Correct!
5. All of the above.
The urine and/or serum histoplasma antigen is an aid in the rapid diagnosis of disseminated or acute pulmonary histoplasmosis. Testing both urine and serum offers the highest sensitivity, as some patients may have a negative serum but a positive urine histoplasma antigen. False-positive and false-negative results do occur. Antigen results should be correlated with clinical and culture findings. Cross-reactions occur in blastomycosis and coccidioidomycosis.
The patient’s Histoplasma complement fixation and immunodiffusion were negative. Bronchoscopy and bronchoalveolar lavage (BAL) had a negative fungal smear, but a blood smear showed intracellular fungal organisms. Surprisingly, her BAL fluid was positive for Pneumocystis jiroveci pneumonia (PCP) by PCR (strong positive per lab) although her PCP smear was negative.
Which of the following is appropriate to do next?