PDF(Pubmed)
Abstract：
Blastomycosis is endemic in Wisconsin with Blastomyces dermatitidis and B. gilchristii responsible for infections. Urine antigen testing is a non-invasive diagnostic method for blastomycosis with up to 93% test sensitivity. However, the test\'s sensitivity has not been evaluated with relationship to B. gilchristii infections.
We aimed to assess physician use of the urine antigen assay and its sensitivity to B. gilchristii and B. dermatitidis infections in a retrospective study. Culture confirmed clinical cases of blastomycosis from 2008-2016 were identified within Marshfield Clinic Health System (MCHS) and UW Hospital and Clinics (UWHC) medical records. Clinical data were abstracted from each medical record and included the following: patient demographics, presence of immune compromising and underlying medical conditions, treatment drugs, presence of isolated pulmonary or disseminated disease, death, urine antigen testing, timeframe of testing, and quantitative test values (EIA units or ng/mL).
A total of 140 blastomycosis cases were included in this study, with MCHS contributing 114 cases to the study and UWHC contributing 26 cases. The majority of UWHC cases (n=22; 85%) were caused by B. dermatitidis and the majority of MCHS cases (n=73; 64%) were caused by B. gilchristii. UWHC physicians were significantly more likely to treat with multiple drugs during the course of infection and were more likely to prescribe amphotericin B and voriconazole. Urine antigen testing was more frequently used at UWHC (n=24; 92%) than MCHS (n=51; 45%; P < 0.00001). In this study, the urine antigen assay demonstrated 79% sensitivity. Sensitivity was significantly associated with the timeframe of testing (P < 0.05), with most true positive urine antigen tests (83%) being performed ≤ 7 days from diagnosis. In this study, the urine antigen assay was capable of detecting both B. dermatitidis and B. gilchristii at about equal sensitivity. Urine antigen concentration (ng/mL) trended higher in B. dermatitidis infections.
This study found that the urine antigen assay is capable of detecting both species of Blastomyces at about the same sensitivity. We recommend continued use of the urine antigen assay for diagnosis of blastomycosis and recommend that the assay be used early in the diagnostic process to minimize the chance of false negative results.
We aimed to assess physician use of the urine antigen assay and its sensitivity to B. gilchristii and B. dermatitidis infections in a retrospective study. Culture confirmed clinical cases of blastomycosis from 2008-2016 were identified within Marshfield Clinic Health System (MCHS) and UW Hospital and Clinics (UWHC) medical records. Clinical data were abstracted from each medical record and included the following: patient demographics, presence of immune compromising and underlying medical conditions, treatment drugs, presence of isolated pulmonary or disseminated disease, death, urine antigen testing, timeframe of testing, and quantitative test values (EIA units or ng/mL).
A total of 140 blastomycosis cases were included in this study, with MCHS contributing 114 cases to the study and UWHC contributing 26 cases. The majority of UWHC cases (n=22; 85%) were caused by B. dermatitidis and the majority of MCHS cases (n=73; 64%) were caused by B. gilchristii. UWHC physicians were significantly more likely to treat with multiple drugs during the course of infection and were more likely to prescribe amphotericin B and voriconazole. Urine antigen testing was more frequently used at UWHC (n=24; 92%) than MCHS (n=51; 45%; P < 0.00001). In this study, the urine antigen assay demonstrated 79% sensitivity. Sensitivity was significantly associated with the timeframe of testing (P < 0.05), with most true positive urine antigen tests (83%) being performed ≤ 7 days from diagnosis. In this study, the urine antigen assay was capable of detecting both B. dermatitidis and B. gilchristii at about equal sensitivity. Urine antigen concentration (ng/mL) trended higher in B. dermatitidis infections.
This study found that the urine antigen assay is capable of detecting both species of Blastomyces at about the same sensitivity. We recommend continued use of the urine antigen assay for diagnosis of blastomycosis and recommend that the assay be used early in the diagnostic process to minimize the chance of false negative results.
摘要：
在威斯康星州，芽生菌病是地方性的，由皮肤芽生菌和吉氏芽孢杆菌引起感染。尿抗原检测是一种非侵入性诊断方法，对芽生菌病具有高达93％的检测灵敏度。然而,该测试的敏感性尚未评估与Gilchristii感染的关系。
我们的目的是在一项回顾性研究中评估医师对尿抗原检测的使用及其对吉氏芽孢杆菌和皮氏芽孢杆菌感染的敏感性。在Marshfield诊所卫生系统（MCHS）和UW医院和诊所（UWHC）医疗记录中确定了2008-2016年培养证实的芽生菌病临床病例。从每个医疗记录中提取临床数据，包括以下内容：患者人口统计学，存在免疫损害和潜在的医疗条件，治疗药物,存在孤立的肺部或播散性疾病，死亡,尿液抗原检测,测试的时间表，和定量测试值（EIA单位或ng/mL）。
本研究共纳入140例芽生菌病病例，研究中MCHS贡献114例，UWHC贡献26例。大多数UWHC病例（n=22；85％）是由B.dermatitidis引起的，大多数MCHS病例（n=73；64％）是由B.gilchristii引起的。UWHC医生在感染过程中使用多种药物治疗的可能性更高，并且更可能开两性霉素B和伏立康唑。UWHC（n=24；92％）比MCHS（n=51；45％；P<0.00001）更频繁地使用尿液抗原测试。在这项研究中,尿抗原检测显示79%的灵敏度。灵敏度与检测的时间范围显著相关(P<0.05)。大多数真正的尿液抗原阳性测试（83％）在诊断后≤7天进行。在这项研究中,尿液抗原分析能够以大约相等的灵敏度检测皮氏芽孢杆菌和吉氏芽孢杆菌。在皮肤芽孢杆菌感染中,尿抗原浓度(ng/mL)有升高的趋势。
本研究发现,尿抗原测定能够以大约相同的灵敏度检测两种胚芽菌属。我们建议继续使用尿液抗原测定法来诊断胚真菌病，并建议在诊断过程中尽早使用该测定法，以最大程度地减少假阴性结果的机会。
我们的目的是在一项回顾性研究中评估医师对尿抗原检测的使用及其对吉氏芽孢杆菌和皮氏芽孢杆菌感染的敏感性。在Marshfield诊所卫生系统（MCHS）和UW医院和诊所（UWHC）医疗记录中确定了2008-2016年培养证实的芽生菌病临床病例。从每个医疗记录中提取临床数据，包括以下内容：患者人口统计学，存在免疫损害和潜在的医疗条件，治疗药物,存在孤立的肺部或播散性疾病，死亡,尿液抗原检测,测试的时间表，和定量测试值（EIA单位或ng/mL）。
本研究共纳入140例芽生菌病病例，研究中MCHS贡献114例，UWHC贡献26例。大多数UWHC病例（n=22；85％）是由B.dermatitidis引起的，大多数MCHS病例（n=73；64％）是由B.gilchristii引起的。UWHC医生在感染过程中使用多种药物治疗的可能性更高，并且更可能开两性霉素B和伏立康唑。UWHC（n=24；92％）比MCHS（n=51；45％；P<0.00001）更频繁地使用尿液抗原测试。在这项研究中,尿抗原检测显示79%的灵敏度。灵敏度与检测的时间范围显著相关(P<0.05)。大多数真正的尿液抗原阳性测试（83％）在诊断后≤7天进行。在这项研究中,尿液抗原分析能够以大约相等的灵敏度检测皮氏芽孢杆菌和吉氏芽孢杆菌。在皮肤芽孢杆菌感染中,尿抗原浓度(ng/mL)有升高的趋势。
本研究发现,尿抗原测定能够以大约相同的灵敏度检测两种胚芽菌属。我们建议继续使用尿液抗原测定法来诊断胚真菌病，并建议在诊断过程中尽早使用该测定法，以最大程度地减少假阴性结果的机会。
