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Journal of Clinical Microbiology, January 1999, p. 117-121, Vol. 37, No. 1
0095-1137/99/$04.00+0
Copyright © 1999, American Society for Microbiology. All rights reserved.

Diagnosis of Penicillium marneffei Infection by Quantitation of Urinary Antigen by Using an Enzyme Immunoassay

V. Desakorn,1 M. D. Smith,1,2,dagger A. L. Walsh,1,2,Dagger A. J. H. Simpson,1,2 D. Sahassananda,1 A. Rajanuwong,3 V. Wuthiekanun,1 P. Howe,1,2 B. J. Angus,1,2 P. Suntharasamai,1 and N. J. White1,2,*

Faculty of Tropical Medicine, Mahidol University, Bangkok 10400,1 and Department of Medicine, Sappasitprasong Hospital, Ubon Ratchathani,3 Thailand, and Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, John Radcliffe Hospital, University of Oxford, Oxford OX3 9DU, United Kingdom2

Received 10 July 1998/Returned for modification 13 August 1998/Accepted 15 October 1998

Penicillium marneffei is a major cause of opportunistic infection in patients with AIDS in north and northeastern Thailand. A method for the quantitation of P. marneffei antigen in urine was developed by using fluorescein isothiocyanate-labelled purified rabbit hyperimmune immunoglobulin G in an enzyme-linked immunosorbent assay. This method was evaluated with 33 patients with culture-proven penicilliosis and 300 controls (52 healthy subjects, 248 hospitalized patients without penicilliosis) from the same area in which penicilliosis is endemic. Urinary antigen was found in all 33 (100%) patients with penicilliosis, with a median titer of 1:20,480. With undiluted samples, 67 (27%) of 248 hospital patients and 3 (6%) of 52 healthy controls were reactive. At a cutoff titer of 1:40, the urine antigen detection assay had a diagnostic sensitivity of 97% and specificity of 98% (positive predictive value, 84%; negative predictive value, 99.7%). This test offers a valuable and rapid method for the diagnosis of penicilliosis in patients with AIDS and could be a useful addition to conventional diagnostic methods in areas in which penicilliosis is endemic.

* Corresponding author. Mailing address: Faculty of Tropical Medicine, Mahidol University, 420/6 Rajvithi Rd., Bangkok 10400, Thailand. Phone: 66 2 246 0832. Fax: 66 2 246 7795. E-mail: fnnjw{at}diamond.mahidol.ac.th.

dagger Present address: Public Health Laboratory, Musgrove Park Hospital, Taunton, Somerset, United Kingdom.

Dagger Present address: Malaria Research Project and Wellcome Trust Centre, Chichiri, Blantyre, Malawi.

Journal of Clinical Microbiology, January 1999, p. 117-121, Vol. 37, No. 1
0095-1137/99/$04.00+0
Copyright © 1999, American Society for Microbiology. All rights reserved.


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