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Molecular cloning, characterization, and expression of the M antigen of Histoplasma capsulatum.

The major diagnostic antigens of Histoplasma capsulatum are the H and M antigens, pluripotent glycoproteins that elicit both humoral and T-cell-mediated immune responses. These antigens may play a role in the pathogenesis of histoplasmosis. M antigen is considered immunodominant because antibodies against it are the first precipitins to arise in acute histoplasmosis and are commonly present during all phases of infection. The biological activity of monomolecular M antigen and its ability to elicit a protective immune response to H. capsulatum are largely unknown. A molecular approach was used to identify the biological nature of M antigen, including its purification from histoplasmin, partial digestion with proteinases, and reverse-phase high-performance liquid chromatography to separate the released peptides. The amino acid sequences of the purified peptides were obtained by Edman degradation, and using degenerate oligonucleotide primers for PCR, a 321-bp fragment of the gene encoding the M antigen was amplified from genomic H. capsulatum DNA. This fragment was used to screen an H. capsulatum genomic DNA library, leading to the isolation, cloning, and sequencing of the full-length gene. The M gene consists of 2, 187-bp DNA encoding a protein of 80,719 Da, which has significant homology to catalases from Aspergillus fumigatus, Aspergillus niger, and Eimericella nidulans. A cDNA was generated by reverse transcription-PCR and cloned into the expression vector pQE40. The identity of the cloned, expressed protein was confirmed by Western blotting. The recombinant fusion protein was immunoreactive with monoclonal antibodies raised against M antigen, with polyclonal mouse anti-M antiserum, and with a serum sample from a patient with histoplasmosis. The gene encoding the major immunodominant M antigen of H. capsulatum is a presumptive catalase, and the recombinant protein retains serodiagnostic activity.

Amino Acid Sequence↗

Preparation of a fluorescent antibody specific for the yeast phase of Histoplasma capsulatum.

Kaufman, Leo (Communicable Disease Center, Atlanta, Ga.) and William Kaplan. Preparation of a fluorescent antibody specific for the yeast phase of Histoplasma capsulatum. J. Bacteriol. 82:729-735. 1961.-Rabbit anti-Histoplasma capsulatum globulin was conjugated with fluorescein isothiocyanate. This labeled antibody, in addition to staining six strains of H. capsulatum, exhibited strong cross-staining with ten strains of Blastomyces dermatitidis and numerous other species of fungi. Adsorption of the labeled antiglobulin either twice with cells of B. dermatitidis or twice with cells of Coccidioides immitis and once with cells of B. dermatitidis resulted in a good staining fluorescent antibody reagent, specific for yeast phase cells of H. capsulatum. Attempts to define the specific labeled antibody by the Ouchterlony procedure were unsuccessful. The specific conjugate did not give a complement fixation titer with yeast phase cells of B. dermatitidis or with coccidioidin. It did, however, show a 1:16 complement fixation titer with homologous yeast phase cells and a weaker reaction with histoplasmin.

Animals↗

Immunodiagnosis of histoplasmosis in a compromised host.

Three serological tests for the diagnosis of histoplasmosis were compared for sensitivity and specificity in serum from blood bank donors, patients with histoplasmosis, and infected or noninfected immunosuppressed patients. The histoplasmin latex agglutination test was positive in 9% of the normal patients, 33% of the histoplasmosis patients, and 61% of the noninfected immunosuppressed patients. Since the test is prone to many false-positive results in patients with inflammatory diseases or non-Histoplasma infections, it has limited potential as a screening test among compromised patients. Immunodiffusion and counterimmunoelectrophoresis using a mycelial antigen were found to be more sensitive than either test using a combined yeast and mycelial antigen or a pure yeast phase antigen. Counterimmunoelectrophoresis at pH 7.2 proved to be the test of choice for serodiagnosis of histoplasmosis, resolving 85% of the immunocompetent infected patients and 100% of the infected immunosuppressed patients. Results indicated that counterimmunoelectrophoresis in conjunction with immunodiffusion could be used as a screening protocol to determine infection in incoming patients in a cancer hospital.

Antibodies, Fungal↗

Presumed ocular histoplasmosis syndrome and linear streak lesions.

Five cases of subretinal neovascular membranes in the macula associated with punched out chorioretinal scars and linear streaks were seen in five Dutch patients. Clinically the fundus lesions are consistent with those of presumed ocular histoplasmosis syndrome (POHS) seen in the United States of America. Cutaneous serological testing for histoplasmin reactivity was negative in the three patients tested. Of special interest is the presence of linear streaks in association with POHS. They have not been previously described in patients from Europe with this syndrome.

Adult↗

Carcinoembryonic antigen and skin test reactivity in tumor radiotherapy.

Serial carcinoembryonic antigen (CEA) levels were obtained from 122 cancer patients. In a random selection, the levels in 67 of these patients were compared with clinical response to radiotherapy. Skin tests were also performed for histoplasmin, tuberculin and mumps. CEA levels, skin-delayed hypersensitivity reaction (DHR) and clinical tumor response were evaluated and correlated. Clinical response of tumors to radiotherapy was more often seen in patients with positive skin tests, but no correlation was observed between skin test reactivity and CEA response curves.

Carcinoembryonic Antigen↗

[Hemorrhagic macular choroidopathy in young subjects].

The haemorrhagic macular choroidopathy is a characteristic and rather frequent disease, which is seen in young subjects. We observed it in 23 patients, aged between 12 and 51 years. The disease resembles the presumed histoplasmin choroiditis, described in the American literature. In our cases, histoplasmosis can nevertheless be excluded and in the American cases it is not proven. In fact, the etiology is still unknown, but in 13 of our cases the origin may have been a disseminated choroiditis.

Adult↗

Prevalence of fungal complement-fixing antibodies in sarcoidosis.

The prevalence of fungal complement-fixing antibodies in sera from 58 patients with sarcoidosis was determined and compared to complement-fixing antibody titers in 50 sera from a normal control group and 50 antinuclear antibody-positive sera. Sera from 9 patients with sarcoidosis had complement-fixing antibody titers greater than 1:8 to Histoplasma yeast antigen; serum from one normal control subject had a titer greater than 1:8; and none of the antinuclear antibody-positive sera demonstrated titers greater than 1:8. There were no significant complement-fixing antibody concentrations observed against histoplasmin, blastomycin, and coccidioidin antigens in any serum from the 3 groups studied. The increase in antibody titers to the Histoplasma yeast antigen might have been related to the generalized increase in immunoglobulin concentrations noted in patients with sarcoidosis.

Antibodies, Fungal↗

Pulmonary hyalinizing granuloma presenting as multiple cavitary calcified nodules.

We describe a patient with PHG who presented with multiple cavitary calcified nodules. Laboratory evaluations revealed that she had serum immune abnormalities, and a histoplasmin skin test yielded positive results. Her Histoplasma infection may have produced a hyperimmune reaction that resulted in PHG and the calcified nodules.

Adult↗

Humoral and cell-mediated immunity to Histoplasma capsulatum during experimental infection in neotropical bats (Artibeus lituratus).

The humoral and cell-mediated immune responses of the large, frugivorus bat, Artibeus lituratus, were studied following intraperitoneal injection of 10 or 10(4) viable mycelial particles of Histoplasma capsulatum. Most bats had both cultural and histologic evidence of disease at autopsy. Utilizing a technique designed to measure the volume of footpad swelling in hypersensitive bats a significant degree of delayed hypersensitivity to histoplasmin was evident in both groups 4 to 6 wk after infection. Precipitating antibodies first appeared in the serum 3 wk after infection, but only in the animals infected with 10(4) viable organisms. Both the double diffusion and counterimmunoelectrophoresis techniques for antibody gave identical results. These findings suggest that A. lituratus is very susceptible to infection with H. capsulatum, and that a mild infection will stimulate delayed hypersensitivity to the organism but only low levels of antibody. The footpad test utilized in this study may be a sensitive and practical method for detecting natural infection in bats.

Animals↗

Histoplasmosis: an outbreak occurring among young men who visited one cave.

Sixteen cases of acute benign inhalational histoplasmosis were investigated after an outbreak of the disease in a group visiting a cave. The diagnosis was confirmed in 13 patients by chest X-ray examination, histoplasmin skin testing and serological examination. An attempt to isolate the organism Histoplasma capsulatum was unsuccessful. The epidemiology and relationship of the disease to bat ecology is discussed.

Animals↗

[Outbreak of acute histoplasmosis in Chilean travelers to the ecuadorian jungle: an example of geographic medicine].

Eight Chilean teenagers traveled to Ecuador in January 1999, where they were bitten by mosquitoes, had contact with parakeets and lodged in poorly hygienic places; 6/8 visited for 5-10 minutes the interior of a bat cave. About a week later these 6 began with headache, myalgia and fever that lasted 2-3 weeks. 5/6 had dry cough with no respiratory distress. The index case was seen in the 2nd week of symptoms. A chest x-ray showed multiple nodular infiltrates as in the other five. Two had histoplasma serology, one was negative and the other positive at a low titer; histoplasmin skin test showed induration of 17-27 mm in all six. An acute histoplasmosis with massive exposure was diagnosed and treated with itraconazole for 3 weeks. All became asymptomatic and chest x-rays returned to normal. Histoplasmosis (non existent endogenously in Chile) is, among other geographic and tropical diseases, a risk for Chilean travelers. Awareness of this in the general population and development of expertise in these diseases by local health care providers is required.

Adolescent↗

Mediastinal granuloma.

In a group of 47 patients with mediastinal granulomas, the most common clinical symptoms were cough, chest pain, dysphagia, hemoptysis, and dyspnea. The main laboratory findings were right paratracheal or hilar mass on chest roentgenogram, positive histoplasmin skin test, and caseating granuloma on histopathologic examination. Complications included fibrosing mediastinitis with superior vena cava obstruction, esophageal compression, and major upper airway compression. Treatment was usually surgical resection or evacuation of caseous contents. The prognosis in most patients with mediastinal granulomas appears to be good--long-term survival with minimal or no disability.

Adolescent↗

[Outbreak of acute histoplasmosis in a family group: identification of the infection source].

An outbreak of acute histoplasmosis occurring in 4 members of the same family, two women, a girl and a male, is reported. The index case presented acute respiratory symptoms, severe enough to require hospitalization. In the remaining persons, the infection was asymptomatic but was evidenced by reactive histoplasmin serologic tests. Search for the common source of infection led to an enriched soil obtained in a local nursery for growing in-door plants. BALB/c mice were inoculated with suspensions of soils from the potted plants. Histoplasma capsulatum var. capsulatum was isolated from various internal organs of the mice. Although histoplasmosis is observed more frequently in persons with occupations implying risk of exposure and is connected to rural areas, outbreaks and intra-family cases are now common in urban areas. This is due to massive urbanization, deforestation, demolitions and the use of soils enriched with organic compounds, mainly bird/bat excrements. This report calls the attention on the danger involved in using such enriched soils for plant nutrition.

Adult↗

Histoplasmosis in Africa: a review.

Classical histoplasmosis caused by Histoplasma capsulatum var. capsulatum, and African histoplasmosis caused by H. capsulatum var. duboisii are both endemic in Africa. In South Africa, only classical histoplasmosis caused by Histoplasma capsulatum var. capsulatum is known to occur and cases are seen frequently. It occurs sporadically in several other African countries. Histoplasma capsulatum var. capsulatum is known to occur naturally in caves inhabited by bats in some parts of South Africa, namely, Transvaal and Cape province, Zimbabwe and Tanzania. Outbreaks of histoplasmosis have been reported in cave explorers. Surveys of histoplasmin skin sensitivity carried out in Africa have shown the rate of positive reactors to be from 0.0% to 28%. African histoplasmosis caused by H. capsulatum var. duboisii is prevalent in Western and Central Africa, and in the island of Madagascar between the Kalahari and Sahara deserts, that is between latitudes 20 degrees North and 20 degrees South of the Equator. A natural reservoir of this fungus in soil admixed with bat guano has been found in a bat cave in a rural area, viz. Ogbunike in Anambra State of Nigeria. The clinical features and epidemiology of the two forms of the disease in Africa are reviewed.

Africa↗

Prevalence of histoplasmosis in a midsouthern population.

We found a histoplasmin reactivity rate of 69% in a selected population of normal midsouthern adults. This prevalence is similar to that previously reported and has major clinical implications for area residents who are infected with human immunodeficiency virus and are at risk for disseminated disease with Histoplasma capsulatum.

Adult↗

Ocular findings in patients with histoplasmosis.

Presumed ocular histoplasmosis syndrome is a multifocal choroiditis; it is not an uncommon cause of visual loss in patients who have positive cutaneous responses to histoplasmin tests. However, Histoplasma capsulatum infection is, most often, a pulmonary disease, or a systemically disseminated disorder, without visual symptoms. For this reason, a correspondence between the nonocular and ocular aspects of this disorder has been difficult to ascertain. In a series of eight patients with histoplasmosis, we found asymptomatic ocular lesions in six. We believe that the presence of asymptomatic lesions may have prevented earlier investigators from recognizing this correlation.

Adult↗

Histoplasmosis and thrombocytopenic purpura: transmission by renal homotransplantation.

Two patients with disseminated histoplasmosis are reported. One patient presented with severe thrombocytopenic purpura and splenomegaly. Histoplasmin skin test, blood and bone marrow cultures and smears, sputum cultures, and chest radiographs were negative for Histoplasma capsulatum. She died on the sixth hospital day from a massive intracerebral hemorrhage. Cardiorespiratory function was maintained until one kidney was removed for homotransplantation. The second patient, with chronic glomerulonephritis and uremia, received the renal homograft from the first patient. Initial signs of homograft rejection developed five days postoperatively. Diffuse thrombocytopenic purpura occurred shortly thereafter. Spores of Histoplasma capsulatum were observed in blood smears, in leukocyte concentrates, and in five-day leukocyte cultures from the blood obtained prior to death. Disseminated histoplasmosis was found in both patients at autopsy. The severe platelet deficit in both cases suggests that systemic histoplasmosis should be considered as a cause of thrombocytopenic purpura.To our knowledge, this is the first reported instance of direct transmission of Histoplasma capsulatum, and must be considered a hazard in homotransplantation.In vitro leukocyte cultures as a method for early diagnosis of certain disseminated fungous infections needs further investigation.

Adult↗

Histoplasmosis diffusion in Somalia: study of skin-test and serological survey.

Histoplasmin skin-test was applied to 1014 patients in two different parts of Somalia: in Mogadishu, an arid area, and in Jilib, a southern village on the banks of the Juba river. Among these patients only three gave areas of induration greater than 5 mm in diameter; all reactors were from Jilib. Results of a serological survey (latex-agglutination test) of histoplasmosis antibodies among 203 Somalian patients from three villages in river valleys are compared with the results of 171 inhabitants of the town of Mogadishu. Indirect agglutination antibody titers greater than or equal to 20 were found in 21.6% of the Mogadishu population as compared to 52.2% found in the river villages. In 96.2% of our cases in which the two tests were contemporarily used, the skin-test was completely negative despite high titres of positivity in the serological test. The results indicate the existence of founts of histoplasmosis infection in Somalia, particularly in humid areas bordering the rivers rather than in the surrounding arid semi-desert area characteristic of most of the country.

Female↗