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Serum LDH level as a clue to the diagnosis of histoplasmosis.




 

Int Conf AIDS. 1998;12:1004 (abstract no. 60008). Unique Identifier :

Histoplasmosis is diagnosed in 2-5% of patients with acquired immunodeficiency syndrome (AIDS) in the endemic areas in the United States. Pneumocystis carinii pneumonia has been the most common opportunistic infection in patients with AIDS. Both diseases carry a significant morbidity and mortality if untreated or inappropriately treated. Both diseases affect the lung and may cause fever and pulmonary infiltrates, although histoplasmosis is much more likely to disseminate especially in patients with AIDS. Since histoplasmosis is less common and suspected less often especially in non-endemic areas, a high index of suspicion is needed for the correct diagnosis and treatment. A clue to the diagnosis of histoplasmosis may be a very high serum lactate dehydrogenase level. 30 patients with histoplasmosis were compared to 120 patients with PCP for their serum LDH level at the time of diagnosis. The mean LDH level for patients with histoplasmosis was 1068 +/- 197 IU/L, and that for PCP was 375 +/- 23 IU/L. An LDH level of over 450 IU/L was 9.33 times more likely (odds ratio 9.33; 95% CI 3.50, 25.47; p < .01), and an LDH level of over 600 IU/L was 9.41 times more likely (odds ratio 9.41; 95% CI 3.43, 26.31; p < .01) to be associated with a diagnosis of histoplasmosis than with PCP. An LDH value of > or = 450 IU/L had a sensitivity and specificity of 0.70 and 0.80 respectively for a diagnosis of histoplasmosis. At LDH level of > or = 600 IU/L, the sensitivity and specificity was 0.50 and 0.89 respectively. Serum LDH level is an early diagnostic clue to the diagnosis of Histoplasmosis rather than PCP in patients with AIDS. This early clue may help clinicians to institute appropriate tests and therapies in certain patients. The authors hope that timely diagnosis and appropriate therapy may lead to reduced morbidity and mortality.

MEETING ABSTRACTS AIDS-Related Opportunistic Infections/*DIAGNOSIS/ENZYMOLOGY Diagnosis, Differential Histoplasmosis/*DIAGNOSIS/ENZYMOLOGY Human Lactate Dehydrogenase/*BLOOD Lung Diseases, Fungal/*DIAGNOSIS/ENZYMOLOGY Odds Ratio Pneumonia, Pneumocystis carinii/DIAGNOSIS/ENZYMOLOGY Sensitivity and Specificity



 




Information in this article was accurate in December 30, 1998. The state of the art may have changed since the publication date. This material is designed to support, not replace, the relationship that exists between you and your doctor. Always discuss treatment options with a doctor who specializes in treating HIV.