Antigen Concentrations as an Indicator of Clinical Remission and Disease Relapse in Cats with Histoplasmosis

Hanzlicek, Andrew S; Meinkoth, James H.; Renschler, Janelle S; Goad, Carla L.; Wheat, L. Joseph

doi:10.1111/jvim.13962

Cited by 29 publications

(44 citation statements)

References 20 publications

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“…Diagnosis most commonly is confirmed by finding H. capsulatum organisms in cytopathologic or histopathologic samples . Treatment includes prolonged administration of antifungal drugs . Despite antifungal treatment, histoplasmosis is commonly fatal with 6‐month survival only being 67% …”

Section: Introductionmentioning

confidence: 99%

“…A commercially available Histoplasma antigen enzyme immunoassay (MiraVista Diagnostics, Indianapolis, IN) is useful for supporting the diagnosis of disseminated histoplasmosis in cats, with a diagnostic sensitivity (DSe) of 94% when urine is tested . It is also useful for monitoring as an indicator of remission and relapse during and after treatment, respectively …”

Section: Introductionmentioning

confidence: 99%

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A monoclonal antibody‐based urine Histoplasma antigen enzyme immunoassay (IMMY®) for the diagnosis of histoplasmosis in cats

Rothenburg

Hanzlicek

Payton

2018

Veterinary Internal Medicne

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Background An in‐house Histoplasma urine antigen test for cats might be desirable in certain situations. Objective To validate and compare the diagnostic performance of a monoclonal antibody‐based IMMY urine Histoplasma antigen enzyme immunoassay (IMMY EIA) to the commercially available urine Histoplasma antigen enzyme immunoassay (MiraVista Diagnostics, MV EIA). Animals One hundred ninety‐three urine samples from 105 client‐owned and purpose‐bred research cats. Methods Cats were classified as Histoplasma positive or negative based on diagnostic investigation. The IMMY EIA and MV EIA were performed on all urine samples. Correlation and agreement between the assays were determined. Diagnostic performance was determined and compared between assays. Results The IMMY EIA, with a 0.25 ng/mL diagnostic cutoff, provided a diagnostic sensitivity (DSe), diagnostic specificity (DSp), and diagnostic accuracy (DAc) of 89% (95% confidence interval [CI]; 73%‐97%), 80% (67%‐89%), and 83% (74%‐90%), respectively. The IMMY EIA, with a 1.1 ng/mL diagnostic cutoff, provided a DSe, DSp, and DAc of 77% (95% CI 60%‐90%), 97% (88%‐100%), and 89% (81%‐95%), respectively. The MV EIA provided a DSe, DSp, and DAc of 94% (95% CI 81%‐99%), 97% (89%‐100%), and 96% (90%‐99%), respectively. Moderate overall agreement was found between MV EIA and IMMY EIA using the 0.25 ng/mL cut‐off (к = 0.44; 95% CI 0.31‐0.57) and the 1.1 ng/mL cut‐off (к = 0.43, 95% CI, 0.31‐0.56). Conclusions and Clinical Importance The IMMY EIA might be useful as a diagnostic test for histoplasmosis in cats. Further modifications of the IMMY EIA are required to achieve the diagnostic performance of the MV EIA.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A monoclonal antibody‐based urine Histoplasma antigen enzyme immunoassay (IMMY®) for the diagnosis of histoplasmosis in cats

Rothenburg

Hanzlicek

Payton

2018

Veterinary Internal Medicne

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“…15 Antigenuria is reported to be more common than antigenemia and testing of paired serum and urine samples may increase the sensitivity of antigen testing for diagnosis of histoplasmosis. 17 According to the manufacturer, 2 cross-reactivity occurs with blastomycosis (99%), coccidioidomycosis (10%), and rarely aspergillosis. In the present case series, four cats had antigen testing performed with only one cat (case 1) not having antigen detected.…”

Section: Discussionmentioning

confidence: 99%

“…1 Monitoring of serial antigen concentrations can be performed to help guide decisions regarding treatment cessation and can help detect disease relapse. 17 Systemic glucocorticoids are often prescribed in cases with respiratory distress or large fungal burden for their anti-inflammatory effects. 17 The ocular adnexal lesions of four cats with follow-up data available had a favorable response to treatment with fluconazole.…”

Section: Discussionmentioning

confidence: 99%

Disseminated histoplasmosis with ocular adnexal involvement in seven cats

Ewald

Rankin

Meekins

et al. 2020

Veterinary Ophthalmology

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Objective To describe the clinical features, diagnosis, and treatment of disseminated histoplasmosis with conjunctival and/or nictitating membrane involvement in cats. Procedure Medical records from seven cats with naturally acquired disseminated histoplasmosis and conjunctival and/or nictitating membrane lesions were reviewed for signalment, clinical findings, diagnostic results, treatment, and outcome. Results Breeds included domestic shorthair (n = 5), Maine Coon (n = 1), and Siamese mix (n = 1) with four spayed females and three castrated males. Conjunctival abnormalities were identified in four cats, and nictitating membrane lesions were identified in four cats; one cat had both a conjunctival and nictitating membrane lesion. Cytologic evaluation of lesions identified Histoplasma capsulatum organisms in two of four cases sampled, and histopathologic evaluation identified H capsulatum in both cases in which a sample was submitted. Histoplasmosis antigen testing was positive in three of four submitted samples. Initial treatment for all cats included fluconazole (median dose: 26 mg/kg/d). Median duration of follow‐up was 11 months (range: 1‐108 months; n = 4). Resolution of ocular adnexal lesions was achieved in three cats. Two cats had relapse of disease, one of which was subsequently euthanized. One cat with concurrent feline immunodeficiency virus (FIV) infection died one month after diagnosis of histoplasmosis. Conclusions Histoplasmosis should be a differential diagnosis for ocular adnexal inflammatory lesions in cats.

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“…Já a realização da cultura fúngica implica principalmente em risco biológico para os técnicos laboratoriais, além de ser pouco sensível. Outros métodos como a detecção antigênica de Histoplasma no soro, na urina e até mesmo em regiões corporais específicas como os olhos, requerem mais estudos para que possam ser de fato utilizados [1,6,9,11,16,23] assim como a Reação em Cadeia da Polimerase, empregada atualmente em alguns estudos [2,13].…”

Section: Introductionunclassified

Histoplasmose pulmonar grave em um gato doméstico: tratamento com Anfotericina B e Itraconazol

Jardim

Silva

Jesus

et al. 2018

Acta Scientiae. Vet.

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Background: Histoplasmosis is a systemic mycosis whose etiologic agent is the fungus Histoplasma capsulatum. This fungal infection, which is the second most frequent systemic mycotic fungal disease in felines in the United States, has rarely been found in cats in Brazil. This paper reports on a case of acute pulmonary histoplasmosis in a domestic cat treated with oral itraconazole associated with amphotericin B administered subcutaneously. This treatment resulted in clinical remission of the patient’s symptoms, as evidenced by radiographic follow-ups.Case: A domestic cat suffering from acute dyspnea was taken to a veterinary clinic. The animal was subjected to emergency oxygen therapy, and kept at rest through sedation with midazolam. A physical examination revealed normally colored mucosa, 8% dehydration, bristly fur, body condition score 2/9, tachypnea with respiratory rate of 100 breaths per minute and expiratory dyspnea. The radiographic examination showed marked opacification of all the pulmonary fields, with a mixed pattern (interstitial and alveolar) of heterogeneous appearance and diffuse distribution, which are changes consistent with an inflammatory infectious process (pneumonia). A cytological analysis of the pleural fluid revealed round to oval-shaped intracytoplasmic structures, varying in size from 2 to 4 μm, inside foamy macrophages, consistent with Histoplasma capsulatum. Based on the diagnosis of pulmonary histoplasmosis, and in view of the patient’s acute respiratory distress, it was decided to treat the cat using itraconazole associated with amphotericin B. Itraconazole was administered orally at a dose of 100 mg/cat every 24 h, while amphotericin B was administered subcutaneously at a dose of 0.5 mg/kg, combined with 100 mL of sodium chloride 0.9% and 100 mL of 5% glycated serum, with monitoring of serum concentrations of symmetric dimethylarginine (SDMA). Amphotericin B was administered every 48 h up to the 7th dose, followed by three times a week up to the 11th dose, and then twice a week up to the 16th dose. The animal was released from the veterinary hospital 10 days after its admission, showing a considerably improved respiratory condition and a respiratory rate of 40 breaths per minute. Continuation of the antifungal treatment with itraconazole was prescribed, maintaining the same dose and frequency of administration until a new recommendation would be made, as well as frequent return visits for the administration of amphotericin B and reassessment of the animal. The administration of amphotericin B was discontinued when the animal’s respiratory condition stabilized; hence, the feline received a total of 16 doses of the drug. The animal showed remission of clinical respiratory symptoms, confirmed by follow-up chest X-rays, which revealed significantly less radiodense pulmonary parenchyma in response to treatment with itraconazole and amphotericin B. Five months after beginning its treatment, the cat is being treated orally with itraconazole (100 mg/cat, every 24 h), without recrudescence of the clinical symptoms.Discussion: To date, six cases of feline histoplasmosis have been reported in Brazil, only one of which had pulmonary involvement and was treated successfully. The use of oral itraconazole associated with subcutaneous amphotericin B has proved to be effective for the treatment of acute pulmonary histoplasmosis in domestic cats. Note that a rapid diagnosis of pulmonary disease is essential in order to immediately implement a combined drug therapy linked with monitoring to ensure the protocol is safe for the patient

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Antigen Concentrations as an Indicator of Clinical Remission and Disease Relapse in Cats with Histoplasmosis

Cited by 29 publications

References 20 publications

A monoclonal antibody‐based urine Histoplasma antigen enzyme immunoassay (IMMY®) for the diagnosis of histoplasmosis in cats

A monoclonal antibody‐based urine Histoplasma antigen enzyme immunoassay (IMMY®) for the diagnosis of histoplasmosis in cats

Disseminated histoplasmosis with ocular adnexal involvement in seven cats

Histoplasmose pulmonar grave em um gato doméstico: tratamento com Anfotericina B e Itraconazol

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