From the Desk of Dr. Wheat

Every day, I’m amazed at the fascinating news and innovations that are constantly helping to advance the field of fungal diagnostics and testing. Below are some of the recent stories I’ve found the most interesting. Please take a minute to read along; I hope you’ll be as engaged as I was!

Recent Studies

Diagnosis Coccidioidomycosis

Question I suspect coccidioidomycosis in a patient. Symptoms include a painful and swollen shoulder, fever, weight loss, cough for the past month and shortness of breath for the past week. Chest x-ray shows diffuse pulmonary infiltrates and shoulder radiographs (not…
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MiraVista Blastomyces Antigen EIA Advantage

Joe Wheat | John Witt | Heather Largura | Deborah Blue | Andrew Hanzlicek Background Blastomycosis is endemic in the United States around the Great Lakes, St. Lawrence seaway, southeastern states, and less frequently elsewhere. Clinical findings include pulmonary disease…
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How Best to Use Histoplasma Antigen for Monitoring Therapy

Case Report A 32-year-old woman who was receiving biological therapy for psoriasis presented with fever of 102.6°F, shortness of breath, 5% weight loss, and hepatomegaly. Histoplasmosis was suspected and urine and serum were submitted for Histoplasma antigen detection. Both results…
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Why Test Urine and Serum for Histoplasma Antigen?

Case Report A healthy 24-year-old man cleaned the gutters on his 16-year-old fishing cabin on a lake in Wisconsin. He presented for medical evaluation 12 days later for symptoms of fever, malaise and cough of 5 days’ duration.   Is…
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Why Should I Send My Fungal Tests to MiraVista Diagnostics?

Reliable Results = Confident Decision Making = Better Patient Outcome As a clinician or laboratory director, you expect accurate and timely results when you submit a diagnostic test. The cost of a mistaken diagnosis, both monetarily and in patient suffering,…
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Improved Serologic Diagnosis Coccidioidomycosis

Introduction. Delays in the diagnosis of coccidioidomycosis are associated with coccidioidomycosis related cost totaling $589,053 [1]. A study assessing the knowledge of clinicians found many were unsure how to use serologic tests for diagnosis of coccidioidomycosis [2], contributing to the…
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MiraVista Histoplasma Antigen Enzyme Immunoassay (EIA) for Diagnosis and Monitoring Treatment

Background. Antigen detection is the most common method for diagnosis of severe and progressive forms of histoplasmosis [1].  The MiraVista Histoplasma antigen EIA is offered as a CAP and CLIA certified laboratory developed tests (LDT) performed only at MiraVista Diagnostics. …
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Does Cross-Reactivity Occur in the Fungal Antigen Assays?

Complete cross-reactivity occurs in the Histoplasma and Blastomyces galactomannan antigen assays in specimens from patients with histoplasmosis or blastomycosis (table). The antigen detected in these infections is identical. There is no need to order both. The two assays use different…
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MiraVista Diagnostics Strives to Continually Improve Fungal Testing

Coming Soon – Improved MVista® Histoplasma Antigen Quantitative EIA Key Points – At a Glance MiraVista Diagnostics will soon transition to an improved Histoplasma antigen test. Urine, serum, plasma, BAL fluid, and CSF can all be tested. An expanded quantifiable…
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Traveler’s Pneumonia Case Study

By Drs. Chokechai Rongkavilit, Monica Ardura, and Joseph Wheat An 11-year-old girl from Michigan took a 3-week summer vacation to the southwest United States (figure 1, map), and upon returning, developed a progressively worsening productive cough and weight loss.  She…
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Is There a Reason to Test Both Serum and Urine for Histoplasma Antigen?

QUESTION: Is there a reason to test both urine and serum for Histoplasma antigen [1]? CASE REPORT: A healthy 24-year-old man cleaned the gutters on his 16-year-old fishing cabin on a lake in Wisconsin. He presented for medical evaluation 12…
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Diagnosis of Progressive Disseminated Histoplasmosis (PDH)

Background. Culture is the gold standard for diagnosis [1] and the sensitivity ranges from about 60 to 80% [2-5] (Table 1). However, growth of Histoplasma is slow, taking up to six weeks and culture rarely provides the initial basis for…
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Diagnosis of Acute Pulmonary Histoplasmosis Can Be Challenging.

Acute pulmonary histoplasmosis is characterized by fever, cough, chest pain, and mediastinal lymphadenopathy with infiltrates. Because presentation resembles other diseases, diagnosis can be challenging. Though antigen detection is highly sensitive in disseminated histoplasmosis (>90%), [1-5], up to 17% of acute…
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An Interesting Case: Histoplasma Antigen and Antibody Detection

CASE REPORT: A non-immunocompromised patient with chronic meningitis and CSF leukocyte count of 256 cells/ μl, glucose of 24 μg/ml and protein of 186 μg/ml has anti-Histoplasma antibody of 62 units but a negative Histoplasma antigen in the CSF. QUESTION:…
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Accuracy of the MVista® Histoplasma Antibody IgG, IgM Immunoassay to Evaluate Suspicious Lung Nodules

Endemic mycoticdiseases (histoplasmosis, blastomycosis, coccidioidomycosis) are common causes of lung granulomas. They present diagnostic challenges when there is radiographic evidence of indeterminate pulmonary nodules (IPN) which are well defined nodules less than 1 centimeter in diameter, especially when found on…
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An Interesting Case

QUESTION: Which triazoles are effective alternatives to itraconazole for treatment of histoplasmosis? ANSWER: Evidence suggests that fluconazole is not adequate. Information about the other triazoles is insufficient to make an evidence-based choice. However, posaconazole appears to be the best alternative….
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Noninvasive Diagnosis of Central Nervous System Blastomycosis

QUESTION: What do you think is the most sensitive test for diagnosis? Culture Pathology Molecular Antigen detection Antibody detection ANSWER: A recently published case report and literature review provides insight into the diagnostic approach, which we have supplemented with literature…
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Nonculture Diagnosis of Central Nervous System Coccidioidomycosis

A previously healthy young man from California presented with a one-month history of headache and intermittent fever. Physical examination was unremarkable. CSF contained 123 leukocytes/µl, 72% mononuclear cells. Protein was 103 mg/dl and glucose 26 mg/dl. No organisms were seen…
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