PDF(Pubmed)
Abstract：
UNASSIGNED: Blastomycosis, coccidioidomycosis, and histoplasmosis are environmentally acquired fungal diseases that clinically resemble bacterial and viral community-acquired pneumonia and require laboratory testing for diagnosis. Patients frequently present to primary care and experience diagnostic delays when a fungal etiology is not initially suspected. Current national-level public health surveillance for these diseases is limited and does not include laboratory data, so nationwide testing practices are unknown.
UNASSIGNED: We identified laboratory tests for blastomycosis, coccidioidomycosis, and histoplasmosis ordered during 1 March 2019-29 February 2024 and performed within a major national commercial laboratory system. We analyzed test results, patient and healthcare provider features, reasons for testing, and temporal trends.
UNASSIGNED: Results included 5693 Blastomyces complement fixation tests (of those, 12% were positive), 71 858 immunodiffusion tests (0.1% positive), and 1186 serum enzyme immunoassay (EIA) tests (11% positive); 154 989 Coccidioides EIA immunoglobulin M results (5% positive) and 154 968 immunoglobulin G results (8% positive); and 46 346 Histoplasma complement fixation tests (30% positive), 49 062 immunodiffusion tests (1% positive), 35 506 serum EIA tests (4% positive), and 82 489 urine EIA tests (2% positive). Most histoplasmosis (58%-74%) and blastomycosis (42%-68%) tests were ordered from hospitals, whereas coccidioidomycosis tests were most frequently ordered by primary care providers (40%). A yearly average of 2727 positive tests were ordered by healthcare providers in states without public health surveillance for these diseases.
UNASSIGNED: Blastomycosis, coccidioidomycosis, and histoplasmosis are likely underdetected in primary care settings or by public health surveillance. Increased testing by primary care providers and expanded surveillance are needed to reduce disease burden.
UNASSIGNED: We identified laboratory tests for blastomycosis, coccidioidomycosis, and histoplasmosis ordered during 1 March 2019-29 February 2024 and performed within a major national commercial laboratory system. We analyzed test results, patient and healthcare provider features, reasons for testing, and temporal trends.
UNASSIGNED: Results included 5693 Blastomyces complement fixation tests (of those, 12% were positive), 71 858 immunodiffusion tests (0.1% positive), and 1186 serum enzyme immunoassay (EIA) tests (11% positive); 154 989 Coccidioides EIA immunoglobulin M results (5% positive) and 154 968 immunoglobulin G results (8% positive); and 46 346 Histoplasma complement fixation tests (30% positive), 49 062 immunodiffusion tests (1% positive), 35 506 serum EIA tests (4% positive), and 82 489 urine EIA tests (2% positive). Most histoplasmosis (58%-74%) and blastomycosis (42%-68%) tests were ordered from hospitals, whereas coccidioidomycosis tests were most frequently ordered by primary care providers (40%). A yearly average of 2727 positive tests were ordered by healthcare providers in states without public health surveillance for these diseases.
UNASSIGNED: Blastomycosis, coccidioidomycosis, and histoplasmosis are likely underdetected in primary care settings or by public health surveillance. Increased testing by primary care providers and expanded surveillance are needed to reduce disease burden.
摘要：
■芽生菌病，球孢子菌病,和组织胞浆菌病是环境获得性真菌病，在临床上类似于细菌性和病毒性社区获得性肺炎，需要实验室检测才能诊断。当最初没有怀疑真菌病因时，患者经常出现在初级保健中，并经历诊断延迟。目前对这些疾病的国家一级公共卫生监测有限，不包括实验室数据，所以全国范围的测试实践是未知的。
■我们确定了芽生菌病的实验室测试，球孢子菌病,和组织胞浆菌病在2019年3月1日至2024年2月29日期间订购，并在主要的国家商业实验室系统内进行。我们分析了测试结果，患者和医疗保健提供者的功能，测试的原因，和时间趋势。
■结果包括5693个胚芽补体固定试验（其中，12%为阳性)，71858免疫扩散试验(0.1%阳性)，和1186个血清酶免疫测定（EIA）测试（11％阳性）；154989个球虫EIA免疫球蛋白M结果（5％阳性）和154968个免疫球蛋白G结果（8％阳性）；和46346个组织血浆补体固定测试（30％阳性），49062免疫扩散试验(1%阳性)，35506血清EIA测试（4％阳性），和82489尿液EIA测试（2％阳性）。大多数组织胞浆菌病（58％-74％）和芽生菌病（42％-68％）的测试都是从医院订购的，而球孢子菌病检查最常由初级保健提供者订购(40%).在没有对这些疾病进行公共卫生监测的州，医疗保健提供者每年平均下令进行2727次阳性检测。
■芽生菌病，球孢子菌病,和组织胞浆菌病在初级保健机构或公共卫生监测中可能未被发现。需要增加初级保健提供者的检测和扩大监测，以减少疾病负担。
■我们确定了芽生菌病的实验室测试，球孢子菌病,和组织胞浆菌病在2019年3月1日至2024年2月29日期间订购，并在主要的国家商业实验室系统内进行。我们分析了测试结果，患者和医疗保健提供者的功能，测试的原因，和时间趋势。
■结果包括5693个胚芽补体固定试验（其中，12%为阳性)，71858免疫扩散试验(0.1%阳性)，和1186个血清酶免疫测定（EIA）测试（11％阳性）；154989个球虫EIA免疫球蛋白M结果（5％阳性）和154968个免疫球蛋白G结果（8％阳性）；和46346个组织血浆补体固定测试（30％阳性），49062免疫扩散试验(1%阳性)，35506血清EIA测试（4％阳性），和82489尿液EIA测试（2％阳性）。大多数组织胞浆菌病（58％-74％）和芽生菌病（42％-68％）的测试都是从医院订购的，而球孢子菌病检查最常由初级保健提供者订购(40%).在没有对这些疾病进行公共卫生监测的州，医疗保健提供者每年平均下令进行2727次阳性检测。
■芽生菌病，球孢子菌病,和组织胞浆菌病在初级保健机构或公共卫生监测中可能未被发现。需要增加初级保健提供者的检测和扩大监测，以减少疾病负担。
