51
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Pineau S, Talarmin JP, Morio F, Grossi O, Boutoille D, Léauté F, Le Pape P, Gay-Andrieu F, Miegeville M, Raffi F. [Contribution of molecular biology and Aspergillus galactomannan antigen assay for the diagnosis of histoplasmosis]. Med Mal Infect 2009; 40:541-3. [PMID: 19945807 DOI: 10.1016/j.medmal.2009.10.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2009] [Revised: 09/15/2009] [Accepted: 10/28/2009] [Indexed: 10/20/2022]
Abstract
We report a case of a pulmonary histoplasmosis in an HIV-positive patient usually living in Cambodia, with a positive Aspergillus galactomannan antigenemia resulting from a cross-reaction, that decreased after antifungal therapy. We discuss the potential interest of the detection of fungal DNA by PCR and Aspergillus galactomannan antigenemia for the diagnosis of histoplasmosis, especially in countries where Histoplasma capsulatum antigen testing is not available.
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Affiliation(s)
- S Pineau
- Service des Maladies Infectieuses et Tropicales, CHU Hôtel-Dieu, 1 place Alexis-Ricordeau, 44093 Nantes cedex 1, France
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52
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53
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Iribarren JA, Rivas González P, Amador Prous C, Velasco Arribas M. [Clinical manifestations of HIV infection in distinct geographical areas]. Enferm Infecc Microbiol Clin 2008; 26 Suppl 5:6-11. [PMID: 18590661 DOI: 10.1157/13123262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The clinical manifestations of HIV infection vary widely in distinct geographical areas. While HIV-related disease has been well characterized in western countries, relatively few publications have described the clinical manifestations of these diseases in tropical areas, where the vast majority of HIV-infected people are concentrated. In addition, HIV infection may alter the natural history of tropical diseases in several ways and tropical diseases influence the course of HIV infection. The present review describes the major opportunistic infections afflicting people with HIV/AIDS in Africa, Latin America, and Asia and discusses the mutual interactions between HIV and the major tropical diseases.
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Affiliation(s)
- José Antonio Iribarren
- Servicio de Enfermedades Infecciosas, Hospital de Donostia San Sebastián, Guipúzcoa, España.
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54
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Abstract
PURPOSE OF REVIEW Fungal infections of the central nervous system, once a relatively rare occurrence, are increasingly common due to the expansion of immunocompromised populations at risk, and therefore are important to recognize early and manage appropriately. RECENT FINDINGS The specific infectious risk posed by novel immune-modifying therapies can, in most cases, be predicted on the basis of the immune target and medication timing. In addition, major advances in noninvasive diagnostic tests (e.g. serum beta glucan and galactomannan assays), and the recent introduction of more effective antifungal therapies, have led to a dramatic improvement in clinical outcomes. SUMMARY The current review provides approaches to patients with suspected central nervous system fungal infections based on host-risk factors, clinical syndromes and specific pathogens.
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55
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Fungemia during murine cryptococcosis sheds some light on pathophysiology 1. Med Mycol 2008. [DOI: 10.1111/j.1365-280x.1999.00215.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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56
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Mata-Essayag S, Colella MT, Roselló A, de Capriles CH, Landaeta ME, de Salazar CP, Magaldi S, Olaizola C, Calatroni MI, Garrido L. Histoplasmosis: a study of 158 cases in Venezuela, 2000-2005. Medicine (Baltimore) 2008; 87:193-202. [PMID: 18626302 DOI: 10.1097/md.0b013e31817fa2a8] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Histoplasmosis, a granulomatous disease caused by Histoplasma capsulatum, is endemic in Venezuela. We conducted the current study to appraise retrospectively the demographic data, clinical features, diagnostic methods, and treatment of patients with histoplasmosis from January 2000 to December 2005. We reviewed the medical records of outpatient cases with a diagnosis of histoplasmosis and considered clinical samples processed at our laboratory. We collected demographic, epidemiologic, and clinical data from each case as available, including results of any mycologic examinations performed. Treatment and outcome data were available for some patients. We assessed 158 cases of histoplasmosis: 103 (65.2%) patients came from the Caracas metropolitan area; 53 were associated with acquired immunodeficiency syndrome (AIDS), 14 with tuberculosis, and 8 with paracoccidioidomycosis. Six pediatric patients were malnourished. Epidemiologic data suggested histoplasmosis in most cases. Patients received treatment with itraconazole and/or amphotericin B. Our results may reflect changes in the epidemiology occurring in Venezuela, perhaps due to environmental changes and the presence of AIDS. Several mycologic exams are necessary to ensure a proper diagnosis. More reliable data and statistics on this infection are necessary to monitor outbreaks closely and to establish if there is an epidemic pattern.
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Affiliation(s)
- Sofía Mata-Essayag
- From Sección de Micología Médica "Dr. Dante Borelli" (SM-E, MTC, AR, CHdC, CPdS, SM), Instituto de Medicina Tropical; Cátedra de Microbiología (MEL), Escuela de Medicina Luis Razetti, Facultad de Medicina; Cátedra de Medicina Tropical (CO), Escuela de Medicina Luis Razetti; Servicio de Medicina II, Hospital Universitario de Caracas (MIC), Universidad Central de Venezuela (UCV), Caracas; and Complejo Hospitalario "José Ignacio Baldó" (LG), Caracas, Venezuela
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57
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Abstract
The incidence of invasive fungal infections has increased dramatically over the past two decades, mostly due to an increase in the number of immunocompromised patients.1–4 Patients who undergo chemotherapy for a variety of diseases, patients with organ transplants, and patients with the acquired immune deficiency syndrome have contributed most to the increase in fungal infections.5 The actual incidence of invasive fungal infections in transplant patients ranges from 15% to 25% in bone marrow transplant recipients to 5% to 42% in solid organ transplant recipients.6,7 The most frequently encountered are Aspergillus species, followed by Cryptococcus and Candida species. Fungal infections are also associated with a higher mortality than either bacterial or viral infections in these patient populations. This is because of the limited number of available therapies, dose-limiting toxicities of the antifungal drugs, fewer symptoms due to lack of inflammatory response, and the lack of sensitive tests to aid in the diagnosis of invasive fungal infections.1 A study of patients with fungal infections admitted to a university-affiliated hospital indicated that community-acquired infections are becoming a serious problem; 67% of the 140 patients had community-acquired fungal pneumonia.8
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58
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López-Perezagua MM, Martínez-Peinado C, Arjona-Zaragozí FJ, Pasquau-Liaño F. [Cervical lymphadenitis, pancytopenia and fever in a patient with HIV infection]. Enferm Infecc Microbiol Clin 2007; 25:157-8. [PMID: 17288913 DOI: 10.1016/s0213-005x(07)74246-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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59
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Étude retrospective des méningites bactériennes et à cryptocoques chez des sujets adultes infectés par le VIH à Abidjan (Côte d’Ivoire). J Mycol Med 2007. [DOI: 10.1016/j.mycmed.2007.02.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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60
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Buitrago MJ, Gómez-López A, Monzón A, Rodríguez-Tudela JL, Cuenca-Estrella M. [Assessment of a quantitative PCR method for clinical diagnosis of imported histoplasmosis]. Enferm Infecc Microbiol Clin 2007; 25:16-22. [PMID: 17261242 DOI: 10.1157/13096748] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Evaluation of the usefulness of a quantitative real-time polymerase chain reaction-based (RT-PCR) technique for clinical diagnosis of histoplasmosis. METHODS Primers and probes were designed on the basis of sequences from the ITS regions of ribosomal DNA of 20 clinical strains of Histoplasma capsulatum. LightCycler procedures (Roche Applied Science) were used with probes marked by fluorescence resonance energy transfer (FRET). Reproducibility, sensitivity, and specificity were analyzed. In addition, an internal control was designed to identify false negative results by PCR inhibition. The RT-PCR assay was tested in 22 clinical samples from 14 patients with proven histoplasmosis. In addition, 30 samples from patients with febrile neutropenia or mycoses other than histoplasmosis, and from healthy volunteers were analyzed as controls. RESULTS The limit of detection of the assay was 1 fg of genomic DNA per microl of sample. The PCR-based technique was reproducible and highly specific. Positive results were obtained in 11/14 (78.6%) patients and in 17/22 (77.3%) clinical samples. RT-PCR was positive in 100% of respiratory secretions and bone marrow samples, but only 70% of sera (p < 0.01). Mean fungal DNA value was 23.1 fg/microl in serum and 4.85 x 10(3) fg/microl in respiratory and bone marrow samples. RT-PCR results were positive in serum from three HIV patients for which antibody detection by immunodiffusion was negative. Specificity was 100%, since PCR results were negative for all the control samples. CONCLUSION Thes RT-PCR technique is a sensitive, specific method for early diagnosis of histoplasmosis, particularly when respiratory secretions or bone marrow samples are analyzed. The reliability is lower in serum, but it can be used as an additional, complementary technique to culture and serology in HIV patients.
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Affiliation(s)
- María José Buitrago
- Servicio de Micología, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, Spain
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61
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Buitrago MJ, Berenguer J, Mellado E, Rodríguez-Tudela JL, Cuenca-Estrella M. Detection of imported histoplasmosis in serum of HIV-infected patients using a real-time PCR-based assay. Eur J Clin Microbiol Infect Dis 2007; 25:665-8. [PMID: 17024507 DOI: 10.1007/s10096-006-0207-y] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
A new real-time PCR-based assay was used for detecting DNA of Histoplasma capsulatum in serum samples collected from four HIV-infected patients with proven histoplasmosis. The assay targeted the ITS1 region of rDNA and its in vitro sensitivity, specificity and reproducibility were evaluated. The technique detected DNA of H. capsulatum in all of the HIV-infected patients with proven histoplasmosis (4/4, 100%). The PCR result was positive for seven of the ten (70%) samples studied. The assay's specificity was determined to be 100%, since the method was negative for 25 other serum samples (10 from patients with proven aspergillosis and 15 from healthy controls). The PCR assay is a new and promising diagnostic alternative and further investigation is warranted.
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Affiliation(s)
- M J Buitrago
- Servicio de Micología, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Carretera Majadahonda-Pozuelo Km 2, 28220 Majadahonda, Madrid, Spain
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62
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Abstract
Tropical mycoses vary from the commonplace to the rare and exotic but they are seen regularly even as imported conditions and it is important to consider the diagnosis, where possible, in individuals who have visited remote areas. Patients may present many years after they have left an endemic area with subcutaneous or endemic systemic mycoses. In establishing a diagnosis, it is always important to take an accurate travel history so that the movements of the individual can be correlated with the potential risk for exposure to infection.
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Affiliation(s)
- Roderick J Hay
- Faculty of Medicine and Health Sciences, Queens University Belfast, Northern Ireland, UK.
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63
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Stevens DA, Brummer E, Clemons KV. Interferon- gamma as an antifungal. J Infect Dis 2006; 194 Suppl 1:S33-7. [PMID: 16921470 DOI: 10.1086/505357] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- David A Stevens
- Department of Medicine, Santa Clara Valley Medical Center and California Institute for Medical Research, San Jose, CA, 95128, USA.
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Motta ACF, Galo R, Lourenço AG, Komesu MC, Arruda D, Velasco FG, Garcia BC, Foss NT. Unusual orofacial manifestations of histoplasmosis in renal transplanted patient. Mycopathologia 2006; 161:161-5. [PMID: 16482388 DOI: 10.1007/s11046-005-0195-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2005] [Accepted: 11/17/2005] [Indexed: 10/25/2022]
Abstract
Histoplasmosis is a fungal infection caused by the Histoplasma capsulatum. Mucosal manifestations are uncommon, but, when present, they are usually associated with pulmonary or chronic disseminated infection. The course of the disease is often related to the host immune response. The purpose of this article is to describe the clinical and microscopic findings of unusual involvement of nasal cartilage and septal destruction, and oral lesions of histoplasmosis in an immunosuppressed patient who presented an unusual form of the disease.
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Affiliation(s)
- Ana Carolina F Motta
- Department of Morphology, Stomatology and Physiology, School of Dentistry of Ribeirão Preto, University of São Paulo, Brazil
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65
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Alcure ML, Di Hipólito Júnior O, Almeida OPD, Bonilha H, Lopes MA. Oral histoplasmosis in an HIV-negative patient. ACTA ACUST UNITED AC 2006; 101:e33-6. [PMID: 16448911 DOI: 10.1016/j.tripleo.2005.06.028] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2005] [Revised: 05/25/2005] [Accepted: 06/22/2005] [Indexed: 11/23/2022]
Abstract
Histoplasmosis is a deep mycosis caused by Histoplasma capsulatum, which has been found in soil with accumulated excreta of bats and birds. This disease has variable clinical findings with only pulmonary or systemic involvement. Upper aerodigestive lesions are found mainly associated with systemic disease, affecting particularly patients with immunosuppression conditions mainly caused by HIV. However, it is uncommon in immunocompetent patients. This report describes a case of oro-laryngeal-esophageal histoplasmosis in a HIV-seronegative patient without detectable systemic involvement.
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Affiliation(s)
- Mônica Leal Alcure
- Department of Oral Diagnosis, Dental School, University of Campinas (UNICAMP), Piracicaba, Sao Paulo, Brazil
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Torres HA, Hachem RY, Chemaly RF, Kontoyiannis DP, Raad II. Posaconazole: a broad-spectrum triazole antifungal. THE LANCET. INFECTIOUS DISEASES 2005; 5:775-85. [PMID: 16310149 DOI: 10.1016/s1473-3099(05)70297-8] [Citation(s) in RCA: 194] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Posaconazale is a new triazole drug being investigated in phase III clinical trials for the treatment and prevention of invasive fungal infections. In-vitro and in-vivo studies showed that posaconazole has broad-spectrum activity against most Candida species, Cryptococcus neoformans, Aspergillus species, Fusarium species, zygomycetes, and endemic fungi. Posaconazole is given orally two to four times daily. This triazole is widely distributed in the body, metabolised mainly by the liver, and is well tolerated, even in long-term courses. Adverse events are generally mild and include headache and gastrointestinal complaints. Posaconazole has shown promising clinical efficacy against life-threatening fungal infections that are often refractory to the currently available antifungal therapies-eg, invasive aspergillosis, fusariosis, and the emerging zygomycosis.
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Affiliation(s)
- Harrys A Torres
- Department of Infectious Diseases, Infection Control and Employee Health, University of Texas M D Anderson Cancer Center, Houston, Texas 77030-4009, USA
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Shelburne SA, Visnegarwala F, Adams C, Krause KL, Hamill RJ, White AC. Unusual manifestations of disseminated Histoplasmosis in patients responding to antiretroviral therapy. Am J Med 2005; 118:1038-41. [PMID: 16164892 DOI: 10.1016/j.amjmed.2005.02.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2004] [Indexed: 11/26/2022]
Affiliation(s)
- Samuel A Shelburne
- Infectious Diseases Section, Department of Medicine (VA), Baylor College of Medicine, Houston, TX 77030, USA
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68
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Faggian F, Lanzafame M, Lattuada E, Brugnaro P, Carretta G, Cadrobbi P, Concia E. Histoplasmosis in Two Human Immunodeficiency Virus-positive Immigrants to Italy: Clinical Features and Management in the Highly Active Antiretroviral Therapy Era. South Med J 2004; 97:398-400. [PMID: 15108837 DOI: 10.1097/01.smj.0000084290.81423.21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We report two cases of histoplasmosis occurring in human immunodeficiency virus-positive patients who immigrated to Italy, and focus our attention on the clinical features and therapeutic aspects, with particular emphasis on secondary prophylaxis. The patients had comparable human immunodeficiency virus baseline parameters, but had a completely different compliance over therapeutic regimens. The two patients were followed in two different city hospitals of our region, Padua and Verona, and the diagnosis was made on the basis of instrumental, histologic, and microbiologic findings. One of them was treated with corticosteroids because of nephrotic syndrome.
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Affiliation(s)
- Federica Faggian
- Clinical Division of Infectious Diseases, Major Civil Hospital, B.go Trento, Verona, Italy.
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69
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Abstract
In countries where highly active antiretroviral therapy (HAART) is widely available, a decrease in the incidence of fungal infections has been observed in the last 5 years compared with countries that cannot afford this treatment. Even refractory fungal infections may be controlled when HAART is given to patients, and end-stage AIDS infections, such as aspergillosis, are now only infrequently seen. In contrast, fungal infections in certain regions, such as penicilliosis in Southeast Asia or cryptococcosis in Sub-Saharan Africa, are a growing problem. Antifungal therapy for documented infections has not changed very much during recent years; however, new drugs such as caspofungin and voriconazole may be more effective in the treatment of opportunistic fungal infections, in particular, those involving resistant organisms. Secondary antifungal prophylaxis for many opportunistic pathogens can now be temporarily or even permanently discontinued in many HIV-positive patients who have a marked improvement in immune function parameters, such as CD4(+) cell counts, after initiation of HAART. The link between effective virustatic control of HIV infection and a decreasing incidence of fungal infections has been recognised; and so, despite the availability of very effective new antifungal drugs, the cornerstone of treatment and prevention of opportunistic fungal infections in patients with HIV infection is effective antiretroviral therapy including protease inhibitors.
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Affiliation(s)
- Markus Ruhnke
- Department of Internal Medicine, Charité Campus Mitte, Berlin, Germany.
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70
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Yamada H, Kotaki H, Takahashi T. Recommendations for the treatment of fungal pneumonias. Expert Opin Pharmacother 2003; 4:1241-58. [PMID: 12877634 DOI: 10.1517/14656566.4.8.1241] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Incidences of fungal pneumonias have increased in immunocompromised patients with HIV infection or receiving bone marrow replacement or solid organ transplantation. Fungal pneumonias including aspergillosis, cryptococcosis, candidiasis, coccidioidomycosis, histoplasmosis and blastomycosis are one of the major causes of morbidity and mortality among the immunosuppressed hosts. Therefore, clinicians should consider the most appropriate and aggressive treatment of fungal pneumonias in this population. This report outlines the state of the art in the treatment of fungal pneumonias and discusses recent advances in antifungal therapy. Practice guidelines for the treatment with commonly used antifungal agents including amphotericin B, fluconazole, itraconazole, ketoconazole and flucytosine, are very useful for clinicians to manage the diseases appropriately. Echinocandins and second-generation triazoles will hopefully help clinicians to overcome the limitations of the current therapy.
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Affiliation(s)
- Harumi Yamada
- Pharmacy Division, Institute of Medical Science, University of Tokyo, Tokyo 108-8639, Japan
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71
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Troncoso A, Gulotta H, Olenchuck A, Bava J. [Laryngeal histoplasmosis as a manifestation of AIDS]. Enferm Infecc Microbiol Clin 2003; 21:273-4. [PMID: 12732119 DOI: 10.1016/s0213-005x(03)72935-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Bracca A, Tosello ME, Girardini JE, Amigot SL, Gomez C, Serra E. Molecular detection of Histoplasma capsulatum var. capsulatum in human clinical samples. J Clin Microbiol 2003; 41:1753-5. [PMID: 12682178 PMCID: PMC153865 DOI: 10.1128/jcm.41.4.1753-1755.2003] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We developed a seminested PCR for the diagnosis of histoplasmosis that amplifies a portion of the Histoplasma capsulatum H antigen gene. This assay is highly sensitive and specific, being able to detect genomic material corresponding to less than 10 yeast cells without cross-reaction against other bacterial or fungal pathogens.
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Affiliation(s)
- Andrea Bracca
- Instituto de Biología Molecular y Celular de Rosario, IBR-CONICET, Facultad de Ciencias Bioquímicas y Farmacéuticas, 2000 Rosario, Argentina
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Samaranayake LP, K. Cheung L, Samaranayake YH. Candidiasis and other fungal diseases of the mouth. Dermatol Ther 2002. [DOI: 10.1046/j.1529-8019.2002.01533.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Ferreira OG, Cardoso SV, Borges AS, Ferreira MS, Loyola AM. Oral histoplasmosis in Brazil. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 2002; 93:654-9. [PMID: 12142871 DOI: 10.1067/moe.2002.122588] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE We report 10 cases of histoplasmosis with oral manifestations seen in a teaching hospital in Brazil. STUDY DESIGN This is a retrospective study of the sociodemographic, clinicopathologic, and treatment data of these cases. RESULTS Overall, 8 of 10 cases were seropositive for human immunodeficiency virus (HIV), whereas 2 were negative. The predominant oral manifestations found in HIV-seropositive patients were ulcers, oral pain, and odynophagia; both of the HIV-seronegative patients were symptom-free. HIV infection was suspected in 7 cases because of the presence of oral lesions of histoplasmosis. Asthenia, fever, weight loss, lymphadenopathy, and hepatosplenomegaly were found only in HIV-seropositive patients. Radiographs in 3 out of 10 patients suggested pulmonary involvement. Amphotericin B was the antifungal therapy chosen, and clinical remission of oral lesions occurred in an average of 30 days (accumulated doses: 500-1500 mg). Itraconazole was very effective as a follow-up treatment in terms of prevention of recurrence. CONCLUSION Histoplasmosis only rarely affects HIV-seronegative patients; however, the possibility of hidden immunodepression should be considered when oral manifestations of histoplasmosis are present.
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75
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Affiliation(s)
- Harrys A Torres
- University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA
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76
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Clemons KV, Martinez M, Calderon L, Stevens DA. Efficacy of ravuconazole in treatment of systemic murine histoplasmosis. Antimicrob Agents Chemother 2002; 46:922-4. [PMID: 11850289 PMCID: PMC127511 DOI: 10.1128/aac.46.3.922-924.2002] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Ravuconazole (RCZ) was evaluated for efficacy in comparison to fluconazole (FCZ) and itraconazole (ITZ) in murine models of disseminated histoplasmosis. All regimens tested prolonged survival (P < 0.05 to 0.0001). At equivalent doses of 50 mg/kg of body weight, RCZ and ITZ were equally effective and RCZ was more effective than FCZ (P = 0.02). Clearance of fungal burden from the livers and spleens of mice showed RCZ and ITZ at doses of 50 mg/kg to be efficacious but not curative. These data indicate that RCZ should be studied further.
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Affiliation(s)
- K V Clemons
- California Institute for Medical Research. Division of Infectious Diseases, Department of Medicine, Santa Clara Valley Medical Center, San Jose, California 95128, USA.
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77
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Abstract
Systemic fungal infections continue to be a major cause of morbidity and mortality among HIV-infected patients. Mucosal candidiasis remains the most common fungal disease in this population, while cryptococcosis and aspergillosis are associated with significant mortality. Histoplasmosis and penicilliosis are relatively common in some areas. Blastomycosis, coccidioidomycosis and paracoccidioidomycosis have also been described in association with HIV. Over the last decade, a number of clinical trials have evaluated the use of antifungal therapies in this population and shaped our approach to prophylaxis and therapy. This report outlines the state of the art in the management of HIV-associated fungal infections and discusses the unique difficulties and drug-drug interactions associated with managing fungal infections in this population. Deoxycholate or liposomal formulations of amphotericin B and the triazoles fluconazole and itraconazole are the most commonly used antifungal agents. Healthcare providers should be familiar with the appropriate antifungal management and its limitations. Possible interactions with antiretrovirals should be considered when prescribing antifungal treatment. An exciting new decade in antifungal therapy is beginning, in which the second-generation triazoles and echinocandins will hopefully help us to overcome the limitations of the current antifungal arsenal.
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Affiliation(s)
- Francisco Marty
- Infectious Disease Division, Massachusetts General and Brigham and Women's Hospitals, Harvard Medical School, Boston, USA
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78
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Abstract
In recent years many remarkable changes occurred in our way of life, producing opportunities for microbes. All these changes are related to the recent emergence of previously unrecognized diseases, or the resurgence of diseases that, at least in developed countries, were thought to be under control. This concept is reviewed regarding fungal infections and their agents in the immunocompromised host. The changing pattern of these infections, the portals of entry of fungi into the human host, fungal pathogenicity and the main predisposing factors are analyzed. Opportunistic fungal infections in cancer, organ transplant and acquired immunodeficiency syndrome patients are reviewed, specially candidiasis and aspergillosis.
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Affiliation(s)
- B Wanke
- Serviço de Micologia, Centro de Pesquisa Hospital Evandro Chagas-Fiocruz, Av. Brasil 4365, 21045-900 Rio de Janeiro, RJ, Brasil.
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79
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Suh KN, Anekthananon T, Mariuz PR. Gastrointestinal histoplasmosis in patients with AIDS: case report and review. Clin Infect Dis 2001; 32:483-91. [PMID: 11170958 DOI: 10.1086/318485] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Histoplasmosis is the most common endemic mycosis in individuals with AIDS, occurring in 2%-5% of this population. Infection is more likely to be disseminated than in immunocompetent individuals and generally presents insidiously with nonspecific symptoms. The gastrointestinal tract is involved in 70%-90% of cases of disseminated histoplasmosis, yet gastrointestinal histoplasmosis per se is infrequently encountered in patients with AIDS. The diagnosis of gastrointestinal histoplasmosis is often not suspected, particularly in areas of nonendemicity, and a delay in diagnosis may lead to increased morbidity and risk of death. Since antifungal therapy improves outcome for >80% of AIDS patients with histoplasmosis, it is essential that caregivers be aware of the varied presentations of gastrointestinal histoplasmosis in order to diagnose and to treat this potentially life-threatening infection effectively.
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Affiliation(s)
- K N Suh
- Infectious Diseases Unit, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
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80
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Clemons KV, Lutz JE, Stevens DA. Efficacy of interferon-gamma and amphotericin B for the treatment of systemic murine histoplasmosis. Microbes Infect 2001; 3:3-10. [PMID: 11226849 DOI: 10.1016/s1286-4579(00)01347-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The number of cases of systemic histoplasmosis has increased substantially in recent years, and improved therapy is needed. We examined the efficacy of immunomodulation with interferon (IFN)-gamma alone or in combination with a suboptimal regimen of amphotericin B for the treatment of primary systemic murine histoplasmosis. In the first study, BALB/c mice were infected with Histoplasma capsulatum G217B and treated with 10(5) U of IFN given every other day either preinfection and postinfection or only postinfection, alone or in combination with amphotericin B. IFN alone given subcutaneously (s.c.) postinfection prolonged survival over untreated controls (P < 0.01), whereas intravenous (i.v.) administration was ineffective. All combination regimens and amphotericin B alone significantly prolonged survival (P < 0.0001). The combination regimens of amphotericin B and IFN i.v. (pre- and postinfection) or IFN s.c. (postinfection) reduced the fungal burden in the liver and spleen; the latter regimen had superior efficacy in the spleen (P < 0.05) to either amphotericin B or IFN alone. After infection with a low-challenge inoculum, IFN given s.c. (pre- and postinfection) alone caused a significant reduction in fungal burden in the spleen (P < 0.001). In an acutely lethal model, combination regimens of IFN s.c. or i.v. and amphotericin B again prolonged survival (P < 0.01-0.001), with amphotericin B plus IFN given s.c. (pre- and postinfection) superior to all regimens (P < 0.05-0.01). This regimen also showed enhanced efficacy in causing the reduction of fungal burden in the spleen (P < 0.05). These results indicate that IFN in combination with AmB shows enhanced efficacy in the treatment of systemic histoplasmosis and support the potential utility of IFN as an adjunctive therapy.
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Affiliation(s)
- K V Clemons
- California Institute for Medical Research and Division of Infectious Diseases, Department of Medicine, Santa Clara Valley Medical Center, San Jose, CA 95128, USA.
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81
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Rodríguez G, Ordóñéz N, Motta A. Histoplasma capsulatum var. capsulatum within cutaneous nerves in patients with disseminated histoplasmosis and AIDS. Br J Dermatol 2001; 144:205-7. [PMID: 11167720 DOI: 10.1046/j.1365-2133.2001.03988.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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82
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Sorensen KN, Clemons KV, Stevens DA. Murine models of blastomycosis, coccidioidomycosis, and histoplasmosis. Mycopathologia 2000; 146:53-65. [PMID: 10822504 DOI: 10.1023/a:1007081707287] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Animal models have contributed much to the knowledge of fungal infections and their corresponding therapeutic treatments. This is true for animal models of the primary fungal pathogens, Blastomyces dermatitidis, Coccidioides immitis, and Histoplasma capsulatum. This review gives a brief background of human diseases associated with these organisms and describes the development, details, and utility of murine models of blastomycosis, as well as coccidioidomycosis and histoplasmosis.
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Affiliation(s)
- K N Sorensen
- Department of Medicine, Santa Clara Valley Medical Center, San Jose, California 95128, USA
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83
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Clinical Prediction Model for Differentiation of Disseminated Histoplasma capsulatum and Mycobacterium avium Complex Infections in Febrile Patients With AIDS. J Acquir Immune Defic Syndr 2000. [DOI: 10.1097/00042560-200005010-00005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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84
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Graviss EA, Vanden Heuvel EA, Lacke CE, Spindel SA, White AC, Hamill RJ. Clinical prediction model for differentiation of disseminated Histoplasma capsulatum and Mycobacterium avium complex infections in febrile patients with AIDS. J Acquir Immune Defic Syndr 2000; 24:30-6. [PMID: 10877492 DOI: 10.1097/00126334-200005010-00005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Disseminated infection with Histoplasma capsulatum and Mycobacterium avium complex (MAC) in patients with AIDS are frequently difficult to distinguish clinically. METHODS We retrospectively compared demographic information, other opportunistic infections, medications, symptoms, physical examination findings and laboratory parameters at the time of hospital presentation for 32 patients with culture documented disseminated histoplasmosis and 58 patients with disseminated MAC infection. RESULTS Positive predictors of histoplasma infection by univariate analysis included lactate dehydrogenase level, white blood cell (WBC) count, platelet count, alkaline phosphatase level, and CD4 cell count. By multivariate logistic regression analysis, those characteristics that remained significant included a lactate dehydrogenase value > or =500 U/L (risk ratio [RR], 42; 95% confidence interval [CI], 18.53-97.5; p < .001), alkaline phosphatase < or =300 U/L (RR, 9.35; 95% CI, 2.61-33.48; p = .008), WBC < or =4.5 x 10(6)/L (RR, 21.29; 95% CI, 6.79-66.75; p = .008), and CD4 cell count (RR, 0.958; 95% CI, 0.946-0.971; p = .001). CONCLUSIONS A predictive model for distinguishing disseminated histoplasmosis from MAC infection was developed using lactate dehydrogenase and alkaline phosphatase levels as well as WBC count. This model had a sensitivity of 83%, a specificity of 91%, and a misclassification rate of 13%.
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Affiliation(s)
- E A Graviss
- Section of Infectious Diseases, Veterans Affairs Medical Center, Houston, Texas 77030-4211, USA
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85
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Abstract
Most species of Penicillium are considered relatively benign with respect to causing human disease. However, one species, P. marneffei, has emerged as a significant pathogen particularly among individuals who live in Southeast Asia and are concurrently infected with the human immunodeficiency virus. While environmental and epidemiological studies have yet to resolve the reason for the heightened virulence of P. marneffi, one characteristic does distinguish this fungus from other Penicillium species. Whereas the latter grow as monomorphic moulds bearing typical asexual propagules (conidia), P. marneffei is thermally dimorphic. At room temperature, P. marneffei exhibits the morphology characteristic of the genus. In contrast to other Penicillia, though, P. marneffei grows as a yeast-like entity (arthroconidium) when found in diseased tissue or cultivated at 37 degrees C. Studies in our laboratory have focused on the differential gene expression between the mould and arthroconidial phases. Many of the genes whose expression differs during mould-to-arthrocondium transition are related to energy metabolism. A better understanding of gene expression during morphogenesis in P. marneffei may help detect unique target sites or cellular processes that can be exploited in the development of antifungal agents or immunomodulation therapies.
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Affiliation(s)
- C R Cooper
- WHO Collaborating Center for Tropical Diseases, Department of Pathology, University of Texas Medical Branch, Galveston 77555-0609, USA.
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86
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Cimerman S, Sokolowski W, Gonçalves SE, Lins MS, Colombo AL. Case report. Histoplasmosis in an AIDS paediatric patient. Mycoses 1999; 42:567-9. [PMID: 10592703 DOI: 10.1046/j.1439-0507.1999.00485.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Histoplasmosis has been little reported among HIV-infected children. We report a case of a 4-year old boy with AIDS who presented with disseminated histoplasmosis diagnosed by lung biopsy. The patient had a good clinical response to amphotericin B followed by itraconazole oral solution.
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87
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LORTHOLARY 2 O, IMPROVISI L, NICOLAS M, PROVOST F, DUPONT B, DROMER F. Fungemia during murine cryptococcosis sheds some light on pathophysiology 1. Med Mycol 1999. [DOI: 10.1046/j.1365-280x.1999.00215.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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88
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Reyes-Montes MR, Bobadilla-Del Valle M, Martínez-Rivera MA, Rodríguez-Arellanes G, Maravilla E, Sifuentes-Osornio J, Taylor ML. Relatedness analyses of Histoplasma capsulatum isolates from Mexican patients with AIDS-associated histoplasmosis by using histoplasmin electrophoretic profiles and randomly amplified polymorphic DNA patterns. J Clin Microbiol 1999; 37:1404-8. [PMID: 10203495 PMCID: PMC84786 DOI: 10.1128/jcm.37.5.1404-1408.1999] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The present paper analyzes the histoplasmin electrophoretic profiles and the randomly amplified polymorphic DNA (RAPD) patterns of the fungus Histoplasma capsulatum isolated from Mexican patients with AIDS-associated histoplasmosis. Clinical isolates from Guatemala, Colombia, and Panama, as well as H. capsulatum isolates from different sources in nature, were also processed. All histoplasmin samples shared four antigenic fractions of 200, 49, 10.5, and 8.5 kDa in sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE). According to their percentage of relatedness, based on SDS-PAGE histoplasmin electrophoretic image analysis, H. capsulatum isolates were divided in two groups: group A contained all AIDS-associated isolates studied and two human reference strains from Mexican histoplasmosis patients without AIDS; group B included bat guano, infected bat, and cock excreta isolates from the State of Guerrero, Mexico, plus three human histoplasmosis strains from Guatemala, Panama, and Colombia. Polymorphic DNA patterns evaluated by RAPD-PCR showed three major bands of 4.4, 3.2, and 2.3 kb in most H. capsulatum isolates studied. Four groups were related by DNA polymorphisms: group I was formed by most of the AIDS-associated H. capsulatum isolates studied, one human histoplasmosis strain from Colombia, two human reference strains from Mexican patients without AIDS, and one human histoplasmosis strain from Guatemala. Group II consisted of only a single strain from Panama. Group III included three strains: one from a Mexican patient with AIDS and two isolated from nature in Guerrero (cock excreta and bat guano). The last, group IV, consisted of only one strain isolated from an infected bat, captured in Guerrero. A tight relationship between phenotypic and genotypic characterization was observed, and both analyses could be useful tools for typing H. capsulatum from different sources and geographic origins.
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Affiliation(s)
- M R Reyes-Montes
- Departamento de Microbiología-Parasitología, Facultad de Medicina, UNAM, Mexico City, Mexico
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89
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Abstract
The isolation of auxotrophic markers is important for molecular genetic studies of the dimorphic fungus Histoplasma capsulatum. We have isolated a UV-induced mutant of H. capsulatum, resulting in nonreverting uracil auxotrophy due to a mutation in the URA5 gene. In this study, we show that this mutation is a GG to TA conversion bordering the 5' donor splice site of intron 2. The mutation results in the lack of splicing of intron 2 from the URA5 transcript, and subsequently premature termination of the peptide. This study is the first showing that consensus Group II intron sequences are both utilized and essential for functional expression of a gene in H. capsulatum.
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Affiliation(s)
- D M Retallack
- University of Wisconsin Medical School, Department of Medical Microbiology and Immunology, Madison, WI, USA
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90
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Winburn GB, Yeh KA. Severe Anal Ulceration Secondary to Histoplasma Capsulatum in a Patient with HIV Disease. Am Surg 1999. [DOI: 10.1177/000313489906500406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Severe fungal infections have become increasingly common in the immunocompromised patient, including those infected with human immunodeficiency virus. Histoplasma capsulatum occurs in about five per cent of acquired immunodeficiency syndrome patients in the endemic areas of the Mississippi and Ohio River Valley. Immunocompromised patients who present with severe ulceration and suppuration of the anus require exam under anesthesia and thorough laboratory evaluation for opportunistic infections. Thus, surgeons play a critical role in diagnosis and initiation of treatment. A case of infiltrating H. capsulatum of the anus is presented, including the natural history, presentation, diagnosis, and treatment.
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Affiliation(s)
- Ginger B. Winburn
- Department of Surgery, Medical College of Georgia Hospital and Clinics, Augusta, Georgia
| | - Karen A. Yeh
- Department of Surgery, Medical College of Georgia Hospital and Clinics, Augusta, Georgia
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91
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Retallack DM, Heinecke EL, Gibbons R, Deepe GS, Woods JP. The URA5 gene is necessary for histoplasma capsulatum growth during infection of mouse and human cells. Infect Immun 1999; 67:624-9. [PMID: 9916068 PMCID: PMC96364 DOI: 10.1128/iai.67.2.624-629.1999] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/1998] [Accepted: 11/09/1998] [Indexed: 11/20/2022] Open
Abstract
The Histoplasma capsulatum URA5 gene, which has recently been cloned and disrupted by allelic replacement, encodes orotidine-5'-monophosphate pyrophosphorylase. Inactivation of URA5 by either targeted or UV mutagenesis results in disruption of the pyrimidine biosynthetic pathway and uracil auxotrophy. We examined the effect of uracil auxotrophy due to a ura5 mutation on H. capsulatum virulence in both cell culture and whole-animal models. Uracil auxotrophs of two H. capsulatum restriction fragment length polymorphism classes were found to be avirulent in cultured murine and human cells, as well as in mice. Moreover, virulence could be restored either by supplying a functional URA5 gene in trans or by supplying exogenous uracil during infection in vitro. These experiments demonstrate that the pyrimidine biosynthetic pathway is essential for H. capsulatum growth and virulence.
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Affiliation(s)
- D M Retallack
- Department of Medical Microbiology and Immunology, University of Wisconsin Medical School, Madison, Wisconsin 53706, USA
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92
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Tami TA, Ferlito A, Rinaldo A, Lee KC, Singh B. Laryngeal pathology in the acquired immunodeficiency syndrome: diagnostic and therapeutic dilemmas. Ann Otol Rhinol Laryngol 1999; 108:214-20. [PMID: 10030245 DOI: 10.1177/000348949910800221] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The acquired immunodeficiency syndrome has produced a growing population of patients who, because of their associated immune system compromise, are prone to opportunistic infections and neoplastic diseases. The larynx, with its relatively inaccessible yet critical anatomic location, is a site in which these processes can produce clinical dilemmas, with respect to diagnosis as well as to therapy. By presenting 4 cases involving unusual laryngeal problems in patients infected with the human immunodeficiency virus (HIV), we emphasize these inherent diagnostic and therapeutic problems. Otolaryngologists must be familiar with the many diagnostic possibilities and therapeutic alternatives when HIV-infected patients present with laryngeal complaints.
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Affiliation(s)
- T A Tami
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati, Ohio, USA
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93
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Abstract
Major developments in research into the azole class of antifungal agents during the 1990s have provided expanded options for the treatment of many opportunistic and endemic fungal infections. Fluconazole and itraconazole have proved to be safer than both amphotericin B and ketoconazole. Despite these advances, serious fungal infections remain difficult to treat, and resistance to the available drugs is emerging. This review describes present and future uses of the currently available azole antifungal agents in the treatment of systemic and superficial fungal infections and provides a brief overview of the current status of in vitro susceptibility testing and the growing problem of clinical resistance to the azoles. Use of the currently available azoles in combination with other antifungal agents with different mechanisms of action is likely to provide enhanced efficacy. Detailed information on some of the second-generation triazoles being developed to provide extended coverage of opportunistic, endemic, and emerging fungal pathogens, as well as those in which resistance to older agents is becoming problematic, is provided.
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Affiliation(s)
- D J Sheehan
- Pfizer Pharmaceuticals Group, Pfizer Inc., New York, New York 10017-5755, USA.
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94
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HAMILTON AJ. Serodiagnosis of histoplasmosis, paracoccidioidomycosis and penicilliosis marneffei; current status and future trends. Med Mycol 1998. [DOI: 10.1046/j.1365-280x.1998.00174.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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95
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São Thiago PDT, Santos JID, Steindel M. Histoplasmose em região de palato duro simulando lesão causada por Leishmania. Rev Soc Bras Med Trop 1998. [DOI: 10.1590/s0037-86821998000200009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Os autores relatam um caso de histoplasmose em indivíduo com suspeita clínica de leishmaniose mucosa. A infecção por Leishmania foi descartada, pela negatividade do teste de Montenegro e ausência do parasita. O diagnóstico de histoplasmose foi confirmado pelo encontro do fungo na lesão e o seu isolamento em Ágar-Sabouraud. O tratamento do paciente com anfotericina B resultou na remissão da lesão.
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96
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Abstract
The clinical use of fluconazole in dosages > or = 800 mg/day has been reported in about 900 patients against candidemia, oropharyngeal candidiasis and cryptococcal meningitis in HIV-infected patients as well as for initial therapy of endemic mycoses. Especially in patients with life-threatening infections caused by Candida spp., Cryptococcus neoformans and Coccidioides immitis, the results of a limited number of dose-finding trials with non-neutropenic and HIV-infected patients show dose-dependent response rates. These findings strongly advocate the application of high dose-fluconazole; their evaluation, however, still awaits final clarification. The good safety profile for dosages up to 2000 mg/day and the linear, predictable pharmacokinetics up to 1600 mg/day indicate the excellent tolerability of fluconazole in the clinical situation which justifies prospective, randomized clinical trials with treatment groups as homogeneous as possible for further evaluation of the optimum dosage and duration of treatment.
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Affiliation(s)
- A Penk
- Pfizer GmbH, Abt. Medizin, Karlsruhe, BR Deutschland
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97
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Abstract
We report a case of blastomycosis presenting as epididymitis and prostatitis. The diagnosis was suggested by pathologic findings in the prostate and epididymis and was further supported by serology. The diagnosis was confirmed by culture and special staining. Long-term cure was accomplished after a 12-month course of oral ketoconazole (400 mg/day). Therapy was monitored by culture and serology. Blastomycosis is an unusual but significant pathogen which occasionally presents with genitourinary tract involvement. Effective diagnostic and oral treatment regimens are now available but are dependent on a high degree of suspicion in cases of chronic prostatitis or epididymitis.
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Affiliation(s)
- R Seo
- Department of Urology, Northwestern University Medical School, Chicago, Illinois 60611-7275, USA
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98
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Fredricks DN, Rojanasthien N, Jacobson MA. AIDS-related disseminated histoplasmosis in San Francisco, California. West J Med 1997; 167:315-21. [PMID: 9392979 PMCID: PMC1304617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The published reports of patients with the acquired immunodeficiency syndrome (AIDS) with disseminated histoplasmosis come mostly from institutions located in endemic areas for histoplasmosis, where disease is thought to occur by either primary infection or reactivation. The characteristics of reactivation disease are not well delineated. We describe the clinical features of reactivation disseminated histoplasmosis in 46 residents of San Francisco, California, with AIDS who did not report recent travel to an area endemic for histoplasmosis. Patients presented with illness lasting days to months, manifested most frequently by fever, chills, sweats, cough or dyspnea, gastrointestinal complaints, malaise, and weight loss. Physical examination and imaging studies were notable for hepatosplenomegaly, lymphadenopathy, or abnormal pulmonary findings in more than half of patients. Laboratory studies revealed a high rate of cytopenia, elevated serum lactate dehydrogenase levels, abnormal liver function test values, respiratory alkalosis with hypoxemia, and a median CD4 lymphocyte count of 36 x 10(9) per liter. The clinical presentation of reactivation disseminated histoplasmosis in patients with AIDS living in San Francisco is similar to that of disseminated histoplasmosis reported in patients with AIDS living in endemic areas. Reactivation disseminated histoplasmosis should be considered in any AIDS patient with a low CD4 lymphocyte count, a febrile illness, and a history of travel or residence in an endemic area.
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Affiliation(s)
- D N Fredricks
- Division of Infectious Diseases and Geographic Medicine, Stanford University Medical Center, California, USA
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99
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Abstract
Fluconazole dosages greater than 800 mg day-1 have been reported in about 900 patients treated for candidemia, oropharyngeal candidiasis and cryptococcal meningitis in HIV-infected patients, and for initial therapy of endemic mycoses. In patients with life-threatening infections caused by Candida spp., Cryptococcus neoformans and Coccidioides immitis, results of a limited number of dose-finding trials with non-neutropenic and HIV-infected patients show dose-dependent responses. These study results indicate that higher daily doses of fluconazole than are currently approved for these indications are well tolerated and tend to provide better clinical efficacy in selected patient populations. An excellent safety profile of dosages up to 2000 mg day-1 and linear predictable pharmacokinetics up to 1600 mg day-1 appear to justify further clinical investigations to better determine the optimum dosage and duration of treatment.
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Affiliation(s)
- K H Duswald
- Chirurgische Klinik, Ludwig-Maximilians-Universität München, FR Germany
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100
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Abstract
The number of HIV-infected persons who travel to the developing world is increasing. Pleasure, business, other work, and illness or death in families brings these special travelers to all corners of the world.1,2 Health care providers should ask patients who are seeking advice whether they are HIV-infected or at risk so that these travelers can be adequately protected and prepared. In most instances international travel is feasible, but in some cases itineraries may be modified or additional recommendations may be given to make trips safer and more enjoyable. This paper reviews the health problems that persons with HIV infection may face during international travel, and their prevention.
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