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Tello-Mercado AC, Martínez-Guerra BA, Román-Montes CM, Seoane-Hernandez L, Rangel-Cordero A, Martínez-Gamboa RA, Sifuentes-Osornio J, Ponce-de-León A, González Lara MF, Niembro-Ortega MD. Histoplasmosis Beyond Human Immunodeficiency Virus (HIV): Clinical Characteristics and Outcomes in a Non-HIV Population. Open Forum Infect Dis 2024; 11:ofae079. [PMID: 38887483 PMCID: PMC11181178 DOI: 10.1093/ofid/ofae079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 02/13/2024] [Indexed: 06/20/2024] Open
Abstract
Histoplasmosis is an endemic and invasive mycosis caused by Histoplasma capsulatum. We conducted a retrospective study comparing immunosuppressed patients without human immunodeficiency virus (HIV) with a historical cohort of people with HIV and histoplasmosis. We included 199 patients with proven or probable histoplasmosis, of which 25.1% were people without HIV. Diabetes mellitus, chronic kidney disease, hematologic neoplasms, rheumatologic diseases, and transplantations were more frequent among people without HIV (P < .01). Forty-four percent of immunocompromised patients without HIV died within the first 6-week period following their diagnosis. A high suspicion index for histoplasmosis should be kept in immunosuppressed patients.
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Affiliation(s)
- Andrea C Tello-Mercado
- Infectious Diseases Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Bernardo A Martínez-Guerra
- Infectious Diseases Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Carla M Román-Montes
- Infectious Diseases Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Lisset Seoane-Hernandez
- Infectious Diseases Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Andrea Rangel-Cordero
- Clinical Microbiology Laboratory, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Rosa A Martínez-Gamboa
- Clinical Microbiology Laboratory, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - José Sifuentes-Osornio
- General Direction, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Alfredo Ponce-de-León
- Infectious Diseases Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - María F González Lara
- Infectious Diseases Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
- Clinical Microbiology Laboratory, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - María D Niembro-Ortega
- Infectious Diseases Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
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Riera F, Cortes Luna J, Rabagliatti R, Scapellato P, Caeiro JP, Chaves Magri MM, Sotomayor CE, Rodrigues Falci D. Antifungal stewardship: the Latin American experience. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY : ASHE 2023; 3:e217. [PMID: 38156226 PMCID: PMC10753509 DOI: 10.1017/ash.2023.471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 09/20/2023] [Accepted: 09/21/2023] [Indexed: 12/30/2023]
Abstract
Antifungal stewardship is a critical component of healthcare management that focuses on optimizing the use of antifungal medications to improve patient outcomes, minimize resistance, and reduce healthcare costs. In resource-limited settings, the prevalence of fungal infections remains a significant health concern, often exacerbated by factors such as compromised immune systems, inadequate diagnostic capabilities, and limited access to antifungal agents. This paper reviews the current state of antifungal stewardship practices in developing countries, addressing the unique socioeconomic and healthcare landscape.
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Affiliation(s)
- Fernando Riera
- Division of Infectious Diseases, Sanatorio Allende Córdoba, Córdoba, Argentina
- Infectious Diseases, Universidad Nacional de Córdoba, Córdoba, Argentina
| | - Jorge Cortes Luna
- Medicine Department of Internal Medicine School of Medicine, Universidad Nacional de Colombia, Colombia
| | - Ricardo Rabagliatti
- Departamento de Enfermedades Infecciosas del Adulto, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Pablo Scapellato
- Chief Infectious Diseases Unit, Hospital D.F. Santojanni, Medicina Universidad Favaloro, Argentina
| | - Juan Pablo Caeiro
- HIV/Infectious Diseases Services at AltaMed, Infectious Diseases, Universidad Nacional de Córdoba, Córdoba, Argentina
| | - Marcello Mihalenko Chaves Magri
- Infectious Diseases Services, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Claudia Elena Sotomayor
- CIBICI-CONICET, Facultad de Ciencias Químicas, Universidad Nacional de Córdoba, Laboratory of Innate Immunity to Fungal Pathogens, Córdoba, Argentina
- Departamento de Bioquímica Clínica, Facultad de Ciencias Químicas, Universidad Nacional de Córdoba, Córdoba, Argentina
| | - Diego Rodrigues Falci
- Infectious Diseases Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Infectious Diseases at the School of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
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Gomes Ferreira D, Gadêlha M, Ricardo Vissoci J, Negri M. Impact of invasive fungal infections in men from a state in southern Brazil: A geospatial analysis. Trop Med Int Health 2023; 28:771-779. [PMID: 37559424 DOI: 10.1111/tmi.13925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/11/2023]
Abstract
OBJECTIVE To analyse the records of male hospitalisation for fungal infections, including their spatial distribution and the main invasive epidemiological and sociodemographic characteristics in the State of Paraná, Brazil. METHODS Spatial analysis based on data from male admission records for invasive fungal infections (IFIs) in the State of Paraná, from 2015 to 2019. Data were taken from the hospital records obtained in the Hospital Information System of the Unified Health System, being collected, georeferenced and analysed to infer the existence of autocorrelation with the hospitalisation rates in the state. RESULTS From 2015 to 2019, there were 385 cases of IFIs in men, being more prevalent in white individuals aged 61-70 years. We observed that the metropolitan, southeast, central-eastern, north-central, northwestern and western regions formed high-high clusters, with regions with a high number of registered cases. In the regression, there was an association with socioeconomic and demographic factors that showed a correlation with the rates of hospitalisation for IFIs. CONCLUSION The study draws attention to Paraná as an endemic region for paracoccidioidomycosis, in addition to presenting high rates of nosocomial fungal infections. We also emphasise the importance of compulsory notification in the state and in the country to gain greater control over the incidence and prevalence of cases and to incentivise the creation of public policies for the prevention of IFIs.
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Affiliation(s)
| | - Marina Gadêlha
- Post-graduate Program in Health Sciences, Universidade Estadual de Maringá, Maringá, Brazil
| | | | - Melyssa Negri
- Department of Clinical Analysis, Universidade Estadual de Maringá, Maringá, Brazil
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Chakrabarti A, Patel AK, Soman R, Todi S. Overcoming clinical challenges in the management of invasive fungal infections in low- and middle-income countries (LMIC). Expert Rev Anti Infect Ther 2023; 21:1057-1070. [PMID: 37698201 DOI: 10.1080/14787210.2023.2257895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 09/07/2023] [Indexed: 09/13/2023]
Abstract
INTRODUCTION The management of invasive fungal infections (IFIs) in low- and middle-income countries (LMIC) is a serious challenge due to limited epidemiology studies, sub-optimal laboratory facilities, gap in antifungal management training and resources. Limited studies highlighted distinctive epidemiology of IFIs in those countries, and difficulty in distinguishing from closely related infections. To overcome the gaps for appropriate management of IFIs, innovative approaches are required. AREAS COVERED Extensive literature search and discussion with experts have helped us to summarize the epidemiology, diagnostic and management difficulties in managing IFIs in LMIC, and recommend certain solutions to overcome the challenges. EXPERT OPINION The strategies to overcome the challenges in diagnosis may include local epidemiology study, training of healthcare workers, association of fungal infections with already existing budgeted national programs, development and incorporation of point-of-care test (POCT) for prompt diagnosis, simplifying clinical diagnostic criteria suitable for LMIC, judicious use of available expertise, and diagnostic stewardship. For management strategies judicious use of antifungal, partnering with industry for inexpensive antifungal agents, development of LMIC specific guidelines for cost-effective management of IFIs and fungal outbreaks, improvement of infection control practices, advocacy for implementation of WHO recommended antifungal use, and integration of IFIs with public health.
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Affiliation(s)
- Arunaloke Chakrabarti
- Department of Infectious Disease and Microbiology, Doodhadhari Burfani Hospital & Research Institute, Haridwar, India
| | - Atul K Patel
- Infectious Diseases Department, Sterling Hospital, Ahmedabad, India
| | - Rajeev Soman
- Infectious Diseases Physician, Jupiter Hospital and Deenanath Mangeskar Hospital, Pune, India
| | - Subhash Todi
- Critical Care and Emergency Medicine, AMRI Hospitals, Kolkata, India
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Mantilla Flórez YF, Uribe YAJ. Letter from Colombia. Respirology 2023; 28:80-81. [PMID: 36375485 DOI: 10.1111/resp.14408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 10/30/2022] [Indexed: 11/16/2022]
Abstract
See Special Series: LEADING WOMEN IN RESPIRATORY MEDICINE
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Affiliation(s)
- Yesid Fabián Mantilla Flórez
- Infectious Diseases Fellowship Program, Pontificia Universidad Javeriana, Bogotá, Colombia
- Infectious Diseases Department, Universidad de La Sabana, Chía, Colombia
- Internal Medicine Department, Clínica de Marly S.A., Bogotá, Colombia
| | - Yei Alberto Jaimes Uribe
- Universidad Industrial de Santander, Bucaramanga, Colombia
- Emergency Department, Clínica de Marly S.A, Bogotá, Colombia
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Paracoccidioidomycosis: What We Know and What Is New in Epidemiology, Diagnosis, and Treatment. J Fungi (Basel) 2022; 8:jof8101098. [PMID: 36294662 PMCID: PMC9605487 DOI: 10.3390/jof8101098] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 10/11/2022] [Accepted: 10/14/2022] [Indexed: 11/29/2022] Open
Abstract
Paracoccidioidomycosis (PCM) is a systemic mycosis endemic to Latin America caused by thermodimorphic fungi of the genus Paracoccidioides. In the last two decades, enhanced understanding of the phylogenetic species concept and molecular variations has led to changes in this genus’ taxonomic classification. Although the impact of the new species on clinical presentation and treatment remains unclear, they can influence diagnosis when serological methods are employed. Further, although the infection is usually acquired in rural areas, the symptoms may manifest years or decades later when the patient might be living in the city or even in another country outside the endemic region. Brazil accounts for 80% of PCM cases worldwide, and its incidence is rising in the northern part of the country (Amazon region), owing to new settlements and deforestation, whereas it is decreasing in the south, owing to agriculture mechanization and urbanization. Clusters of the acute/subacute form are also emerging in areas with major human intervention and climate change. Advances in diagnostic methods (molecular and immunological techniques and biomarkers) remain scarce, and even the reference center’s diagnostics are based mainly on direct microscopic examination. Classical imaging findings in the lungs include interstitial bilateral infiltrates, and eventually, enlargement or calcification of adrenals and intraparenchymal central nervous system lesions are also present. Besides itraconazole, cotrimoxazole, and amphotericin B, new azoles may be an alternative when the previous ones are not tolerated, although few studies have investigated their use in treating PCM.
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Li R, Qiao M, Li S, Wei A, Ren S, Tao M, Zhao Y, Zhang L, Huang L, Shen Y. Antifungal Peptide CGA-N9 Protects Against Systemic Candidiasis in Mice. Int J Pept Res Ther 2022. [DOI: 10.1007/s10989-022-10368-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Ekeng BE, Edem K, Akintan P, Oladele RO. Histoplasmosis in African children: clinical features, diagnosis and treatment. Ther Adv Infect Dis 2022; 9:20499361211068592. [PMID: 35083042 PMCID: PMC8785273 DOI: 10.1177/20499361211068592] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 11/28/2021] [Indexed: 11/17/2022] Open
Abstract
Most of the reviews on histoplasmosis documented in literature have been in the adult population. Very few studies highlight the peculiarities associated with histoplasmosis in Africa especially in the pediatric population. This review addresses the above concerns with clinical summaries and diagnosis of some case reports of histoplasmosis in African children. We highlighted 44 case reports of histoplasmosis in African children (1950–2021) distributed across Western Africa (38.6%, n = 17), Eastern Africa (9.1%, n = 4), Southern Africa (9.1%, n = 4), and Central Africa (43.2%, n = 19). No case report was found from Northern Africa. The age range was 1–17 years, with a mean of 9.2. Of the 44 case reports, 8 cases (18.2%, 8/44) were caused by Histoplasma capsulatum var capsulatum, 33 cases (75%, 33/44) were caused by Histoplasma capsulatum var duboisii, and specie identification was not found in 3 cases. Only three (6.8%) cases were HIV positive; 56.8% (25/44) were disseminated histoplasmosis, pulmonary histoplasmosis accounted for just one case (2.3%, 1/44). Extrapulmonary presentation included skin lesions (ulcers, fistulas, nodules, patches, pigmentations, papules, and abscesses), bone lesions, osteoarthritis, and fractures. The commonest sites affected were skin ( n = 29, 65.9%), bones ( n = 20, 45.5%), and lymph nodes ( n = 15, 34.1%). Histopathology was the commonest diagnostic method ( n = 33, 75%). Amphotericin B was first-line therapy in 45.5% of the cases ( n = 20) followed by ketoconazole (20.5%, n = 9); 27 cases (61.4%) had favorable outcomes, 8 cases (18.2%) had fatal outcomes, while in 9 cases, the outcome was not revealed. This review revealed several cases of histoplasmosis misdiagnosed as other conditions including tuberculosis ( n = 3, 6.8%), pneumonia ( n = 1, 2.3%), cancers ( n = 4, 9.1%), nephritic syndrome ( n = 1, 2.3%), leishmaniasis ( n = 1, 2.3%), and hyperreactive malarial splenomegaly syndrome ( n = 1, 2.3%). In addition, histoplasmosis was not considered in some case reports even when symptoms were suggestive. Diagnosis of histoplasmosis was made at autopsy with postmortem findings suggestive of histoplasmosis ( n = 3, 6.8%). This report highlights the need for a paradigm shift on the part of pediatricians in Africa. They need to look beyond clinical conditions considered common in our environment for this age group and evaluate for other diseases including histoplasmosis.
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Affiliation(s)
- Bassey Ewa Ekeng
- Department of Medical Microbiology and Parasitology, University of Calabar Teaching Hospital, Calabar 540271, Nigeria
- Medical Mycology Society of Nigeria, Lagos, Nigeria
| | - Kevin Edem
- Department of Paediatrics, University of Uyo Teaching Hospital, Uyo, Nigeria
| | - Patricia Akintan
- Department of Paediatrics, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Rita O. Oladele
- Department of Medical Microbiology and Parasitology, Faculty of Basic Medical Sciences, College of Medicine, University of Lagos, Lagos, NigeriaMedical Mycology Society of Nigeria, Nigeria
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Medina N, Rodriguez-Tudela JL, Aguirre L, Salazar LR, Gamboa O, Bonilla O, Pérez JC, Arathoon E, Denning DW, Alastruey-Izquierdo A. Incidence of Histoplasmosis in a Cohort of People with HIV: From Estimations to Reality. Microorganisms 2021; 9:microorganisms9122596. [PMID: 34946197 PMCID: PMC8703839 DOI: 10.3390/microorganisms9122596] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 12/06/2021] [Accepted: 12/11/2021] [Indexed: 11/24/2022] Open
Abstract
Among people with HIV, histoplasmosis represents an important cause of mortality. Previous studies provided estimates of the disease incidence. Here, we compared those estimates with the results obtained from a screening program implemented in Guatemala, which included histoplasmosis detection for people with HIV. To compare the results of this program with previous estimations, a literature search was performed and reports concerning histoplasmosis incidence were analyzed. The screening program enrolled 6366 patients. The overall histoplasmosis incidence in the screening program was 7.4%, which was almost double that estimated in previous studies. From 2017 to 2019, the screening program showed an upward trend in histoplasmosis cases from 6.5% to 8.8%. Histoplasmosis overall mortality among those who were newly HIV diagnosed showed a decrease at 180 days from 32.8% in 2017 to 21.2% in 2019. The screening approach using rapid diagnostic assays detects histoplasmosis cases more quickly, allowing a specific treatment to be administered, which decreases the mortality of the disease. Therefore, the use of these new techniques, especially in endemic areas of histoplasmosis, must be implemented.
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Affiliation(s)
- Narda Medina
- Asociación de Salud Integral, Guatemala City 01001, Guatemala; (N.M.); (L.A.); (L.R.S.); (O.G.); (E.A.)
| | | | - Luis Aguirre
- Asociación de Salud Integral, Guatemala City 01001, Guatemala; (N.M.); (L.A.); (L.R.S.); (O.G.); (E.A.)
| | - Luis R. Salazar
- Asociación de Salud Integral, Guatemala City 01001, Guatemala; (N.M.); (L.A.); (L.R.S.); (O.G.); (E.A.)
| | - Osmar Gamboa
- Asociación de Salud Integral, Guatemala City 01001, Guatemala; (N.M.); (L.A.); (L.R.S.); (O.G.); (E.A.)
| | - Oscar Bonilla
- Clínica Familiar “Luis Ángel García”, Hospital General San Juan de Dios, Guatemala City 01001, Guatemala; (O.B.); (J.C.P.)
| | - Juan C. Pérez
- Clínica Familiar “Luis Ángel García”, Hospital General San Juan de Dios, Guatemala City 01001, Guatemala; (O.B.); (J.C.P.)
| | - Eduardo Arathoon
- Asociación de Salud Integral, Guatemala City 01001, Guatemala; (N.M.); (L.A.); (L.R.S.); (O.G.); (E.A.)
- Clínica Familiar “Luis Ángel García”, Hospital General San Juan de Dios, Guatemala City 01001, Guatemala; (O.B.); (J.C.P.)
| | - David W. Denning
- Global Action Fund for Fungal Infections, 01564 Geneva, Switzerland; (J.L.R.-T.); (D.W.D.)
- The National Aspergillosis Centre, University Hospital of South Manchester, Manchester M23 9LT, UK
- Manchester Academic Health Science Centre, School of Medicine, The University of Manchester, Manchester M23 9LT, UK
| | - Ana Alastruey-Izquierdo
- Global Action Fund for Fungal Infections, 01564 Geneva, Switzerland; (J.L.R.-T.); (D.W.D.)
- Mycology Reference Laboratory, National Centre for Microbiology, Instituto de Salud Carlos III, 28222 Madrid, Spain
- Correspondence:
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López-Romero T, Ramírez-Bravo OE, Camargo-Rivera EE, Jiménez-García D, Bernal-Mendoza H, Marques R. Detection of mucormycosis caused by Apophysomyces elegans in a Lesser Long-nosed Bat (Leptonycteris yerbabuenae) in Central Mexico. NEOTROPICAL BIOLOGY AND CONSERVATION 2021. [DOI: 10.3897/neotropical.16.e73365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
We describe a case of mucormycosis in a Lesser Long-nosed Bat (Leptonycteris yerbabuenae) caused by Apophysomyces elegans in Puebla, Central Mexico. The diagnosis was supported by laboratory analysis and necropsy. We present the first report of the fungus in a wild host; therefore, we indicate that further studies are necessary to understand its infection cycle since this pathogen may indicate a risk of zoonotic, and anthropozoonotic diseases.
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Wang L, Zhang M, Guo J, Guo W, Zhong N, Shen H, Cai J, Zhu Z, Wu W. In vitro activities of the tetrazole VT-1161 compared with itraconazole and fluconazole against Cryptococcus and non- albicans Candida species. Mycologia 2021; 113:918-925. [PMID: 34132632 DOI: 10.1080/00275514.2021.1913949] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Recently, Cryptococcus and non-albicans Candida (NAC) have emerged as health-threatening pathogens for clinical fungal infections. Due to their increased resistance to existing antifungal drugs, novel antifungals are urgently needed. In this study, we evaluated the antifungal effect of VT-1161 and its comparators itraconazole and fluconazole against common fluconazole-sensitive or -resistant Cryptococcus and NAC strains. The tested strains were obtained from Chinese patients by the Invasive Fungal Infection Group within the past 2 years. The minimum inhibitory concentrations (MICs) of VT-1161 and other triazoles were measured according to the Clinical and Laboratory Standards Institute (CLSI) M27-Ed4 guidelines. We found that VT-1161 exhibited strong in vitro activity against Cryptococcus spp.. VT-1161 (geometric mean MIC = 0.024 μg/mL) was 21.7-fold and 104.5-fold more potent than itraconazole and fluconazole, respectively. Against the seven Cryptococcus neoformans isolates with higher fluconazole MICs (≥8 μg/mL based on the MIC90 value of this azole), VT-1161 maintained potent activities, with MICs ranging between 0.031 and 0.5 μg/mL. For NAC spp., VT-1161 (geometric mean MIC = 0.099 μg/mL) was 6.0-fold and 11.4-fold more effective than itraconazole and fluconazole, respectively. There is a positive correlation of the MICs between VT-1161 and itraconazole/fluconazole. The MIC values of VT-1161 against Candida glabrata and Candida tropicalis were significantly lower than those of fluconazole, whereas for Candida parapsilosis the differences in the MIC values between VT-1161 and fluconazole were not statistically significant. The results showed that tetrazole VT-1161 might be a promising candidate for treating Cryptococcus and NAC infections.
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Affiliation(s)
- Lili Wang
- Department of Laboratory Medicine, Shanghai East Hospital, Tongji University School of Medicine, 1800 Yuntai Road, Pudong New District, Shanghai, China
| | - Min Zhang
- Department of Laboratory Medicine, Shanghai East Hospital, Tongji University School of Medicine, 1800 Yuntai Road, Pudong New District, Shanghai, China
| | - Jian Guo
- Department of Laboratory Medicine, Shanghai East Hospital, Tongji University School of Medicine, 1800 Yuntai Road, Pudong New District, Shanghai, China
| | - Wenzheng Guo
- Department of Laboratory Medicine, Shanghai East Hospital, Tongji University School of Medicine, 1800 Yuntai Road, Pudong New District, Shanghai, China
| | - Ni Zhong
- Department of Laboratory Medicine, Shanghai East Hospital, Tongji University School of Medicine, 1800 Yuntai Road, Pudong New District, Shanghai, China
| | - Hui Shen
- Department of Laboratory Medicine, Shanghai East Hospital, Tongji University School of Medicine, 1800 Yuntai Road, Pudong New District, Shanghai, China
| | - Jinfeng Cai
- Shanghai Public Health Clinical Center, 2901 Caolang Road, Jinshan District, Shanghai, China
| | - Zhaoqin Zhu
- Shanghai Public Health Clinical Center, 2901 Caolang Road, Jinshan District, Shanghai, China
| | - Wenjuan Wu
- Department of Laboratory Medicine, Shanghai East Hospital, Tongji University School of Medicine, 1800 Yuntai Road, Pudong New District, Shanghai, China
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Martínez-Gamboa A, Niembro-Ortega MD, Torres-González P, Santiago-Cruz J, Velázquez-Zavala NG, Rangel-Cordero A, Crabtree-Ramírez B, Gamboa-Domínguez A, Reyes-Gutiérrez E, Reyes-Terán G, Lozano-Fernandez VH, Ahumada-Topete VH, Martínez-Ayala P, Manríquez-Reyes M, Ramírez-Hinojosa JP, Rodríguez-Zulueta P, Hernández-León C, Ruíz-Quiñones J, Rivera-Martínez NE, Chaparro-Sánchez A, Andrade-Villanueva J, González-Hernández LA, Cruz-Martínez S, Flores-Barrientos O, Gaytán-Martínez JE, Magaña-Aquino M, Cervantes-Sánchez A, Olivas-Martínez A, Araujo-Meléndez J, del Rocío Reyes-Montes M, Duarte-Escalante E, Frías-De León MG, Ramírez JA, Taylor ML, de León-Garduño AP, Sifuentes-Osornio J. Diagnostic accuracy of antigen detection in urine and molecular assays testing in different clinical samples for the diagnosis of progressive disseminated histoplasmosis in patients living with HIV/AIDS: A prospective multicenter study in Mexico. PLoS Negl Trop Dis 2021; 15:e0009215. [PMID: 33684128 PMCID: PMC7971897 DOI: 10.1371/journal.pntd.0009215] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 03/18/2021] [Accepted: 02/06/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The progressive disseminated histoplasmosis (PDH) has been associated with severe disease and high risk of death among people living with HIV (PLWHIV). Therefore, the purpose of this multicenter, prospective, double-blinded study done in ten Mexican hospitals was to determine the diagnostic accuracy of detecting Histoplasma capsulatum antigen in urine using the IMMY ALPHA Histoplasma EIA kit (IAHE), clarus Histoplasma GM Enzyme Immunoassay (cHGEI IMMY) and MiraVista Histoplasma Urine Antigen LFA (MVHUALFA); as well as the Hcp100 and 1281-1283220SCAR nested PCRs in blood, bone-marrow, tissue biopsies and urine. METHODOLOGY/PRINCIPAL FINDINGS We included 415 PLWHIV older than 18 years of age with suspicion of PDH. Using as diagnostic standard recovery of H. capsulatum in blood, bone marrow or tissue cultures, or histopathological exam compatible, detected 108 patients (26%, [95%CI, 21.78-30.22]) with proven-PDH. We analyzed 391 urine samples by the IAHE, cHGEI IMMY and MVHUALFA; the sensitivity/specificity values obtained were 67.3% (95% CI, 57.4-76.2) / 96.2% (95% CI, 93.2-98.0) for IAHE, 91.3% (95% CI, 84.2-96.0) / 90.9% (95% CI, 87.0-94.0) for cHGEI IMMY and 90.4% (95% CI, 83.0-95.3) / 92.3% (95% CI, 88.6-95.1) for MVHUALFA. The Hcp100 nested PCR was performed on 393, 343, 75 and 297, blood, bone marrow, tissue and urine samples respectively; the sensitivity/specificity values obtained were 62.9% (95%CI, 53.3-72.5)/ 89.5% (95%CI, 86.0-93.0), 65.9% (95%CI, 56.0-75.8)/ 89.0% (95%CI, 85.2-92.9), 62.1% (95%CI, 44.4-79.7)/ 82.6% (95%CI, 71.7-93.6) and 34.9% (95%CI, 24.8-46.2)/ 67.3% (95%CI, 60.6-73.5) respectively; and 1281-1283220SCAR nested PCR was performed on 392, 344, 75 and 291, respectively; the sensitivity/specificity values obtained were 65.3% (95% CI, 55.9-74.7)/ 58.8% (95%CI, 53.2-64.5), 70.8% (95%CI, 61.3-80.2)/ 52.9% (95%CI, 46.8-59.1), 71.4% (95%CI, 54.7-88.2)/ 40.4% (95%CI, 26.4-54.5) and 18.1% (95%CI, 10.5-28.1)/ 90.4% (95%CI, 85.5-94.0), respectively. CONCLUSIONS/SIGNIFICANCE The cHGEI IMMY and MVHUALFA tests showed excellent performance for the diagnosis of PDH in PLWHIV. The integration of these tests in clinical laboratories will certainly impact on early diagnosis and treatment.
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Affiliation(s)
- Areli Martínez-Gamboa
- Department of Infectious Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; Tlalpan, Mexico City, Mexico
| | - María Dolores Niembro-Ortega
- Department of Infectious Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; Tlalpan, Mexico City, Mexico
| | - Pedro Torres-González
- Department of Infectious Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; Tlalpan, Mexico City, Mexico
| | - Janeth Santiago-Cruz
- Department of Infectious Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; Tlalpan, Mexico City, Mexico
| | - Nancy Guadalupe Velázquez-Zavala
- Department of Infectious Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; Tlalpan, Mexico City, Mexico
| | - Andrea Rangel-Cordero
- Department of Infectious Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; Tlalpan, Mexico City, Mexico
| | - Brenda Crabtree-Ramírez
- Department of Infectious Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; Tlalpan, Mexico City, Mexico
| | - Armando Gamboa-Domínguez
- Department of Pathology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpan, Mexico City, Mexico
| | - Edgardo Reyes-Gutiérrez
- Department of Pathology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpan, Mexico City, Mexico
| | - Gustavo Reyes-Terán
- Centro de Investigación en Enfermedades Infecciosas, Instituto Nacional de Enfermedades Respiratorias Ismael Cosio Villegas; Tlalpan, Mexico City, Mexico
| | - Víctor Hugo Lozano-Fernandez
- Centro de Investigación en Enfermedades Infecciosas, Instituto Nacional de Enfermedades Respiratorias Ismael Cosio Villegas; Tlalpan, Mexico City, Mexico
| | - Víctor Hugo Ahumada-Topete
- Centro de Investigación en Enfermedades Infecciosas, Instituto Nacional de Enfermedades Respiratorias Ismael Cosio Villegas; Tlalpan, Mexico City, Mexico
| | - Pedro Martínez-Ayala
- HIV Unit, Hospital Civil de Guadalajara “Fray Antonio Alcalde”; Guadalajara, Jalisco, Mexico
| | - Marisol Manríquez-Reyes
- Department of Internal Medicine, Hospital de Alta Especialidad de Veracruz; Veracruz, Veracruz, Mexico
| | | | - Patricia Rodríguez-Zulueta
- Department of Infectious Diseases, Hospital General Dr. Manuel Gea González; Tlalpan, Mexico City, Mexico
| | - Christian Hernández-León
- Area of Infectious Diseases, Department of Internal Medicine, Hospital General de Puebla “Dr. Eduardo Vázquez Navarro”; Puebla, Puebla, Mexico
| | - Jesús Ruíz-Quiñones
- Intensive Care Unit, Department of Internal Medicine, Hospital “Dr. Juan Graham Casasus”; Villahermosa, Tabasco, Mexico
| | - Norma Eréndira Rivera-Martínez
- Adult Infectious Diseases Department, Hospital Regional de Alta Especialidad de Oaxaca, HRAEO; San Bartolo Coyotepec, Oaxaca, Mexico
| | - Alberto Chaparro-Sánchez
- Department of Infectious Diseases, Hospital de Infectología del Centro Médico Nacional “La Raza”, Instituto Mexicano del Seguro Social; Azcapotzalco, Mexico City, Mexico
| | | | | | - Sofia Cruz-Martínez
- Adult Infectious Diseases Department, Hospital Regional de Alta Especialidad de Oaxaca, HRAEO; San Bartolo Coyotepec, Oaxaca, Mexico
| | - Oscar Flores-Barrientos
- Intensive Care Unit, Department of Internal Medicine, Hospital “Dr. Juan Graham Casasus”; Villahermosa, Tabasco, Mexico
| | - Jesús Enrique Gaytán-Martínez
- Department of Infectious Diseases, Hospital de Infectología del Centro Médico Nacional “La Raza”, Instituto Mexicano del Seguro Social; Azcapotzalco, Mexico City, Mexico
| | - Martín Magaña-Aquino
- Department of Internal Medicine, Hospital Central Dr. Ignacio Morones Prieto; San Luis Potosí, San Luis Potosí, Mexico
| | - Axel Cervantes-Sánchez
- Department of Infectious Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; Tlalpan, Mexico City, Mexico
| | - Antonio Olivas-Martínez
- Department of Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; Tlalpan, Mexico City, Mexico
| | - Javier Araujo-Meléndez
- Department of Internal Medicine, Hospital Central Dr. Ignacio Morones Prieto; San Luis Potosí, San Luis Potosí, Mexico
| | - María del Rocío Reyes-Montes
- Mycology Unit, Department of Microbiology and Parasitology, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Esperanza Duarte-Escalante
- Mycology Unit, Department of Microbiology and Parasitology, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | | | - José Antonio Ramírez
- Mycology Unit, Department of Microbiology and Parasitology, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - María Lucia Taylor
- Mycology Unit, Department of Microbiology and Parasitology, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Alfredo Ponce de León-Garduño
- Department of Infectious Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; Tlalpan, Mexico City, Mexico
| | - José Sifuentes-Osornio
- Department of Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; Tlalpan, Mexico City, Mexico
- * E-mail:
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13
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Holanda MA, da Silva CR, de A Neto JB, do Av Sá LG, do Nascimento FB, Barroso DD, da Silva LJ, Cândido TM, Leitão AC, Barbosa AD, de Moraes MO, Cc B, Júnior HVN. Evaluation of the antifungal activity in vitro of midazolam against fluconazole-resistant Candida spp. isolates. Future Microbiol 2021; 16:71-81. [PMID: 33459560 DOI: 10.2217/fmb-2020-0080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Aim: The purpose of this study was to evaluate the antifungal activity of midazolam, alone and in association with azoles, against isolates of clinical Candida spp. in planktonic and biofilm form. Materials & methods: The antifungal activity was observed using the broth microdilution technique. Flow cytometry tests were performed to investigate the probable mechanism of action and the comet test and cytotoxicity test were applied to evaluate DNA damage. Results: Midazolam (MIDAZ) showed antifungal activity against planktonic cells (125-250 μg/ml) and reduced the viability of Candida spp. biofilms (125 a 2500 μg/ml). The interaction of MIDAZ against Candida spp. biofilms was observed through scanning electron microscopy, causing alteration of their appearance. Therefore, MIDAZ has antifungal potential against Candida spp.
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Affiliation(s)
- Maria Av Holanda
- Department of Clinical & Toxicological Analysis, School of Pharmacy, Laboratory of Bioprospection in Antimicrobial Molecules (LABIMAN), Federal University of Ceará, Fortaleza, CE 60430 1160, Brazil.,Drug Research & Development Center, Federal University of Ceará, Fortaleza, CE 60430 276, Brazil
| | - Cecília R da Silva
- Department of Clinical & Toxicological Analysis, School of Pharmacy, Laboratory of Bioprospection in Antimicrobial Molecules (LABIMAN), Federal University of Ceará, Fortaleza, CE 60430 1160, Brazil.,Drug Research & Development Center, Federal University of Ceará, Fortaleza, CE 60430 276, Brazil
| | - João B de A Neto
- Department of Clinical & Toxicological Analysis, School of Pharmacy, Laboratory of Bioprospection in Antimicrobial Molecules (LABIMAN), Federal University of Ceará, Fortaleza, CE 60430 1160, Brazil.,Drug Research & Development Center, Federal University of Ceará, Fortaleza, CE 60430 276, Brazil.,University Center Christus, Fortaleza, CE 60160 230, Brazil
| | - Lívia G do Av Sá
- Department of Clinical & Toxicological Analysis, School of Pharmacy, Laboratory of Bioprospection in Antimicrobial Molecules (LABIMAN), Federal University of Ceará, Fortaleza, CE 60430 1160, Brazil.,Drug Research & Development Center, Federal University of Ceará, Fortaleza, CE 60430 276, Brazil
| | - Francisca Bsa do Nascimento
- Department of Clinical & Toxicological Analysis, School of Pharmacy, Laboratory of Bioprospection in Antimicrobial Molecules (LABIMAN), Federal University of Ceará, Fortaleza, CE 60430 1160, Brazil.,Drug Research & Development Center, Federal University of Ceará, Fortaleza, CE 60430 276, Brazil
| | - Daiana D Barroso
- Department of Clinical & Toxicological Analysis, School of Pharmacy, Laboratory of Bioprospection in Antimicrobial Molecules (LABIMAN), Federal University of Ceará, Fortaleza, CE 60430 1160, Brazil.,Drug Research & Development Center, Federal University of Ceará, Fortaleza, CE 60430 276, Brazil
| | - Lisandra J da Silva
- Department of Clinical & Toxicological Analysis, School of Pharmacy, Laboratory of Bioprospection in Antimicrobial Molecules (LABIMAN), Federal University of Ceará, Fortaleza, CE 60430 1160, Brazil.,Drug Research & Development Center, Federal University of Ceará, Fortaleza, CE 60430 276, Brazil
| | - Thiago M Cândido
- Department of Clinical & Toxicological Analysis, School of Pharmacy, Laboratory of Bioprospection in Antimicrobial Molecules (LABIMAN), Federal University of Ceará, Fortaleza, CE 60430 1160, Brazil.,Drug Research & Development Center, Federal University of Ceará, Fortaleza, CE 60430 276, Brazil.,University Center Christus, Fortaleza, CE 60160 230, Brazil
| | - Amanda C Leitão
- Department of Clinical & Toxicological Analysis, School of Pharmacy, Laboratory of Bioprospection in Antimicrobial Molecules (LABIMAN), Federal University of Ceará, Fortaleza, CE 60430 1160, Brazil.,Drug Research & Development Center, Federal University of Ceará, Fortaleza, CE 60430 276, Brazil
| | - Amanda D Barbosa
- Department of Clinical & Toxicological Analysis, School of Pharmacy, Laboratory of Bioprospection in Antimicrobial Molecules (LABIMAN), Federal University of Ceará, Fortaleza, CE 60430 1160, Brazil.,Drug Research & Development Center, Federal University of Ceará, Fortaleza, CE 60430 276, Brazil
| | - Manoel O de Moraes
- Drug Research & Development Center, Federal University of Ceará, Fortaleza, CE 60430 276, Brazil
| | - Bruno Cc
- Drug Research & Development Center, Federal University of Ceará, Fortaleza, CE 60430 276, Brazil
| | - Hélio V Nobre Júnior
- Department of Clinical & Toxicological Analysis, School of Pharmacy, Laboratory of Bioprospection in Antimicrobial Molecules (LABIMAN), Federal University of Ceará, Fortaleza, CE 60430 1160, Brazil.,Drug Research & Development Center, Federal University of Ceará, Fortaleza, CE 60430 276, Brazil
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14
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Magalhães TFF, da Silva CM, Dos Santos LBF, Santos DA, Silva LM, Fuchs BB, Mylonakis E, Martins CVB, de Resende-Stoianoff MA, de Fátima Â. Cinnamyl Schiff bases: synthesis, cytotoxic effects and antifungal activity of clinical interest. Lett Appl Microbiol 2020; 71:490-497. [PMID: 32777092 DOI: 10.1111/lam.13356] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 06/24/2020] [Accepted: 07/12/2020] [Indexed: 02/01/2023]
Abstract
The aim of this study was to synthesize and investigate the in vitro antifungal properties of 23 cinnamyl Schiff bases. In addition, cytotoxic effects of such cinnamyl Schiff bases against human lung, kidney or red blood cells were also checked. The compounds were synthesized in a single-step, 2 min of reaction under microwave irradiation produced up to 97% yield. Six of the 23 cinnamyl Schiff bases possessed antifungal activities against strains of Candida, Aspergillus, Fonsecaea and, particularly, Cryptococcus species. Indeed, cinnamyl Schiff bases 1 and 23 exhibited minimum inhibitory concentration (MIC) values more than twofold lower than fluconazole (FCZ) against all the Cryptococcus neoformans strains (MIC = 1·33, 1·4 and 5·2 µg ml-1 , respectively) and Cryptococcus gattii strains (MIC = 5·3, 2·8 and 9·2 µg ml-1 , respectively) (12 strains of each species) while cinnamyl Schiff base 11 was as potent as FCZ against all strains from both Cryptococcus species. No significant cytotoxic effects were observed for Schiff bases against human lung, kidney or red blood cells, all presenting selective indexes higher than 10. In conclusion, this study revealed cinnamyl Schiff bases, especially 1 and 23, as new lead anticryptococcal agents for the discovery of novel antifungal drugs. SIGNIFICANCE AND IMPACT OF THE STUDY: The occurrence and severity of fungal infections have increased in recent decades due to resistance to available antifungal drugs and the appearance of new emerging pathogens. Thus, the search for new antifungal agents is mandatory. From a series of 23 cinnamyl Schiff bases, two compounds (1 and 23) were interrogated as new anticryptococcal agents without significant cytotoxicity against human lung, kidney or red blood cells. In turns, these new Schiff bases are lead compounds for the discovery of novel antifungal drugs.
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Affiliation(s)
- T F F Magalhães
- Departamento de Microbiologia, ICB, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - C M da Silva
- Grupo de Estudos em Química Orgânica e Biológica (GEQOB), Departamento de Química, ICEx, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - L B F Dos Santos
- Grupo de Estudos em Química Orgânica e Biológica (GEQOB), Departamento de Química, ICEx, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - D A Santos
- Departamento de Microbiologia, ICB, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - L M Silva
- Laboratório de Biologia Celular, Fundação Ezequiel Dias, Belo Horizonte, MG, Brazil
| | - B B Fuchs
- Division of Infectious Diseases, Rhode Island Hospital, Alpert Medical School, Brown University, Providence, RI, USA
| | - E Mylonakis
- Division of Infectious Diseases, Rhode Island Hospital, Alpert Medical School, Brown University, Providence, RI, USA
| | - C V B Martins
- Centro de Engenharias e Ciência Exatas, Universidade Estadual do Oeste do Paraná, Toledo, PR, Brazil
| | - M A de Resende-Stoianoff
- Departamento de Microbiologia, ICB, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Â de Fátima
- Grupo de Estudos em Química Orgânica e Biológica (GEQOB), Departamento de Química, ICEx, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
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15
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Rubio-Carrasquilla M, Santa CD, Rendón JP, Botero-Garcés J, Guimarães AJ, Moreno E, Cano LE. An interferon gamma release assay specific for Histoplasma capsulatum to detect asymptomatic infected individuals: A proof of concept study. Med Mycol 2020; 57:724-732. [PMID: 30534945 DOI: 10.1093/mmy/myy131] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 10/14/2018] [Accepted: 11/07/2018] [Indexed: 12/17/2022] Open
Abstract
Histoplasmosis is the most common endemic mycosis in the Americas. Currently, there is no laboratory test capable to detect subclinical or latent infections by Histoplasma capsulatum (Hc), which might develop as severe infections in immunocompromised individuals. For the first time to our knowledge, we explore the suitability of an interferon gamma release assay (IGRA) to detect latent Hc infection in asymptomatic individuals. A cohort of 126 volunteers was enrolled in the study, 13 of which underwent a Hc infection in the past, and 93 of them showing risk factors for this infection. The remaining 20 participants did not refer any risk factors of Hc infection, but eight of them showed evidences of infection with Mycobacterium tuberculosis. All participants were recruited in Medellin, Colombia, between January 2014 and December 2017. Whole blood samples were cultured with four different Hc crude antigens and phytohemaglutinin as positive control. The interferon (IFN)-γ released by T lymphocytes upon antigen stimulation was quantified by ELISA. A defined cutoff value of 20 pg/ml for the IFN-γ concentration allowed us to distinguish between the group with documented past infections and the group of noninfected individuals with high sensitivity (70-92%) and specificity (85-95%), for the four tested antigens. Positive 82-95% and negative 77-92% predictive values were also very high, comparable to those reported for commercially available IGRAs. The new test constitutes a promising screening method to detect individuals with latent Hc infection, even decades after the primary infection, as evidenced in this study.
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Affiliation(s)
- Marcela Rubio-Carrasquilla
- Grupo de Micología Médica y Experimental, Corporación para Investigaciones Biológicas (CIB), Medellín, Colombia.,Instituto de Biología, Universidad de Antioquia, Medellín, Colombia
| | | | - Juan Pablo Rendón
- Grupo de Micología Médica y Experimental, Corporación para Investigaciones Biológicas (CIB), Medellín, Colombia
| | | | - Allan J Guimarães
- Depto de Microbiologia e Parasitologia, Universidade Federal Fluminense, Niterói-RJ, Brasil
| | - Ernesto Moreno
- Facultad de Ciencias Básicas, Universidad de Medellín, Medellín, Colombia
| | - Luz Elena Cano
- Grupo de Micología Médica y Experimental, Corporación para Investigaciones Biológicas (CIB), Medellín, Colombia.,Escuela de Microbiología, Universidad de Antioquia, Medellín, Colombia
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16
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Davis MR, Nguyen MVH, Donnelley MA, Thompson Iii GR. Tolerability of long-term fluconazole therapy. J Antimicrob Chemother 2020; 74:768-771. [PMID: 30535104 DOI: 10.1093/jac/dky501] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 11/04/2018] [Accepted: 11/05/2018] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Fluconazole is a commonly prescribed first-generation triazole antifungal. Although the toxicity profile of fluconazole has been evaluated in clinical trials, there are scant data regarding its tolerability with long-term therapy. Treatment guidelines for coccidioidomycosis recommend fluconazole therapy and severe or disseminated infections can require lifelong treatment. OBJECTIVES To assess the prevalence of long-term fluconazole adverse effects, their consequences for antifungal therapy, time to adverse effects and the association between dosing regimen or fluconazole serum level and adverse effect status. METHODS We conducted a single-centre, retrospective study of adult patients (≥18 years) with proven or probable coccidioidomycosis receiving long-term fluconazole therapy for an intended duration of ≥28 days. RESULTS Out of 124 patients included, 64 (51.6%) experienced adverse effects. The most common adverse effects were xerosis (16.9%), alopecia (16.1%) and fatigue (11.3%). Of the 64 patients experiencing adverse effects, 42 (65.6%) required a therapeutic intervention such as dose reduction, discontinuation or switch to a new antifungal. Patients experiencing adverse effects were prescribed higher total daily fluconazole doses (6.7 versus 5.7 mg/kg; P < 0.01). The median therapeutic drug levels did not differ significantly between patients who experienced adverse effects and those who did not (36.1 versus 28.1 mg/L; P = 0.35). CONCLUSIONS A significant number of patients receiving long-term fluconazole therapy for coccidioidomycosis experienced adverse effects. Of these, around two-thirds required a therapeutic change. We believe these findings are representative of the adverse effect profile of long-term fluconazole therapy as it is used in clinical practice for coccidioidomycosis as opposed to use in clinical trials.
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Affiliation(s)
- Matthew R Davis
- Department of Pharmacy, University of California, Davis Health, Stockton Blvd., Sacramento, CA, USA
| | - Minh-Vu H Nguyen
- Department of Internal Medicine, University of California, Davis Health, V St., Sacramento, CA, USA
| | - Monica A Donnelley
- Department of Pharmacy, University of California, Davis Health, Stockton Blvd., Sacramento, CA, USA
| | - George R Thompson Iii
- Department of Medical Microbiology and Immunology, University of California, Med Science Dr., Davis, CA, USA.,Department of Internal Medicine, Division of Infectious Diseases, University of California, Davis Health, V Street, Suite G500, Sacramento, CA, USA
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17
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Frequency of Invasive Fungal Disease in Adults: Experience of a Specialized Laboratory in Medellín, Colombia (2009-2015). J Fungi (Basel) 2020; 6:jof6010039. [PMID: 32244949 PMCID: PMC7151061 DOI: 10.3390/jof6010039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 03/04/2020] [Accepted: 03/09/2020] [Indexed: 10/27/2022] Open
Abstract
Invasive fungal diseases (IFD) contribute significantly to worldwide morbidity and mortality, but their frequency is not well-described in some countries. The present work describes the frequency of IFD in a specialized laboratory in Colombia. A retrospective, descriptive study was implemented between March 2009 and December 2015. Results: 13,071 patients with clinical suspicion of IFD were referred during the study period, from which 33,516 biological samples were processed and analyzed using 14 laboratory methods. Diagnosis was confirmed in 1425 patients (11%), distributed according to the mycoses of interest analyzed here: histoplasmosis in 641/11,756 patients (6%), aspergillosis in 331/10,985 patients (3%), cryptococcosis in 239/8172 patients (3%), pneumocystosis in 111/1651 patients (7%), paracoccidioidomycosis in 60/10,178 patients (0.6%), and invasive candidiasis in 48/7525 patients (0.6%). From the first year of the study period to the last year, there was a 53% increase in the number of cases of IFD diagnosed. Our laboratory experienced a high frequency of IFD diagnosis, possibly attributable to the availability of a greater range of diagnostic tools. Frequency of IFD in this study was atypical compared with other studies, probably as a result of the single laboratory-site analysis. This demonstrates that implementing educational strategies helps to create a high index of clinical suspicion, while the availability and utilization of appropriate diagnostic assays assure greater reliability in identification of these cases.
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18
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Rodriguez YJ, Quejada LF, Villamil JC, Baena Y, Parra-Giraldo CM, Perez LD. Development of Amphotericin B Micellar Formulations Based on Copolymers of Poly(ethylene glycol) and Poly(ε-caprolactone) Conjugated with Retinol. Pharmaceutics 2020; 12:E196. [PMID: 32106492 PMCID: PMC7150995 DOI: 10.3390/pharmaceutics12030196] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 01/21/2020] [Accepted: 01/22/2020] [Indexed: 12/02/2022] Open
Abstract
Amphotericin B (AmB) is a broad spectrum of antifungal drug used to treat antifungal diseases. However, due to the high toxicity of AmB, treated patients may suffer the risk of side effects, such as renal failure. Nanoencapsulation strategies have been reported to elicit low toxicity, albeit most of them possess low encapsulation efficiency. The aim of this research is to develop micellar delivery systems for AmB with reduced toxicity while maintaining its affectivity by employing retinol (RET)-conjugated amphiphilic block copolymers (ABCs) as precursors. Copolymers composed of poly(ε-caprolactone) (A) and polyethylenglycol (B) of types AB and ABA were synthesized by ring opening polymerization and subsequently conjugated with RET by Steglich esterification. 1H-NMR spectroscopy was used to corroborate the structure of copolymers and their conjugates and determine their molecular weights. Analysis by gel permeation chromatography also found that the materials have narrow distributions. The resulting copolymers were used as precursors for delivery systems of AmB, thus reducing its aggregation and consequently causing a low haemolytic effect. Upon conjugation with RET, the encapsulation capacity was enhanced from approximately 2 wt % for AB and ABA copolymers to 10 wt %. AmB encapsulated in polymer micelles presented improved antifungal efficiency against Candida albicans and Candida auris strains compared with Fungizone®, as deduced from the low minimum inhibitory concentration.
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Affiliation(s)
- Yeimy J. Rodriguez
- Grupo de Investigación en Macromoléculas, Departamento de Química, Facultad de Ciencias, Universidad Nacional de Colombia-Sede Bogotá, Carrera 45 No. 26-85, Edificio 451 of. 449, Bogotá D.C. 11001, Colombia;
| | - Luis F. Quejada
- Unidad de Proteómica y Micosis Humanas, Grupo de Enfermedades Infecciosas Departamento de Microbiología, Facultad de Ciencias, Pontificia Universidad Javeriana, Carrera 7 No. 43-82, Bogotá D.C. 110231, Colombia; (L.F.Q.); (J.C.V.)
| | - Jean C. Villamil
- Unidad de Proteómica y Micosis Humanas, Grupo de Enfermedades Infecciosas Departamento de Microbiología, Facultad de Ciencias, Pontificia Universidad Javeriana, Carrera 7 No. 43-82, Bogotá D.C. 110231, Colombia; (L.F.Q.); (J.C.V.)
| | - Yolima Baena
- Grupo de Investigación SILICOMOBA, Departamento de Farmacia, Facultad de Ciencias, Universidad Nacional de Colombia-Sede Bogotá, Carrera 45 No. 26-85, Edificio 451 of. 449, Bogotá D.C. 11001, Colombia
| | - Claudia M. Parra-Giraldo
- Unidad de Proteómica y Micosis Humanas, Grupo de Enfermedades Infecciosas Departamento de Microbiología, Facultad de Ciencias, Pontificia Universidad Javeriana, Carrera 7 No. 43-82, Bogotá D.C. 110231, Colombia; (L.F.Q.); (J.C.V.)
| | - Leon D. Perez
- Grupo de Investigación en Macromoléculas, Departamento de Química, Facultad de Ciencias, Universidad Nacional de Colombia-Sede Bogotá, Carrera 45 No. 26-85, Edificio 451 of. 449, Bogotá D.C. 11001, Colombia;
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Use of an Argentinean Wildlife Tissue Collection for Epidemiological Studies of Histoplasmosis. Mycopathologia 2020; 185:905-915. [PMID: 31993951 DOI: 10.1007/s11046-020-00430-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Accepted: 01/21/2020] [Indexed: 12/13/2022]
Abstract
Histoplasmosis is a worldwide systemic endemic mycosis caused by several cryptic species included within the Histoplasma capsulatum complex. Domestic and wild mammals are susceptible to infection by this fungus and could be used as indicators of its presence in the environment. The aim of the study was to identify the natural reservoirs of H. capsulatum in the Argentinean Humid Pampas eco-region analyzing a wildlife frozen-tissue collection and trace its distribution patterns over time and space. Tissue samples from 34 small wild mammals caught in the Humid Pampas were analyzed using two molecular markers: 100 kDa protein coding gene (Hcp100) and ITS1 rDNA. Results showed that 32.4% of them were infected with H. capsulatum and its DNA was detected in 5/17 Calomys laucha; 3/6 Calomys musculinus; 1/5 Akodon azarae, 1/3 Monodelphis dimidiata; and 1/2 Didelphis albiventris. In the single specimen studied of Cavia aperea, no H. capsulatum DNA was detected. This is the first H. capsulatum infection report in C. laucha and C. musculinus rodents and M. dimidiate opossum which proves that tissue collections are an important source of material for epidemiological studies of endemic disease over time.
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Pineda J, Merino-Alado R, Mata-Essayag S, Landaeta ME, Garrido L, Rosas MDM. Nasal Septum Perforation Associated to Histoplasmosis: A Retrospective Study. PESQUISA BRASILEIRA EM ODONTOPEDIATRIA E CLÍNICA INTEGRADA 2020. [DOI: 10.1590/pboci.2020.090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Rubio-Carrasquilla M, Ochoa R, Santa C, Guimarães AJ, Cano LE, Moreno E. Identifying molecularly defined antigens for a Histoplasma capsulatum-specific interferon gamma release assay. Rev Iberoam Micol 2019; 36:186-191. [PMID: 31757594 DOI: 10.1016/j.riam.2019.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 05/05/2019] [Accepted: 06/14/2019] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND In a previous work we showed the feasibility of an interferon gamma release assay (IGRA) for detecting latent infection by Histoplasma capsulatum. While in that proof-of-concept study we used crude fungal extracts as antigens, the newest IGRAs developed for other infections are based on molecularly defined antigens, mostly on mixtures of immunogenic peptides. AIMS To identify proteins in H. capsulatum that might serve as molecularly defined antigens for an IGRA test. METHODS We surveyed the literature looking for known H. capsulatum-immunogenic proteins and assayed two of them as antigens in an IGRA test, in a study that involved 80 volunteers. Furthermore, we used several bioinformatics tools to identify specific H. capsulatum proteins and to analyze possible strategies for the design of H. capsulatum-specific immunogenic peptides. RESULTS Seven H. capsulatum-immunogenic proteins were retrieved from the literature. IGRA tests using either the heat shock protein 60 or the M antigen showed high sensitivities but low specificities, most likely due to the high sequence similarity with the corresponding orthologs in other pathogenic microorganisms. We identified around 2000 H. capsulatum-specific proteins, most of which remain unannotated. Class II T-cell epitope predictions for a small number of these proteins showed a great variability among different alleles, prompting for a "brute force" approach for peptide design. CONCLUSIONS The H. capsulatum genome encodes a large number of distinctive proteins, which represent a valuable source of potential specific antigens for an IGRA test. Among them, the Cfp4 protein stands out as a very attractive candidate.
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Affiliation(s)
- Marcela Rubio-Carrasquilla
- Grupo de Micología Médica y Experimental, Corporación para Investigaciones Biológicas (CIB), Medellín, Colombia; Instituto de Biología, Universidad de Antioquia, Medellín, Colombia
| | - Rodrigo Ochoa
- Programa de Estudio y Control de Enfermedades Tropicales - PECET, Universidad de Antioquia, Medellín, Colombia
| | - Cristian Santa
- Universidad Nacional de Colombia, Sede Medellín, Medellín, Colombia
| | - Allan J Guimarães
- Depto de Microbiologia e Parasitologia, Universidade Federal Fluminense, Niterói, RJ, Brazil
| | - Luz Elena Cano
- Grupo de Micología Médica y Experimental, Corporación para Investigaciones Biológicas (CIB), Medellín, Colombia; Escuela de Microbiología, Universidad de Antioquia, Medellín, Colombia
| | - Ernesto Moreno
- Facultad de Ciencias Básicas, Universidad de Medellín, Medellín, Colombia.
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Bonifaz A, Estrada-Caraveo Y, Tirado-Sánchez A. Epidemiology of Endemic Mycosis in Children. CURRENT FUNGAL INFECTION REPORTS 2019. [DOI: 10.1007/s12281-019-00358-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Fillinger RJ, Anderson MZ. Seasons of change: Mechanisms of genome evolution in human fungal pathogens. INFECTION, GENETICS AND EVOLUTION : JOURNAL OF MOLECULAR EPIDEMIOLOGY AND EVOLUTIONARY GENETICS IN INFECTIOUS DISEASES 2019; 70:165-174. [PMID: 30826447 DOI: 10.1016/j.meegid.2019.02.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 02/23/2019] [Accepted: 02/26/2019] [Indexed: 06/09/2023]
Abstract
Fungi are a diverse kingdom of organisms capable of thriving in various niches across the world including those in close association with multicellular eukaryotes. Fungal pathogens that contribute to human disease reside both within the host as commensal organisms of the microbiota and the environment. Their niche of origin dictates how infection initiates but also places specific selective pressures on the fungal pathogen that contributes to its genome organization and genetic repertoire. Recent efforts to catalogue genomic variation among major human fungal pathogens have unveiled evolutionary themes that shape the fungal genome. Mechanisms ranging from large scale changes such as aneuploidy and ploidy cycling as well as more targeted mutations like base substitutions and gene copy number variations contribute to the evolution of these species, which are often under multiple competing selective pressures with their host, environment, and other microbes. Here, we provide an overview of the major selective pressures and mechanisms acting to evolve the genome of clinically important fungal pathogens of humans.
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Affiliation(s)
- Robert J Fillinger
- Department of Microbial Infection and Immunity, The Ohio State University, Columbus, OH 43210, USA
| | - Matthew Z Anderson
- Department of Microbial Infection and Immunity, The Ohio State University, Columbus, OH 43210, USA; Department of Microbiology, The Ohio State University, Columbus, OH 43210, USA.
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Romero M, Messina F, Marin E, Arechavala A, Depardo R, Walker L, Negroni R, Santiso G. Antifungal Resistance in Clinical Isolates of Aspergillus spp.: When Local Epidemiology Breaks the Norm. J Fungi (Basel) 2019; 5:E41. [PMID: 31117260 PMCID: PMC6617206 DOI: 10.3390/jof5020041] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 05/13/2019] [Accepted: 05/16/2019] [Indexed: 11/24/2022] Open
Abstract
Aspergillosis is a set of very frequent and widely distributed opportunistic diseases. Azoles are the first choice for most clinical forms. However, the distribution of azole-resistant strains is not well known around the world, especially in developing countries. The aim of our study was to determine the proportion of non-wild type strains among the clinical isolates of Aspergillus spp. To this end, the minimum inhibitory concentration of three azoles and amphotericin B (used occasionally in severe forms) was studied by broth microdilution. Unexpectedly, it was found that 8.1% of the isolates studied have a diminished susceptibility to itraconazole. This value turned out to be similar to the highest azole resistance rate reported in different countries across the world.
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Affiliation(s)
- Mercedes Romero
- Mycology Unit of the Infectious Diseases Hospital F.J. Muñiz, Reference Center of Mycology of Buenos Aires City, Buenos Aires C1282A, Argentina.
| | - Fernando Messina
- Mycology Unit of the Infectious Diseases Hospital F.J. Muñiz, Reference Center of Mycology of Buenos Aires City, Buenos Aires C1282A, Argentina.
| | - Emmanuel Marin
- Mycology Unit of the Infectious Diseases Hospital F.J. Muñiz, Reference Center of Mycology of Buenos Aires City, Buenos Aires C1282A, Argentina.
| | - Alicia Arechavala
- Mycology Unit of the Infectious Diseases Hospital F.J. Muñiz, Reference Center of Mycology of Buenos Aires City, Buenos Aires C1282A, Argentina.
| | - Roxana Depardo
- Mycology Unit of the Infectious Diseases Hospital F.J. Muñiz, Reference Center of Mycology of Buenos Aires City, Buenos Aires C1282A, Argentina.
| | - Laura Walker
- Mycology Unit of the Infectious Diseases Hospital F.J. Muñiz, Reference Center of Mycology of Buenos Aires City, Buenos Aires C1282A, Argentina.
| | - Ricardo Negroni
- Mycology Unit of the Infectious Diseases Hospital F.J. Muñiz, Reference Center of Mycology of Buenos Aires City, Buenos Aires C1282A, Argentina.
| | - Gabriela Santiso
- Mycology Unit of the Infectious Diseases Hospital F.J. Muñiz, Reference Center of Mycology of Buenos Aires City, Buenos Aires C1282A, Argentina.
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Costa MV, Landgraf TN, Corrêa PC, Souza IEL, Fernandes FF, Panunto-Castelo A. Quantitation of pulmonary fungal burden in Paracoccidioides brasiliensis-infected mice by real-time PCR. Rev Inst Med Trop Sao Paulo 2018; 61:e2. [PMID: 30570075 PMCID: PMC6300791 DOI: 10.1590/s1678-9946201961002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 11/12/2018] [Indexed: 11/21/2022] Open
Abstract
Although colony-forming unit (CFU) counting is widely used to quantify fungal
load in tissue from animal experimentally infected with Paracoccidioides
brasiliensis, several technical disadvantages have been described.
Here we developed highly accurate quantitative PCR (qPCR) assays to determine
the relative P brasiliensis load in lungs from infected mice.
SYBR Green- and TaqMan-based assays using primers and probe for the 43-kDa
glycoprotein (gp43) gene detected as little as 270 gene copies (about 2 fg of
DNA) per reaction. Although qPCR assays cannot distinguish between living and
dead yeasts, we found a highly positive linear correlation between CFU and
qPCR.
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Affiliation(s)
- Marcelo Vieira Costa
- Universidade de São Paulo, Faculdade de Filosofia, Ciências e Letras de Ribeirão Preto, Departamento de Biologia, Ribeirão Preto, São Paulo, Brazil
| | - Taise Natali Landgraf
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Programa de Pós-Graduação em Imunologia Básica e Aplicada, Ribeirão Preto, São Paulo, Brazil
| | - Priscila C Corrêa
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Programa de Pós-Graduação em Imunologia Básica e Aplicada, Ribeirão Preto, São Paulo, Brazil
| | - Igor Emiliano Lemos Souza
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Programa de Pós-Graduação em Imunologia Básica e Aplicada, Ribeirão Preto, São Paulo, Brazil
| | - Fabrício Freitas Fernandes
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Biologia Celular e Molecular, Ribeirão Preto, São Paulo, Brazil
| | - Ademilson Panunto-Castelo
- Universidade de São Paulo, Faculdade de Filosofia, Ciências e Letras de Ribeirão Preto, Departamento de Biologia, Ribeirão Preto, São Paulo, Brazil
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Torres-González P, Niembro-Ortega MD, Martínez-Gamboa A, Ahumada-Topete VH, Andrade-Villanueva J, Araujo-Meléndez J, Chaparro-Sánchez A, Crabtree-Ramírez B, Cruz-Martínez S, Gamboa-Domínguez A, Flores-Barrientos OI, Gaytán-Martínez JE, González-Hernández LA, Hernández-León C, Lozano-Fernandez VH, Manríquez-Reyes M, Magaña-Aquino M, Martínez-Ayala P, Ramírez-Hinojosa JP, Rangel-Cordero A, Rivera-Martínez NE, Reyes-Gutiérrez E, Reyes-Terán G, Rodríguez-Zulueta P, Ruíz-Quiñones J, Santiago-Cruz J, Velázquez-Zavala NG, Sifuentes-Osornio J, Ponce de León A. Diagnostic accuracy cohort study and clinical value of the Histoplasma urine antigen (ALPHA Histoplasma EIA) for disseminated histoplasmosis among HIV infected patients: A multicenter study. PLoS Negl Trop Dis 2018; 12:e0006872. [PMID: 30395572 PMCID: PMC6237426 DOI: 10.1371/journal.pntd.0006872] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 11/15/2018] [Accepted: 09/25/2018] [Indexed: 11/23/2022] Open
Abstract
Background The Histoplasma urine antigen (HUAg) is the preferred method to diagnose progressive disseminated histoplasmosis (PDH) in HIV patients. In 2007, IMMY ALPHA Histoplasma EIA was approved for clinical for on-site use, and therefore useful for regions outside the United States. However, ALPHA-HUAg is considered inferior to the MVista-HUAg which is only available on referral. We aim to evaluate the diagnostic accuracy of ALPHA-HUAg. Methodology/Principal findings We conducted a multicenter, prospective, diagnostic test study in two secondary and eight tertiary-care facilities in Mexico. We included HIV patient with PDH suspicion and evaluated ALPHA-HUAg diagnostic accuracy using as reference standard the Histoplasma capsulatum growth on blood, bone marrow, and tissue cultures or compatible histopathologic exam (PDH–proven). We evaluated the results of 288 patients, 29.5% (85/288; 95% confidence interval [CI], 24.3–35.1) had PDH. The sensitivity of ALPHA-HUAg was 67.1% (95% CI, 56–76.8%) and the specificity was 97.5% (95% CI, 94.3%-99.1%). The positive likelihood ratio was 27.2 (95% CI; 11.6–74.4). In 10.5% of the PDH–proven patients, a co-existing opportunistic infection was diagnosed, mostly disseminated Mycobacterium avium complex infection. Conclusions/Significance We observed a high specificity but low sensitivity of IMMY-HUAg. The test may be useful to start early antifungals, but a culture-based approach is necessary since co-infections are frequent and a negative IMMY-HUAg result does not rule out PDH. Histoplasmosis is an endemic mycosis in many regions of Latin America. In the HIV population it manifests as progressive disseminated histoplasmosis (PDH), an entity hard to diagnose since the causative fungi—Histoplasma capsulatum—is slow growing and requires advance biosafety for its handling. As an alternative, the diagnosis can be made by detecting the histoplasma urinary antigen, but only one kit is commercially available outside the US. We evaluated this kit (IMMY ALPHA Histoplasma EIA) among HIV patients with suspected and found a high specificity but low sensitivity (i.e., a positive histoplasma urine antigen is almost unequivocal, but a negative result does not rule out the PDH). However, we believe the test is useful since the positive likelihood rates show that a patient with PDH is 27 times more likely to have an IMMY-HUAg positive result; this may allow early targeted treatment.
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Affiliation(s)
- Pedro Torres-González
- Department of Infectious Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpan, Mexico City, Mexico
| | - María Dolores Niembro-Ortega
- Department of Infectious Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpan, Mexico City, Mexico
| | - Areli Martínez-Gamboa
- Department of Infectious Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpan, Mexico City, Mexico
| | - Víctor Hugo Ahumada-Topete
- Centro de Investigación en Enfermedades Infecciosas, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Tlalpan, Mexico City, Mexico
| | | | - Javier Araujo-Meléndez
- Department of Internal Medicine, Hospital Central Dr. Ignacio Morones Prieto, San Luis Potosí, San Luis Potosí, Mexico
| | - Alberto Chaparro-Sánchez
- Adult Infectious Diseases Department, Hospital de Infectología del Centro Médico Nacional “La Raza”, Instituto Mexicano del Seguro Social, Atzcapotzalco, Mexico City, Mexico
| | - Brenda Crabtree-Ramírez
- Department of Infectious Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpan, Mexico City, Mexico
| | - Sofia Cruz-Martínez
- Department of Infectious Diseases, Hospital Regional de Alta Especialidad de Oaxaca, HRAEO, San Bartolo Coyotepec, Oaxaca, Mexico
| | - Armando Gamboa-Domínguez
- Department of Pathology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubiran, Tlalpan, Mexico City, Mexico
| | - Oscar I. Flores-Barrientos
- Intensive Care Unit, Department of Internal Medicine, Hospital “Dr. Juan Graham Casasus”, Villahermosa, Tabasco, Mexico
| | - Jesús Enrique Gaytán-Martínez
- Adult Infectious Diseases Department, Hospital de Infectología del Centro Médico Nacional “La Raza”, Instituto Mexicano del Seguro Social, Atzcapotzalco, Mexico City, Mexico
| | | | - Christian Hernández-León
- Area of Infectious Diseases, Department of Internal Medicine, Hospital General de Puebla “Dr. Eduardo Vazquez Navarro”, Puebla, Puebla, Mexico
| | - Víctor Hugo Lozano-Fernandez
- Centro de Investigación en Enfermedades Infecciosas, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Tlalpan, Mexico City, Mexico
| | - Marisol Manríquez-Reyes
- Department of Internal Medicine, Hospital de Alta Especialidad de Veracruz, Veracruz, Veracruz, Mexico
| | - Martin Magaña-Aquino
- Department of Internal Medicine, Hospital Central Dr. Ignacio Morones Prieto, San Luis Potosí, San Luis Potosí, Mexico
| | - Pedro Martínez-Ayala
- HIV Unit, Hospital Civil de Guadalajara “Fray Antonio Alcalde”, Guadalajara, Jalisco, Mexico
| | | | - Andrea Rangel-Cordero
- Department of Infectious Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpan, Mexico City, Mexico
| | - Norma Erendira Rivera-Martínez
- Department of Infectious Diseases, Hospital Regional de Alta Especialidad de Oaxaca, HRAEO, San Bartolo Coyotepec, Oaxaca, Mexico
| | - Edgardo Reyes-Gutiérrez
- Department of Pathology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubiran, Tlalpan, Mexico City, Mexico
| | - Gustavo Reyes-Terán
- Centro de Investigación en Enfermedades Infecciosas, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Tlalpan, Mexico City, Mexico
| | | | - Jesús Ruíz-Quiñones
- Intensive Care Unit, Department of Internal Medicine, Hospital “Dr. Juan Graham Casasus”, Villahermosa, Tabasco, Mexico
| | - Janeth Santiago-Cruz
- Department of Infectious Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpan, Mexico City, Mexico
| | - Nancy Guadalupe Velázquez-Zavala
- Department of Infectious Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpan, Mexico City, Mexico
| | - José Sifuentes-Osornio
- Department of Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpan, Mexico City, Mexico
| | - Alfredo Ponce de León
- Department of Infectious Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpan, Mexico City, Mexico
- * E-mail:
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Oliveira LT, Lopes LG, Ramos SB, Martins CHG, Jamur MC, Pires RH. Fungal biofilms in the hemodialysis environment. Microb Pathog 2018; 123:206-212. [DOI: 10.1016/j.micpath.2018.07.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 07/15/2018] [Accepted: 07/15/2018] [Indexed: 01/01/2023]
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da Paz GS, Adorno BMV, Richini-Pereira VB, Bosco SMG, Langoni H. Infection byHistoplasma capsulatum, Cryptococcusspp. andParacoccidioides brasiliensisin bats collected in urban areas. Transbound Emerg Dis 2018; 65:1797-1805. [DOI: 10.1111/tbed.12955] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 06/07/2018] [Accepted: 06/15/2018] [Indexed: 12/26/2022]
Affiliation(s)
- Giselle S. da Paz
- Department of Veterinary Hygiene and Public Health; School of Veterinary Medicine and Animal Science; UNESP Univ Estadual Paulista; Botucatu Brazil
| | - Brunna Mayla V. Adorno
- Department of Veterinary Hygiene and Public Health; School of Veterinary Medicine and Animal Science; UNESP Univ Estadual Paulista; Botucatu Brazil
| | - Virgínia B. Richini-Pereira
- Center of Regional Laboratories II - Bauru; Center of Biomedical Science; Adolfo Lutz Institute; Bauru Brazil
| | - Sandra M. G. Bosco
- Department of Microbiology and Immunology; Biosciences Institute; UNESP Univ Estadual Paulista; Botucatu Brazil
| | - Helio Langoni
- Department of Veterinary Hygiene and Public Health; School of Veterinary Medicine and Animal Science; UNESP Univ Estadual Paulista; Botucatu Brazil
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Morfín-Otero R, Alvarado-Ibarra M, Rodriguez-Noriega E, Resendiz-Sanchez J, Patel DA, Stephens JM, Di Fusco M, Mendoza CF, Charbonneau C. Cost-effectiveness analysis of voriconazole, fluconazole, and amphotericin B for invasive fungal infections following allogeneic hematopoietic stem cell transplantation in Mexico. CLINICOECONOMICS AND OUTCOMES RESEARCH 2018; 10:511-520. [PMID: 30233223 PMCID: PMC6130275 DOI: 10.2147/ceor.s157642] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Background Patients receiving allogeneic hematopoietic stem cell transplantation (alloHSCT) are at high risk of invasive fungal infections (IFIs), which are associated with high mortality and economic burden. The cost-effectiveness of prophylaxis for the prevention of IFIs in alloHSCT recipients in Mexico has not yet been assessed. Methods This analysis modeled a hypothetical cohort of 1,000 patients to estimate costs and outcomes for patients receiving prophylaxis for IFIs following alloHSCT, from the perspective of institutional payers in Mexico. The main prophylaxis agents currently used in Mexican clinical practice are voriconazole, fluconazole, and amphotericin B (AmB). The model accounted for event rates of IFIs during each treatment, assuming IFI causality due to invasive aspergillosis, invasive candidiasis, or other IFIs, and that the outcome for patients during follow-up was IFI-related death, death from other causes, or survival. Clinical efficacies were obtained from published literature; costs were based on local sources. Cost-effectiveness was assessed using incremental cost-effectiveness ratios (ICERs). Univariate (assessing the impact of varying each model parameter) and probabilistic sensitivity analyses were performed. Results Voriconazole was associated with the lowest number of breakthrough IFIs, IFI-related deaths, and total number of deaths. Total costs were lower for fluconazole (Mexican pesos [MXN] 72,944; US $4,079) than voriconazole (MXN 101,413; US $5,671) or AmB (MXN 110,529; US $6,180). Voriconazole had better clinical outcomes and lower costs than AmB and could be considered cost-effective compared with fluconazole in line with the local ICER threshold. Drug costs, monitoring costs, and duration of prophylaxis were most sensitive to variation from univariate sensitivity analysis. Findings from the probabilistic sensitivity analysis were consistent with the base-case results. Conclusion Voriconazole had the most favorable clinical outcomes, but overall prophylaxis costs were higher than with fluconazole. Overall, based on local ICER thresholds (MXN 184,665; US $10,326), voriconazole was considered a cost-effective option for prophylaxis of IFI in Mexico.
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Affiliation(s)
- Rayo Morfín-Otero
- Institute of Infectious and Experimental Pathology, University Center for Health Science, University of Guadalajara, Guadalajara, Jalisco, Mexico.,Division of Infectious Diseases, Civil Hospital of Guadalajara, Fray Antonio Alcalde, Guadalajara, Jalisco, Mexico
| | | | - Eduardo Rodriguez-Noriega
- Institute of Infectious and Experimental Pathology, University Center for Health Science, University of Guadalajara, Guadalajara, Jalisco, Mexico.,Division of Infectious Diseases, Civil Hospital of Guadalajara, Fray Antonio Alcalde, Guadalajara, Jalisco, Mexico
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Moreira J, Bressan CS, Brasil P, Siqueira AM. Epidemiology of acute febrile illness in Latin America. Clin Microbiol Infect 2018; 24:827-835. [PMID: 29777926 PMCID: PMC7172187 DOI: 10.1016/j.cmi.2018.05.001] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 05/01/2018] [Accepted: 05/03/2018] [Indexed: 12/11/2022]
Abstract
Background The causes of acute febrile illness (AFI) in Latin America are diverse and their complexity increases as the proportion of fever due to malaria decreases, as malaria control measures and new pathogens emerge in the region. In this context, it is important to shed light on the gaps in the epidemiological characteristics and the geographic range for many AFI aetiologies. Objectives To review studies on community-acquired fever aetiology other than malaria in Latin America, and to highlight knowledge gaps and challenges needing further investigation. Sources PubMed from 2012 to April 2018. Content We found 17 eligible studies describing 13 539 patients. The median number of pathogens tested per individual was 3.5 (range 2–17). A causative pathogen could be determined for 6661 (49.2%) individuals. The most frequently reported pathogen during the study periods was dengue virus (DENV) (14 studies), followed by chikungunya virus (nine studies) and Zika virus (seven studies). Among the studies reporting concurrent infections, 296 individuals (2.2%) were found to have co-infections. In-hospital mortality was reported in eight (47%) studies, ranging between 0% and 18%. Implications DENV fever is the febrile illness most frequently reported, reflecting its importance, while chikungunya and zika viruses present increasing trends since their emergence in the region. Studies with systematic and harmonized approaches for detection of multiple pathogens are needed and would probably reveal a higher burden of neglected pathogens such as Rickettsia spp. and arenaviruses. The lack of point-of-care tests and harmonized approach limits the care provided by health professionals and the efficacy of surveillance for AFI in the region.
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Affiliation(s)
- J Moreira
- Instituto Nacional de Infectologia Evandro Chagas, Fundacao Oswaldo Cruz, Rio de Janeiro, Brazil; Programa de Pós-Graduação em Pesquisa Clínica, Fundacao Oswaldo Cruz, Rio de Janeiro, Brazil
| | - C S Bressan
- Instituto Nacional de Infectologia Evandro Chagas, Fundacao Oswaldo Cruz, Rio de Janeiro, Brazil; Programa de Pós-Graduação em Pesquisa Clínica, Fundacao Oswaldo Cruz, Rio de Janeiro, Brazil
| | - P Brasil
- Instituto Nacional de Infectologia Evandro Chagas, Fundacao Oswaldo Cruz, Rio de Janeiro, Brazil; Programa de Pós-Graduação em Pesquisa Clínica, Fundacao Oswaldo Cruz, Rio de Janeiro, Brazil
| | - A M Siqueira
- Instituto Nacional de Infectologia Evandro Chagas, Fundacao Oswaldo Cruz, Rio de Janeiro, Brazil; Programa de Pós-Graduação em Pesquisa Clínica, Fundacao Oswaldo Cruz, Rio de Janeiro, Brazil.
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Alvarado P, Teixeira MDM, Andrews L, Fernandez A, Santander G, Doyle A, Perez M, Yegres F, Barker BM. Detection of Coccidioides posadasii from xerophytic environments in Venezuela reveals risk of naturally acquired coccidioidomycosis infections. Emerg Microbes Infect 2018; 7:46. [PMID: 29593263 PMCID: PMC5874253 DOI: 10.1038/s41426-018-0049-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 01/10/2018] [Accepted: 01/29/2018] [Indexed: 01/09/2023]
Abstract
A wide range of mammals are susceptible to infection by the fungal species Coccidioides immitis and C. posadasii. In humans, 60% of infections are asymptomatic; however, certain patients may develop a severe and deep systemic mycosis called coccidioidomycosis. Genetic analysis suggests that the majority of clinical isolates recovered from South America are C. posadasii; however, little is known about the prevalence, species distribution, and ecological factors that favor the occurrence of this pathogen in those areas. By using a combined quantitative polymerase chain reaction (qPCR)-based approach and mycobiome amplicon sequencing, we provide evidence that at least two genotypes of C. posadasii are found in the xerophytic environment in Venezuela. We detected a 3806-fold range in the amount of Coccidioides DNA when comparing among the sampled locations, which indicates that human exposure risk is variable, and is one critical factor for disease manifestation. We identified fungal communities that are correlated with a higher prevalence of C. posadasii, suggesting that a combination of specific microbes and a xeric microenvironment may favor the growth of Coccidioides in certain locations. Moreover, we discuss the use of a combinatorial approach, using both qPCR and deep-sequencing methods to assess and monitor fungal pathogen burden at outbreak sources.
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Affiliation(s)
- Primavera Alvarado
- Laboratorio de Micología, Servicio Autonomo Instituto de Biomedicina Dr. Jacinto Convit, Caracas, 4043, Venezuela
| | | | - Lela Andrews
- Environmental Genetics and Genomics Laboratory, Northern Arizona University, Flagstaff, AZ, 86011, USA
| | - Alexis Fernandez
- Laboratorio de Inmunología II, Servicio Autónomo Instituto de Biomedicina Dr. Jacinto Convit, Caracas, 4043, Venezuela
| | - Gerardo Santander
- Laboratory Geomatics, Universidad Bolivariana de Venezuela, Caracas, 1040, Venezuela
| | - Adina Doyle
- Division of Pathogen Genomics, Translational Genomics Research Institute-North, Flagstaff, AZ, 86005, USA
| | - Magaly Perez
- Laboratory Geomatics, Universidad Bolivariana de Venezuela, Caracas, 1040, Venezuela
| | - Francisco Yegres
- Laboratorio de Investigación y Apoyo Docente del Santa Ana (LIADSA), Universidad Nacional Experimental Francisco de Miranda (UNEFM), Coro, 4101, Venezuela
| | - Bridget Marie Barker
- Pathogen and Microbiome Institute, Northern Arizona University, Flagstaff, AZ, 86011, USA.
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Endemic Fungal Infection Recommendations for Solid-Organ Transplant Recipients and Donors. Transplantation 2018; 102:S52-S59. [DOI: 10.1097/tp.0000000000002020] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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González-Lara MF, Torres-González P, Cornejo-Juárez P, Velázquez-Acosta C, Martinez-Gamboa A, Rangel-Cordero A, Bobadilla-del-Valle M, Ostrosky-Zeichner L, Ponce-de-León A, Sifuentes-Osornio J. Impact of inappropriate antifungal therapy according to current susceptibility breakpoints on Candida bloodstream infection mortality, a retrospective analysis. BMC Infect Dis 2017; 17:753. [PMID: 29212442 PMCID: PMC5719515 DOI: 10.1186/s12879-017-2846-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 11/21/2017] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND The mortality of Candida Bloodstream Infection (CBSI) remains high. Antifungal susceptibility breakpoints were recently updated for Candida species, the impact remains unknown. In this study we evaluated the impact of inappropriate antifungal treatment according to recent breakpoints on 30-day mortality of CBSI. METHODS From June 2008 to July 2014, data on CBSI episodes from two tertiary-care centers, treated > 72 h were analyzed. Antifungal therapy and 30-day mortality were registered. Inappropriate antifungal treatment according to current Clinical & Laboratory Standards Institute (CLSI) breakpoints was adjusted with 30-day mortality-related co-variates. RESULTS One hundred forty-nine episodes of CBSI were analyzed. The most frequent species were: C. albicans (40%), C. tropicalis (23%) and C. glabrata complex (20%). According to the 2012 CLSI, 10.7% received inappropriate treatment. The 30-day mortality was 38%; severe sepsis [Odds ratio (OR) 3.4; 95% CI 1.3-8.4], cirrhosis (OR 36; 95% CI 12.2-605), early central venous catheter removal (OR 0.23; 95% CI 0.08-0.66) and previous antifungal therapy (OR 0.15; 95%CI 0.03-0.62), were associated with 30-day mortality by multivariate analysis. Inappropriate antifungal treatment was not (OR 0.19; 95% CI 0.03-1.2). CONCLUSIONS Appropriate antifungal therapy according to CLSI 2012 did not have an impact on mortality. Mortality of CBSI remains high due to disease severity and comorbidities; early antifungal therapy and catheter removal may reduce it.
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Affiliation(s)
- María Fernanda González-Lara
- Department of Infectious Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Belisario Domínguez Sección XVI, Tlalpan, Zip Code 14080 Mexico City, Mexico
| | - Pedro Torres-González
- Department of Infectious Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Belisario Domínguez Sección XVI, Tlalpan, Zip Code 14080 Mexico City, Mexico
| | - Patricia Cornejo-Juárez
- Department of Infectious Diseases, Instituto Nacional de Cancerología, Ave. San Fernando 22, Belisario Dominguez Sección XVI, Zip code 14080 Mexico City, Mexico
| | - Consuelo Velázquez-Acosta
- Department of Infectious Diseases, Instituto Nacional de Cancerología, Ave. San Fernando 22, Belisario Dominguez Sección XVI, Zip code 14080 Mexico City, Mexico
| | - Areli Martinez-Gamboa
- Department of Infectious Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Belisario Domínguez Sección XVI, Tlalpan, Zip Code 14080 Mexico City, Mexico
| | - Andrea Rangel-Cordero
- Department of Infectious Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Belisario Domínguez Sección XVI, Tlalpan, Zip Code 14080 Mexico City, Mexico
| | - Miriam Bobadilla-del-Valle
- Department of Infectious Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Belisario Domínguez Sección XVI, Tlalpan, Zip Code 14080 Mexico City, Mexico
| | - Luis Ostrosky-Zeichner
- University of Texas Health Science Center at Houston, 6431 Fannin. MSB 2.112, Houston, TX 77030 USA
| | - Alfredo Ponce-de-León
- Department of Infectious Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Belisario Domínguez Sección XVI, Tlalpan, Zip Code 14080 Mexico City, Mexico
| | - José Sifuentes-Osornio
- Department of Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Belisario Domínguez Sección XVI, Tlalpan, Zip Code 14080 Mexico City, Mexico
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de S Araújo GR, Souza WD, Frases S. The hidden pathogenic potential of environmental fungi. Future Microbiol 2017; 12:1533-1540. [PMID: 29168657 DOI: 10.2217/fmb-2017-0124] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Invasive fungal infections are a growing threat to immunocompromised patients, highlighting the importance of monitoring fungal pathogens. Global warming (including climatic oscillations) may select for environmental species that have acquired thermotolerance, a key step toward pathogenesis to humans. Also, important virulence factors have developed in environmental fungi, because they are essential for yeast survival in the environment. Thus, fungi traditionally regarded as nonpathogenic to humans have virulence factors similar to those of their pathogenic relatives. Here, we highlight the emergence of saprophytic environmental fungi - including species of Cryptococcus, Aspergillus, Penicillium, Candida and Scedosporium - as new human pathogens. Emerging pathogens are, in some cases, resistant to the available antifungals, potentiating the threat of novel fungal diseases.
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Affiliation(s)
- Glauber R de S Araújo
- Laboratório de Ultraestrutura Celular Hertha Meyer, Instituto de Biofísica Carlos Chagas Filho, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Wanderley de Souza
- Laboratório de Ultraestrutura Celular Hertha Meyer, Instituto de Biofísica Carlos Chagas Filho, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Susana Frases
- Laboratório de Ultraestrutura Celular Hertha Meyer, Instituto de Biofísica Carlos Chagas Filho, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
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Gupta A, Ghosh A, Singh G, Xess I. A Twenty-First-Century Perspective of Disseminated Histoplasmosis in India: Literature Review and Retrospective Analysis of Published and Unpublished Cases at a Tertiary Care Hospital in North India. Mycopathologia 2017; 182:1077-1093. [PMID: 29080114 DOI: 10.1007/s11046-017-0191-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2016] [Accepted: 08/08/2017] [Indexed: 11/29/2022]
Abstract
PURPOSE Published literature lacks systematic studies on disseminated histoplasmosis in India, and previous reviews on its epidemiology in India were conducted two decades back. Thus, we review the Indian studies published in this century to understand the recent epidemiology of histoplasmosis in India and do a retrospective analysis of all cases diagnosed at our institute. METHODS A literature of review search was done in Pubmed/Medline and Scopus. Studies published during January 2001-December 2015 were considered along with retrospective analysis of cases presented to us. A distinction was made in the clinical presentation of immunocompetent and immunocompromised cases. RESULTS Ninety-five included studies described 204 cases, and 10 cases from our retrospective analysis were included. The mean age at presentation was 45.1 ± 15.4 years [range 3-83, median 45, interquartile range 37-55], and male-to-female ratio was 6:1. Most cases were reported from northern and northeastern states of India along the rivers Ganges, Yamuna and Brahmaputra and in people associated with agricultural activity. About 33% of cases were immunocompromised, out of which immunosuppression due to HIV was seen in 72% cases. The mean age of presentation was significantly lower in immunocompromised cases (37.9 vs. 49.2 years; p < 0.00001, Mann-Whitney test), and mortality was also higher (10 vs. 27.5%, p = 0.01, Fisher's exact test). Adrenal involvement was in significantly higher proportion of immunocompetent patients compared to immunocompromised population. CONCLUSIONS Disseminated histoplasmosis is being increasingly recognized in India. There is a need to undertake well-designed, analytical studies utilizing appropriate diagnostic modalities to understand the epidemiology of this neglected disease in proper perspective.
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Affiliation(s)
- Ayush Gupta
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Arnab Ghosh
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Gagandeep Singh
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Immaculata Xess
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India.
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Gois PHF, Ferreira D, Olenski S, Seguro AC. Vitamin D and Infectious Diseases: Simple Bystander or Contributing Factor? Nutrients 2017; 9:E651. [PMID: 28672783 PMCID: PMC5537771 DOI: 10.3390/nu9070651] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 06/19/2017] [Accepted: 06/22/2017] [Indexed: 02/07/2023] Open
Abstract
Vitamin D (VD) is a fat-soluble steroid essential for life in higher animals. It is technically a pro-hormone present in few food types and produced endogenously in the skin by a photochemical reaction. In recent decades, several studies have suggested that VD contributes to diverse processes extending far beyond mineral homeostasis. The machinery for VD production and its receptor have been reported in multiple tissues, where they have a pivotal role in modulating the immune system. Similarly, vitamin D deficiency (VDD) has been in the spotlight as a major global public healthcare burden. VDD is highly prevalent throughout different regions of the world, including tropical and subtropical countries. Moreover, VDD may affect host immunity leading to an increased incidence and severity of several infectious diseases. In this review, we discuss new insights on VD physiology as well as the relationship between VD status and various infectious diseases such as tuberculosis, respiratory tract infections, human immunodeficiency virus, fungal infections and sepsis. Finally, we critically review the latest evidence on VD monitoring and supplementation in the setting of infectious diseases.
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Affiliation(s)
- Pedro Henrique França Gois
- Laboratory of Medical Research-LIM12, Nephrology Department, University of São Paulo School of Medicine, São Paulo CEP 01246-903, Brazil.
- Nephrology Department, Royal Brisbane and Women's Hospital, Herston QLD 4029, Australia.
| | - Daniela Ferreira
- Laboratory of Medical Research-LIM12, Nephrology Department, University of São Paulo School of Medicine, São Paulo CEP 01246-903, Brazil.
| | - Simon Olenski
- Nephrology Department, Royal Brisbane and Women's Hospital, Herston QLD 4029, Australia.
| | - Antonio Carlos Seguro
- Laboratory of Medical Research-LIM12, Nephrology Department, University of São Paulo School of Medicine, São Paulo CEP 01246-903, Brazil.
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Radisic MV, Linares L, Afeltra J, Pujato N, Vitale RG, Bravo M, Dotta AC, Casadei DH. Acute pulmonary involvement by paracoccidiodomycosis disease immediately after kidney transplantation: Case report and literature review. Transpl Infect Dis 2017; 19. [PMID: 28039947 DOI: 10.1111/tid.12655] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Accepted: 09/18/2016] [Indexed: 11/26/2022]
Abstract
Paracoccidioides brasiliensis is the cause of paracoccidioidomycosis, one of the most important systemic mycoses in Latin America. Human disease has been observed in a limited geographic and ecological niche, and it is attributed to exposure to the fungus in soil. Most primary infections are subclinical, as the infection is contained by the host mainly through cell-mediated immune response. However, as the fungus has the ability to survive in a dormant state for long periods, an impairment of the immune response may lead to reactivation and clinical disease. Surprisingly, paracoccidioidomycosis has rarely been reported in transplanted patients. The aim of this communication is to report a case occurring in a kidney recipient in an acute clinical form immediately after transplantation, and to review the available information on previously reported cases.
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Affiliation(s)
- Marcelo V Radisic
- Infectious Diseases Department, Instituto de Nefrología/Nephrology, Buenos Aires, Buenos Aires, Argentina
| | - Laura Linares
- Infectious Diseases Department, Instituto de Nefrología/Nephrology, Buenos Aires, Buenos Aires, Argentina
| | - Javier Afeltra
- Parasitology Unit, Mycology (Unidad de Parasitologia Micología) Hospital JM Ramos Mejía, Buenos Aires, Argentina.,Microbiology Department (Departamento de Microbiología), Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Natalia Pujato
- Infectious Diseases Department, Instituto de Nefrología/Nephrology, Buenos Aires, Buenos Aires, Argentina
| | - Roxana G Vitale
- Parasitology Unit, Mycology (Unidad de Parasitologia Micología) Hospital JM Ramos Mejía, Buenos Aires, Argentina.,Consejo Nacional de Investigaciones Científicas y Tecnológicas (CONICET), Buenos Aires, Argentina
| | - Martin Bravo
- Infectious Diseases Department, Instituto de Nefrología/Nephrology, Buenos Aires, Buenos Aires, Argentina
| | - Ana C Dotta
- Kidney Transplant Unit, Department of Transplantation, Instituto de Nefrología/Nephrology, Buenos Aires, Buenos Aires, Argentina
| | - Domingo H Casadei
- Kidney Transplant Unit, Department of Transplantation, Instituto de Nefrología/Nephrology, Buenos Aires, Buenos Aires, Argentina
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Bentrad N, Gaceb-Terrak R, Benmalek Y, Rahmania F. STUDIES ON CHEMICAL COMPOSITION AND ANTIMICROBIAL ACTIVITIES OF BIOACTIVE MOLECULES FROM DATE PALM (PHOENIXDACTYLIFERA L.) POLLENS AND SEEDS. AFRICAN JOURNAL OF TRADITIONAL, COMPLEMENTARY, AND ALTERNATIVE MEDICINES 2017; 14:242-256. [PMID: 28480436 PMCID: PMC5412231 DOI: 10.21010/ajtcam.v14i3.26] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Background: Natural resources have been the crucial origin of chemical elements. They have been used in many traditions as alternative medicines. The chemical profiling of some plant extracts and essential oils related to different plants were followed to unveil their most active components. In this paper, Phoenix dactilyfera L was selected as a host plant to investigate the composition of different organs with different cultivars. Materials and method: The antibacterial and antifungal activities of the extracts have been tested using different techniques, including optical density and GC/MS analyses of the natural extracts. Results: GC/MS analysis revealed the presence of abundant oleic (36.69%) and lauric (20.49%) acids in date seeds. However, the pollen contains a high amount of palmitic (22.27 %), linoleic (33.4%) and linolenic (17.055%) acids. Moreover, the largest inhibition zone is obtained with the organic extract of Deglet Nour which showed a strong antibacterial activity against Escherichia coli and pollen extract showed also a strong inhibition against Escherichia coli, Staphylococcus aureus, S. aureus MRSA and Enterococcus faecalis. Aqueous extracts of date palm seeds of and pollen seem to have a fongitoxique activity from a concentration of 6 mg.mL-1 and 12mg.mL-1 of cyanidine; as well as the organic extracts of pollen with a concentration of 90 μg.mL”1 induce an inhibition to the growth of five special forms of Fusarium oxysporum. Conclusion: The bioactive compounds of date palm can be used for drug development and in the food industry.
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Affiliation(s)
| | | | - Yamina Benmalek
- Laboratory of Cell Biology and Microbiology, Faculty of Biological Sciences, University of Sciences and Technology Houari Boumediene (USTHB), BP 32, 16111 El-Alia, Bab Ezzouar, Algiers (Algeria)
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Medina N, Samayoa B, Lau-Bonilla D, Denning DW, Herrera R, Mercado D, Guzmán B, Pérez JC, Arathoon E. Burden of serious fungal infections in Guatemala. Eur J Clin Microbiol Infect Dis 2017; 36:965-969. [PMID: 28243758 DOI: 10.1007/s10096-017-2920-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 12/21/2016] [Indexed: 10/20/2022]
Abstract
Guatemala is a developing country in Central America with a high burden of HIV and endemic fungal infections; we attempted to estimate the burden of serious fungal infections for the country. A full literature search was done to identify epidemiology papers reporting fungal infections from Guatemala. We used specific populations at risk and fungal infection frequencies in the population to estimate national rates. The population of Guatemala in 2013 was 15.4 million; 40% were younger than 15 and 6.2% older than 60. There are an estimated 53,000 adults with HIV infection, in 2015, most presenting late. The estimated cases of opportunistic fungal infections were: 705 cases of disseminated histoplasmosis, 408 cases of cryptococcal meningitis, 816 cases of Pneumocystis pneumonia, 16,695 cases of oral candidiasis, and 4,505 cases of esophageal candidiasis. In the general population, an estimated 5,568 adult asthmatics have allergic bronchopulmonary aspergillosis (ABPA) based on a 2.42% prevalence of asthma and a 2.5% ABPA proportion. Amongst 2,452 pulmonary tuberculosis patients, we estimated a prevalence of 495 for chronic pulmonary aspergillosis in this group, and 1,484 for all conditions. An estimated 232,357 cases of recurrent vulvovaginal candidiasis is likely. Overall, 1.7% of the population are affected by these conditions. The true fungal infection burden in Guatemala is unknown. Tools and training for improved diagnosis are needed. Additional research on prevalence is needed to employ public health measures towards treatment and improving the reported data of fungal diseases.
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Affiliation(s)
- N Medina
- Asociación de Salud Integral, Guatemala City, Guatemala
| | - B Samayoa
- Asociación de Salud Integral, Guatemala City, Guatemala. .,Universidad de San Carlos de Guatemala, Guatemala City, Guatemala.
| | - D Lau-Bonilla
- Asociación de Salud Integral, Guatemala City, Guatemala
| | - D W Denning
- The National Aspergillosis Centre, University Hospital of South Manchester, Manchester, UK.,The University of Manchester and the Manchester Academic Health Science Centre, Manchester, UK
| | - R Herrera
- Asociación de Salud Integral, Guatemala City, Guatemala
| | - D Mercado
- Asociación de Salud Integral, Guatemala City, Guatemala
| | - B Guzmán
- Asociación de Salud Integral, Guatemala City, Guatemala
| | - J C Pérez
- Asociación de Salud Integral, Guatemala City, Guatemala
| | - E Arathoon
- Asociación de Salud Integral, Guatemala City, Guatemala
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Tamayo D, Muñoz JF, Almeida AJ, Puerta JD, Restrepo Á, Cuomo CA, McEwen JG, Hernández O. Paracoccidioides spp. catalases and their role in antioxidant defense against host defense responses. Fungal Genet Biol 2017; 100:22-32. [PMID: 28093309 DOI: 10.1016/j.fgb.2017.01.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2016] [Revised: 12/20/2016] [Accepted: 01/12/2017] [Indexed: 11/30/2022]
Abstract
Dimorphic human pathogenic fungi interact with host effector cells resisting their microbicidal mechanisms. Yeast cells are able of surviving within the tough environment of the phagolysosome by expressing an antioxidant defense system that provides protection against host-derived reactive oxygen species (ROS). This includes the production of catalases (CATs). Here we identified and analyzed the role of CAT isoforms in Paracoccidioides, the etiological agent of paracoccidioidomycosis. Firstly, we found that one of these isoforms was absent in the closely related dimorphic pathogen Coccidioides and dermatophytes, but all of them were conserved in Paracoccidioides, Histoplasma and Blastomyces species. We probed the contribution of CATs in Paracoccidioides by determining the gene expression levels of each isoform through quantitative RT-qPCR, in both the yeast and mycelia phases, and during the morphological switch (transition and germination), as well as in response to oxidative agents and during interaction with neutrophils. PbCATP was preferentially expressed in the pathogenic yeast phase, and was associated to the response against exogenous H2O2. Therefore, we created and analyzed the virulence defects of a knockdown strain for this isoform, and found that CATP protects yeast cells from H2O2 generated in vitro and is relevant during lung infection. On the other hand, CATA and CATB seem to contribute to ROS homeostasis in Paracoccidioides cells, during endogenous oxidative stress. CAT isoforms in Paracoccidioides might be coordinately regulated during development and dimorphism, and differentially expressed in response to different stresses to control ROS homeostasis during the infectious process, contributing to the virulence of Paracoccidioides.
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Affiliation(s)
- Diana Tamayo
- Cellular and Molecular Biology Unit, Corporación para Investigaciones Biológicas, Medellín, Colombia; Institute of Biology, Universidad de Antioquia, Medellín, Colombia; School of Microbiology, Universidad de Antioquia, Medellín, Colombia
| | - José F Muñoz
- Cellular and Molecular Biology Unit, Corporación para Investigaciones Biológicas, Medellín, Colombia; Institute of Biology, Universidad de Antioquia, Medellín, Colombia; Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Agostinho J Almeida
- Cellular and Molecular Biology Unit, Corporación para Investigaciones Biológicas, Medellín, Colombia; Department of Biological Sciences, School of Sciences, Universidad EAFIT, Medellín, Colombia; Instituto Universitario da Maia, Maia, Portugal
| | - Juan D Puerta
- Cellular and Molecular Biology Unit, Corporación para Investigaciones Biológicas, Medellín, Colombia
| | - Ángela Restrepo
- Cellular and Molecular Biology Unit, Corporación para Investigaciones Biológicas, Medellín, Colombia
| | | | - Juan G McEwen
- Cellular and Molecular Biology Unit, Corporación para Investigaciones Biológicas, Medellín, Colombia; School of Medicine, Universidad de Antioquia, Medellín, Colombia
| | - Orville Hernández
- Cellular and Molecular Biology Unit, Corporación para Investigaciones Biológicas, Medellín, Colombia; School of Microbiology, Universidad de Antioquia, Medellín, Colombia; MICROBA Research Group, School of Microbiology, Universidad de Antioquia, Medellín, Colombia.
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Noman EA, Al-Gheethi AA, Rahman NNNA, Nagao H, Ab Kadir MO. Assessment of relevant fungal species in clinical solid wastes. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2016; 23:19806-19824. [PMID: 27417327 DOI: 10.1007/s11356-016-7161-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 06/28/2016] [Indexed: 06/06/2023]
Abstract
The study aimed to determine the fungal diversity in clinical waste samples from a healthcare facility in Penang Malaysia. Different fungi species were detected in 83.75 % of the 92 clinical waste samples that were screened from different sections of the healthcare facility. One hundred fifty fungal isolates comprising of 8 genera and 36 species were obtained. They were purified by using single spore isolation technique. Subsequently, the isolates were identified by phenotypic method based on morphological and culture characteristics on different culture media. Among all fungal isolates, Aspergillus spp. in section Nigri 10.2 %, Aspergillus niger 9.5 %, Aspergillus fumigatus 8.8 %, Penicillium. simplicissium 8 %, Aspergillus tubingensis 7.3 %, Aspergillus terreus var. terreus 6.6 %, Penicillium waksmanii 5.9 % and Curvularia lunata 6.5 % were the most frequent. Among five sections of the Wellness Centre, the clinical wastes collected from the diagnostic labs of haematology section had the highest numbers of fungal species (29 species). Glove wastes had the highest numbers of fungal species (19 species) among 17 types of clinical wastes screened. Among all fungal species, Aspergillus spp. exhibited higher growth at 37 °C than at 28 °C, indicating the potential of these opportunistic fungi to cause diseases in human. These results indicated the potential of hospital wastes as reservoirs for fungal species.
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Affiliation(s)
- Efaq Ali Noman
- School of Industrial Technology, University Science Malaysia, 11800, Penang, Malaysia.
| | - A A Al-Gheethi
- Micro-pollution Research Centre (MPRC), Department of Water and Environmental Engineering, Faculty of Civil & Environmental Engineering, Universiti Tun Hussein Onn Malaysia, 86400 Parit Raja, Batu Pahat, Johor, Malaysia
| | | | - H Nagao
- School of Biological Sciences, University Science Malaysia, 11800, Penang, Malaysia
| | - M O Ab Kadir
- School of Industrial Technology, University Science Malaysia, 11800, Penang, Malaysia
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Zhang C, Chen M, Wang G, Fang W, Ye C, Hu H, Fa Z, Yi J, Liao WQ. Pd@Ag Nanosheets in Combination with Amphotericin B Exert a Potent Anti-Cryptococcal Fungicidal Effect. PLoS One 2016; 11:e0157000. [PMID: 27271376 PMCID: PMC4896421 DOI: 10.1371/journal.pone.0157000] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 05/23/2016] [Indexed: 12/12/2022] Open
Abstract
Silver nanoparticles have received considerable interest as new "nanoantibiotics" with the potential to kill drug-resistant microorganisms. Recently, a class of new core-shell nanostructures, Pd@Ag nanosheets (Pd@Ag NSs), were created using deposition techniques and demonstrated excellent inhibitory effects on various bacteria in vitro. In this study, we evaluated the antifungal activity of Pd@Ag NSs against common invasive fungal pathogens. Among these organisms, Cryptococcus neoformans complex species was most susceptible to Pd@Ag NSs, which exhibited potent antifungal activity against various molecular types or sources of cryptococcal strains including fluconazole-resistant isolates. The anticryptococcal activity of Pd@Ag NSs was significantly greater than fluconazole and similar to that of amphotericin B (AmB). At relatively high concentrations, Pd@Ag NSs exhibited fungicidal activity against Cryptococcus spp., which can likely be attributed to the disruption of cell integrity, intracellular protein synthesis, and energy metabolism. Intriguingly, Pd@Ag NSs also exhibited strong synergistic anti-cryptococcal fungicidal effects at low concentrations in combination with AmB but exhibited much better safety in erythrocytes than AmB, even at the minimal fungicidal concentration. Therefore, Pd@Ag NSs may be a promising adjunctive agent for treating cryptococcosis, and further investigation for clinical applications is required.
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Affiliation(s)
- Chao Zhang
- Shanghai Key Laboratory of Molecular Medical Mycology, Shanghai Institute of Medical Mycology, Second Military Medical University, Shanghai, China
- PLA Key Laboratory of Mycosis, Department of Dermatology and Venereology, Changzheng Hospital, Shanghai, China
| | - Mei Chen
- State Key Laboratory for Physical Chemistry of Solid Surfaces, Collaborative Innovation Centre of Chemistry for Energy Materials and Department of Chemistry, College of Chemistry and Chemical Engineering, Xiamen University, Xiamen, China
| | - Guizhen Wang
- ICU department, Urumuqi Army General Hospital, Urumqi, Xinjiang, China
| | - Wei Fang
- PLA Key Laboratory of Mycosis, Department of Dermatology and Venereology, Changzheng Hospital, Shanghai, China
| | - Chen Ye
- Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Hanhua Hu
- UEM department, Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Zhenzong Fa
- PLA Key Laboratory of Mycosis, Department of Dermatology and Venereology, Changzheng Hospital, Shanghai, China
| | - Jiu Yi
- Shanghai Key Laboratory of Molecular Medical Mycology, Shanghai Institute of Medical Mycology, Second Military Medical University, Shanghai, China
| | - Wan-qing Liao
- Shanghai Key Laboratory of Molecular Medical Mycology, Shanghai Institute of Medical Mycology, Second Military Medical University, Shanghai, China
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Local Population Structure and Patterns of Western Hemisphere Dispersal for Coccidioides spp., the Fungal Cause of Valley Fever. mBio 2016; 7:e00550-16. [PMID: 27118594 PMCID: PMC4850269 DOI: 10.1128/mbio.00550-16] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Coccidioidomycosis (or valley fever) is a fungal disease with high morbidity and mortality that affects tens of thousands of people each year. This infection is caused by two sibling species, Coccidioides immitis and C. posadasii, which are endemic to specific arid locales throughout the Western Hemisphere, particularly the desert southwest of the United States. Recent epidemiological and population genetic data suggest that the geographic range of coccidioidomycosis is expanding, as new endemic clusters have been identified in the state of Washington, well outside the established endemic range. The genetic mechanisms and epidemiological consequences of this expansion are unknown and require better understanding of the population structure and evolutionary history of these pathogens. Here we performed multiple phylogenetic inference and population genomics analyses of 68 new and 18 previously published genomes. The results provide evidence of substantial population structure in C. posadasii and demonstrate the presence of distinct geographic clades in central and southern Arizona as well as dispersed populations in Texas, Mexico, South America, and Central America. Although a smaller number of C. immitis strains were included in the analyses, some evidence of phylogeographic structure was also detected in this species, which has been historically limited to California and Baja, Mexico. Bayesian analyses indicated that C. posadasii is the more ancient of the two species and that Arizona contains the most diverse subpopulations. We propose a southern Arizona-northern Mexico origin for C. posadasii and describe a pathway for dispersal and distribution out of this region. Coccidioidomycosis, or valley fever, is caused by the pathogenic fungi Coccidioides posadasii and C. immitis. The fungal species and disease are primarily found in the American desert southwest, with spotted distribution throughout the Western Hemisphere. Initial molecular studies suggested a likely anthropogenic movement of C. posadasii from North America to South America. Here we comparatively analyze eighty-six genomes of the two Coccidioides species and establish local and species-wide population structures to not only clarify the earlier dispersal hypothesis but also provide evidence of likely ancestral populations and patterns of dispersal for the known subpopulations of C. posadasii.
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Reyes HA, Carbajal WH, Valdez LM, Lozada C. Successful medical treatment of infective endocarditis caused by Candida parapsilosis in an immunocompromised patient. BMJ Case Rep 2015; 2015:bcr-2015-212128. [PMID: 26452742 DOI: 10.1136/bcr-2015-212128] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Candida spp is a common pathogen of nosocomial infections that has increased in recent decades, with mortality rates close to 40% in cases of systemic candidiasis. One type of presentation is infective endocarditis, which, by its prolonged need for treatment, represents a constant challenge for clinicians. We describe a 36-year-old woman, recently diagnosed with ovarian cancer, who developed aortic valve infective endocarditis caused by Candida parapsilosis and who was treated with oral antifungal medication, with no surgical intervention required.
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Affiliation(s)
- Hans Alexi Reyes
- Department of Medicine, British American Hospital, Lima, Lima, Peru
| | | | - Luis Manuel Valdez
- Department of Infectious Diseases, British American Hospital, Lima, Lima, Peru
| | - Claudia Lozada
- Department of Oncology, British American Hospital, Lima, Lima, Peru
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Nosanchuk JD, Nosanchuk MD, Rodrigues ML, Nimrichter L, de Carvalho ACC, Weiss LM, Spray DC, Tanowitz HB. The Einstein-Brazil Fogarty: A decade of synergy. Braz J Microbiol 2015; 46:945-55. [PMID: 26691452 PMCID: PMC4704644 DOI: 10.1590/s1517-838246420140975] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 03/05/2015] [Indexed: 02/08/2023] Open
Abstract
A rich, collaborative program funded by the US NIH Fogarty program in 2004 has provided for a decade of remarkable opportunities for scientific advancement through the training of Brazilian undergraduate, graduate and postdoctoral students from the Federal University and Oswaldo Cruz Foundation systems at Albert Einstein College of Medicine. The focus of the program has been on the development of trainees in the broad field of Infectious Diseases, with a particular focus on diseases of importance to the Brazilian population. Talented trainees from various regions in Brazil came to Einstein to learn techniques and study fungal, parasitic and bacterial pathogens. In total, 43 trainees enthusiastically participated in the program. In addition to laboratory work, these students took a variety of courses at Einstein, presented their results at local, national and international meetings, and productively published their findings. This program has led to a remarkable synergy of scientific discovery for the participants during a time of rapid acceleration of the scientific growth in Brazil. This collaboration between Brazilian and US scientists has benefitted both countries and serves as a model for future training programs between these countries.
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Affiliation(s)
- Joshua D. Nosanchuk
- Departments of Medicine, Microbiology & Immunology, Albert
Einstein College of Medicine, Bronx, NY, EUA
- Send correspondence to J.D. Nosanchuk. Departments of Medicine,
Microbiology & Immunology, Albert Einstein College of Medicine, Bronx, NY, EUA.
E-mail:
| | - Murphy D. Nosanchuk
- Departments of Medicine, Microbiology & Immunology, Albert
Einstein College of Medicine, Bronx, NY, EUA
- Instituto de Microbiologia Professor Paulo de Góes, Universidade
Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Marcio L. Rodrigues
- Instituto de Microbiologia Professor Paulo de Góes, Universidade
Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
- Centro de Desenvolvimento Tecnológico em Saúde, Fundação Oswaldo
Cruz, Rio de Janeiro, RJ, Brazil
| | - Leonardo Nimrichter
- Instituto de Microbiologia Professor Paulo de Góes, Universidade
Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | | | - Louis M. Weiss
- Departments of Pathology and Medicine, Albert Einstein College of
Medicine, Bronx, NY, EUA
| | - David C. Spray
- Departments of Neuroscience and Medicine, Albert Einstein College of
Medicine, Bronx, NY, EUA
| | - Herbert B. Tanowitz
- Departments of Pathology and Medicine, Albert Einstein College of
Medicine, Bronx, NY, EUA
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Gaviria M, Rivera V, Muñoz-Cadavid C, Cano LE, Naranjo TW. Validation and clinical application of a nested PCR for paracoccidioidomycosis diagnosis in clinical samples from Colombian patients. Braz J Infect Dis 2015; 19:376-83. [PMID: 26100437 PMCID: PMC9427526 DOI: 10.1016/j.bjid.2015.04.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Revised: 04/08/2015] [Accepted: 04/22/2015] [Indexed: 11/30/2022] Open
Abstract
Paracoccidioidomycosis is a systemic and endemic mycosis, restricted to tropical and subtropical areas of Latin America. The infection is caused by the thermal dimorphic fungus Paracoccidioides brasiliensis and Paracoccidioides lutzii. The diagnosis of paracoccidioidomycosis is usually performed by microscopic examination, culture and immunodiagnostic tests to respiratory specimens, body fluids and/or biopsies; however these methods require laboratory personnel with experience and several days to produce a result. In the present study, we have validated and evaluated a nested PCR assay targeting the gene encoding the Paracoccidioides gp43 membrane protein in 191 clinical samples: 115 samples from patients with proven infections other than paracoccidioidomycosis, 51 samples as negative controls, and 25 samples from patients diagnosed with paracoccidioidomycosis. Additionally, the specificity of the nested PCR assay was also evaluated using purified DNA isolated from cultures of different microorganisms (n=35) previously identified by culture and/or sequencing. The results showed that in our hands, this nested PCR assay for gp43 protein showed specificity and sensitivity rates of 100%. The optimized nested PCR conditions in our laboratory allowed detection down to 1fg of P. brasiliensis DNA.
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Affiliation(s)
- Marcela Gaviria
- Corporación para Investigaciones Biológicas, Medellín, Colombia
| | - Vanessa Rivera
- Corporación para Investigaciones Biológicas, Medellín, Colombia
| | | | - Luz Elena Cano
- Corporación para Investigaciones Biológicas, Medellín, Colombia; Escuela de Microbiología, Universidad de Antioquia, Medellín, Colombia
| | - Tonny Williams Naranjo
- Corporación para Investigaciones Biológicas, Medellín, Colombia; Escuela de Ciencias de la Salud, Universidad Pontifica Bolivariana, Medellín, Colombia.
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48
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Canteros CE, Vélez H A, Toranzo AI, Suárez-Alvarez R, Tobón O Á, Jimenez A MDP, Restrepo M Á. Molecular identification of Coccidioides immitis in formalin-fixed, paraffin-embedded (FFPE) tissues from a Colombian patient. Med Mycol 2015; 53:520-7. [PMID: 25908652 DOI: 10.1093/mmy/myv019] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 02/10/2015] [Indexed: 11/14/2022] Open
Abstract
Coccidioides immitis and C. posadasii are the etiologic agents of coccidioidomycosis, an endemic fungal disease of the Americas. In Colombia, this mycosis is uncommon, and only five cases, two of them imported, have been documented.By means of DNA sequencing, C. immitis was identified in formalin-fixed, paraffin-embedded archival tissues samples from the 5th Colombian patient diagnosed in 1997. The patient was born in Pinto, Department of Magdalena, and had never visited other geographic regions, a reason to consider that the mycosis had been acquired locally.This species is primarily found in California although it has been occasionally reported in other geographic areas such as Mexico and Brazil. This is the first indigenous report of C. immitis-associated coccidioidomycosis in a Colombian patient.
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Affiliation(s)
- Cristina E Canteros
- Departamento de Micología. Instituto Nacional de Enfermedades Infecciosas INEI-ANLIS "Dr. Carlos G. Malbrán", Buenos Aires, Argentina
| | - Alejandro Vélez H
- Departamento de Patología, Hospital Pablo Tobón Uribe, Medellín, Colombia Laboratorios Dinámica, Institución Prestadora de Servicios (IPS), Medellín, Colombia Universidad Pontificia Bolivariana, Escuela de Ciencias de la Salud, Medellín, Colombia
| | - Adriana I Toranzo
- Departamento de Micología. Instituto Nacional de Enfermedades Infecciosas INEI-ANLIS "Dr. Carlos G. Malbrán", Buenos Aires, Argentina
| | - Roberto Suárez-Alvarez
- Departamento de Micología. Instituto Nacional de Enfermedades Infecciosas INEI-ANLIS "Dr. Carlos G. Malbrán", Buenos Aires, Argentina
| | - Ángela Tobón O
- Corporación para Investigaciones Biológicas (CIB), Medellín, Colombia Hospital La María, Medellín, Colombia
| | - María del Pilar Jimenez A
- Corporación para Investigaciones Biológicas (CIB), Medellín, Colombia Departamento de Microbiología y Parasitología, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia
| | - Ángela Restrepo M
- Corporación para Investigaciones Biológicas (CIB), Medellín, Colombia
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Da Silva RM, Da Silva Neto JR, Santos CS, Frickmann H, Poppert S, Cruz KS, Koshikene D, De Souza JVB. Evaluation of fluorescence in situ hybridisation (FISH) for the detection of fungi directly from blood cultures and cerebrospinal fluid from patients with suspected invasive mycoses. Ann Clin Microbiol Antimicrob 2015; 14:6. [PMID: 25637361 PMCID: PMC4322816 DOI: 10.1186/s12941-015-0065-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Accepted: 01/18/2015] [Indexed: 11/16/2022] Open
Abstract
The aim of this study was to evaluate the diagnostic performance of in-house FISH (fluorescence in situ hybridisation) procedures for the direct identification of invasive fungal infections in blood cultures and cerebrospinal fluid (CSF) samples and to compare these FISH results with those obtained using traditional microbiological techniques and PCR targeting of the ITS1 region of the rRNA gene. In total, 112 CSF samples and 30 positive blood cultures were investigated by microscopic examination, culture, PCR-RFLP and FISH. The sensitivity of FISH for fungal infections in CSF proved to be slightly better than that of conventional microscopy (India ink) under the experimental conditions, detecting 48 (instead of 46) infections in 112 samples. The discriminatory powers of traditional microbiology, PCR-RFLP and FISH for fungal bloodstream infections were equivalent, with the detection of 14 fungal infections in 30 samples. However, the mean times to diagnosis after the detection of microbial growth by automated blood culture systems were 5 hours, 20 hours and 6 days for FISH, PCR-RFLP and traditional microbiology, respectively. The results demonstrate that FISH is a valuable tool for the identification of invasive mycoses that can be implemented in the diagnostic routine of hospital laboratories.
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Affiliation(s)
| | | | | | - Hagen Frickmann
- Department of Tropical Medicine at the Bernhard Nocht Institute, German Armed Forces Hospital of Hamburg, Hamburg, Germany.
| | - Sven Poppert
- Institute of Medical Microbiology, Justus-Liebig-University Giessen, Giessen, Germany.
| | - Kátia Santana Cruz
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil.
| | | | - João Vicente Braga De Souza
- Instituto Nacional de Pesquisas da Amazônia, Manaus, Brazil. .,Biotecnólogo/Tecnologista Pleno III, Instituto Nacional de Pesquisas da Amazônia, Coordenação de Sociedade, Ambiente e Saúde, Laboratório de Micologia, Av. André Araújo, 2936, Aleixo, Manaus, AM, CEP 69060-001, Brazil.
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Li W, Hu YA, Li FQ, Shi LN, Shao HF, Huang M, Wang Y, Han DD, Liao H, Ma CF, Zhang GY. Distribution of Yeast Isolates from Invasive Infections and Their In Vitro Susceptibility to Antifungal Agents: Evidence from 299 Cases in a 3-Year (2010 to 2012) Surveillance Study. Mycopathologia 2015; 179:397-405. [DOI: 10.1007/s11046-015-9858-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Accepted: 01/06/2015] [Indexed: 02/01/2023]
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