Point of care tests for invasive fungal infections: a blueprint for increasing availability in Africa

Osaigbovo, Iriagbonse Iyabo; Bongomin, Felix

doi:10.1177/20499361211034266

Cited by 10 publications

(7 citation statements)

References 79 publications

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“…10,17 These techniques (EIA and LFA) that compensate the lack of laboratory infrastructure and laboratory personnel trained in diagnostic mycology. 18 Culture remains the gold standard with 100% specificity 9 but with a poor sensitivity in case of pulmonary forms of the disease. 19 Skin biopsy is rapid method of arriving at a specific diagnosis of DH.…”

Section: Discussionmentioning

confidence: 99%

Diagnosing disseminated histoplasmosis in advanced HIV/AIDS disease in Cameroon using a point of care lateral flow assay

Kuate

Abessolo²,

Denning

et al. 2022

Therapeutic Advances in Infection

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Histoplasmosis is an AIDS-defining opportunistic infection. Disseminated histoplasmosis (DH) can be fatal without early diagnosis and treatment initiation. We present one confirmed and three probable cases of DH in advanced HIV/AIDS disease patients diagnosed using OIDx Histoplasma LFA in Yaoundé, Cameroon. Four women with HIV but unknown CD4 count presented with asthenia, weight loss, productive cough, and fever (39°C) as common symptoms for at least 3 weeks. Two of the patients had skin lesions. These included facial papules, macules, and umbilicated vesicles scattered over the trunk and limbs. These were diffuse lesions which were purulent, itching, and papillomatous lesions with a necrotic centre, and one patient had a right forearm ulcer. We performed the Histoplasma antigen tests using the OIDx Histo LFA, and they were strongly positive in all four patients. Histopathology in skin biopsy allowed identification of the species as Histoplasma capsulatum var capsulatum in one patient. In this same patient, Pseudomonas aeruginosa and Proteus mirabilis were cultured from the forearm ulcer. This patient later commenced antibiotics (Levofloxacin 500 mg) and oral itraconazole (800 mg/day) with immediate improvement. Unfortunately, the other three patients could not access itraconazole, were discharged and lost to follow-up. Early diagnosis and treatment are essential for the management of DH. LFA is a test that can be set up in any setting with limited resource. Access to this can be a major advance in the diagnosis of histoplasmosis in resource-limited settings.

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Section: Discussionmentioning

confidence: 99%

Diagnosing disseminated histoplasmosis in advanced HIV/AIDS disease in Cameroon using a point of care lateral flow assay

Kuate

Abessolo²,

Denning

et al. 2022

Therapeutic Advances in Infection

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show abstract

“…Antigen assays have shown good performances in the diagnosis of histoplasmosis in the past [5,15]. It is a technique that compensate the lack of laboratory infrastructure and laboratory personnel trained in diagnostic mycology [16]. Culture remains the gold standard but has a poor sensitivity [17,11].…”

Section: Discussionmentioning

confidence: 99%

Diagnosing disseminated histoplasmosis in advanced HIV/AIDS disease in Cameroon using a point of care lateral flow assay – a case series

Kuate

Abessolo

Denning

et al. 2022

Preprint

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Background Histoplasmosis is an AIDS-defining opportunistic infection. Disseminated histoplasmosis (DH) can be fatal without early diagnosis and treatment initiation. We present four cases of disseminated histoplasmosis in advanced HIV/AIDS disease patients diagnosed using Histoplasma lateral flow assay (LFA) in Yaoundé, Cameroon. Cases presentation : Four women with HIV but unknown CD4 + T cell count were received at the Hospital presenting with asthenia, weight loss, productive cough and fever (39°C) as common symptoms for at least three weeks. Two of the patients had skin lesions. These included facial papules, macules and umbilicated vesicles scattered over the trunk and limbs. These were diffuse lesions which were purulent, itching and papillomatous lesions with a necrotic center, and one patient had a right forearm ulcer. We performed the Histoplasma antigen tests using the Histoplasma antigen lateral flow assay (LFA) and they were strongly positive in all four patients. Histopathology in skin biopsy allowed identification of the species as Histoplasma capsulatum var capsulatum in one patient. In this same patient, Pseudomonas aeruginosa and Proteus mirabilis were cultured from the forearm ulcer. This patient later commenced antibiotics (Levofloxacin 500 mg) and oral itraconazole (800mg/day) with immediate improvement. Unfortunately, the other three patients could not afford itraconazole, were discharged and lost to follow up. Conclusion Early diagnosis and treatment are essential for the management of DH. LFA is a test that can be set up in any setting with limited resource. Access to this can be a major advance in the diagnosis of histoplasmosis in resource limited settings.

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“…There is therefore an urgent need for simple, rapid and accurate diagnostic tests for the disease that can be performed at point-of-care. Lateralflow immunoassays are ideally suited to point-of-care detection of fungal infections in resource-limited settings (Thornton, 2020;Osaigbovo and Bongomin, 2021;Thornton, 2023), and might help to improve the speed and accuracy of mucoromycosis detection compared to insensitive and time-consuming culture and histopathology, the cornerstones of detection in LMIC countries (Rudramurthy et al, 2021;Thornton, 2023).…”

Section: Introductionmentioning

confidence: 99%

Development of a monoclonal antibody and a lateral-flow device for the rapid detection of a Mucorales-specific biomarker

Thornton,

Davies,

Dougherty

2023

Front. Cell. Infect. Microbiol.

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Mucoromycosis is a highly aggressive angio-invasive disease of humans caused by fungi in the zygomycete order, Mucorales. While Rhizopus arrhizus is the principal agent of mucoromycosis, other Mucorales fungi including Apophysomyces, Cunninghamella, Lichtheimia, Mucor, Rhizomucor and Syncephalastrum are able to cause life-threatening rhino-orbital-cerebral, pulmonary, gastro-intestinal and necrotising cutaneous infections in humans. Diagnosis of the disease currently relies on non-specific CT, lengthy and insensitive culture from invasive biopsy, and time-consuming histopathology of tissue samples. At present, there are no rapid antigen tests that detect Mucorales-specific biomarkers of infection, and which allow point-of-care diagnosis of mucoromycosis. Here, we report the development of an IgG2b monoclonal antibody (mAb), TG11, which binds to extracellular polysaccharide (EPS) antigens of between 20 kDa and 250 kDa secreted during hyphal growth of Mucorales fungi. The mAb is Mucorales-specific and does not cross-react with other yeasts and molds of clinical importance including Aspergillus, Candida, Cryptococcus, Fusarium, Lomentospora and Scedosporium species. Using the mAb, we have developed a Competitive lateral-flow device that allows rapid (30 min) detection of the EPS biomarker in human serum and bronchoalveolar lavage (BAL), with a limit of detection (LOD) in human serum of ~100 ng/mL serum (~224.7 pmol/L serum). The LFD therefore provides a potential novel opportunity for detection of mucoromycosis caused by different Mucorales species.

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Point of care tests for invasive fungal infections: a blueprint for increasing availability in Africa

Cited by 10 publications

References 79 publications

Diagnosing disseminated histoplasmosis in advanced HIV/AIDS disease in Cameroon using a point of care lateral flow assay

Diagnosing disseminated histoplasmosis in advanced HIV/AIDS disease in Cameroon using a point of care lateral flow assay

Diagnosing disseminated histoplasmosis in advanced HIV/AIDS disease in Cameroon using a point of care lateral flow assay – a case series

Development of a monoclonal antibody and a lateral-flow device for the rapid detection of a Mucorales-specific biomarker

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