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

doi:10.1093/ofid/ofac277

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

Open Forum Infect Dis. 2022 Jun 3;9(7):ofac277. doi: 10.1093/ofid/ofac277. eCollection 2022 Jul.

Authors

Affiliations

¹ Division of Evolution, Infection and Genomics, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom.
² Department of Bacteriology, Noguchi Memorial Institute of Medical Research, University of Ghana, Legon, Ghana.
³ Fevers Unit, Department of Medicine, Korle-Bu Teaching Hospital, Korle-Bu, Ghana.
⁴ Dermatology Unit, Department of Internal Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana.
⁵ Laboratory Department, Juaboso Government Hospital, Juaboso, Ghana.
⁶ Department of Medical Microbiology, University of Ghana Medical School, Korle-Bu, Ghana.

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.

Keywords: Ghana; antigen tests; cryptococcosis; histoplasmosis; people with HIV.