093/ofid/ofab306 . - DOI - PMC - PubMed
    1. Wheat LJ, Conces D, Allen SD, Blue-Hnidy D, Loyd J. Pulmonary histoplasmosis syndromes: recognition, diagnosis, and management. Semin Respir Crit Care Med. 2004;25(2):129–44. doi: 10.1055/s-2004-824898 . - DOI - PubMed
    1. Chromoblastomycosis and other deep mycoses have been added to the NTD portfolio [Internet]. In: World Health Organization; 2017

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