Practical Guidance for Clinical Microbiology Laboratories: Antibody and antigen detection methods for dimorphic fungal infections

SUMMARY Antibody and antigen detection assays continue to play a significant role in the diagnosis of dimorphic fungal pathogens, including Blastomyces dermatitidis complex, Coccidioides immitis/posadasii , Paracoccidioides species, Histoplasma species , Sporothrix species, and Talaromyces marneffei . The performance characteristics of serologic and antigen detection assays for these pathogens are variable, however, influenced by multiple factors, including sample type, disease presentation, patient immunostatus, and timing of specimen collection relative to symptom onset. As a result, there is a need for a centralized document summarizing the accuracy of currently available antibody and antigen detection assays for each of these agents, including discussion of individual assay nuances and caveats that should be considered by clinicians and laboratorians alike. In addition, this review provides expert recommendations for the utilization and interpretation of serologic and antigen detection assays for these dimorphic pathogens.