In disseminated histoplasmosis, Histoplasma antigen is detectable in blood or urine with 85% to 95% sensitivity. For isolated pulmonary histoplasmosis, BAL or transbronchial biopsy may be required. Coccidioides organisms may be cultured or seen on histopathologic tissue stains or detected by serologic tests of blood or CSF. Aspergillus spp. may be cultured from sputum samples, which is sufficient for diagnosis in the presence of a typical clinical syndrome and no alternative diagnosis. More definitive diagnosis may be made by BAL (50% sensitivity) or open-lung biopsy.

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