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Sepúlveda VE, Goldman WE, Matute DR. Genotypic diversity, virulence, and molecular genetic tools in Histoplasma. Microbiol Mol Biol Rev 2024; 88:e0007623. [PMID: 38819148 DOI: 10.1128/mmbr.00076-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2024] Open
Abstract
SUMMARYHistoplasmosis is arguably the most common fungal respiratory infection worldwide, with hundreds of thousands of new infections occurring annually in the United States alone. The infection can progress in the lung or disseminate to visceral organs and can be difficult to treat with antifungal drugs. Histoplasma, the causative agent of the disease, is a pathogenic fungus that causes life-threatening lung infections and is globally distributed. The fungus has the ability to germinate from conidia into either hyphal (mold) or yeast form, depending on the environmental temperature. This transition also regulates virulence. Histoplasma and histoplasmosis have been classified as being of emergent importance, and in 2022, the World Health Organization included Histoplasma as 1 of the 19 most concerning human fungal pathogens. In this review, we synthesize the current understanding of the ecological niche, evolutionary history, and virulence strategies of Histoplasma. We also describe general patterns of the symptomatology and epidemiology of histoplasmosis. We underscore areas where research is sorely needed and highlight research avenues that have been productive.
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Affiliation(s)
- Victoria E Sepúlveda
- Department of Biology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - William E Goldman
- Department of Microbiology and Immunology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Daniel R Matute
- Department of Biology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Sepúlveda VE, Rader JA, Li JJ, Goldman WE, Matute DR. Phenotypic characterization of cryptic species in the fungal pathogen Histoplasma. mSphere 2024; 9:e0000924. [PMID: 38771035 DOI: 10.1128/msphere.00009-24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 04/11/2024] [Indexed: 05/22/2024] Open
Abstract
Histoplasmosis is an endemic mycosis that often presents as a respiratory infection in immunocompromised patients. Hundreds of thousands of new infections are reported annually around the world. The etiological agent of the disease, Histoplasma, is a dimorphic fungus commonly found in the soil where it grows as mycelia. Humans can become infected by Histoplasma through inhalation of its spores (conidia) or mycelial particles. The fungi transition into the yeast phase in the lungs at 37°C. Once in the lungs, yeast cells reside and proliferate inside alveolar macrophages. Genomic work has revealed that Histoplasma is composed of at least five cryptic phylogenetic species that differ genetically. Three of those lineages have received new names. Here, we evaluated multiple phenotypic characteristics (colony morphology, secreted proteolytic activity, yeast size, and growth rate) of strains from five of the phylogenetic species of Histoplasma to identify phenotypic traits that differentiate between these species: Histoplasma capsulatum sensu stricto, Histoplasma ohiense, Histoplasma mississippiense, Histoplasma suramericanum, and an African lineage. We report diagnostic traits for three species. The other two species can be identified by a combination of traits. Our results suggest that (i) there are significant phenotypic differences among the cryptic species of Histoplasma and (ii) those differences can be used to positively distinguish those species in a clinical setting and for further study of the evolution of this fungal pathogen.IMPORTANCEIdentifying species boundaries is a critical component of evolutionary biology. Genome sequencing and the use of molecular markers have advanced our understanding of the evolutionary history of fungal pathogens, including Histoplasma, and have allowed for the identification of new species. This is especially important in organisms where morphological characteristics have not been detected. In this study, we revised the taxonomic status of the four named species of the genus Histoplasma, H. capsulatum sensu stricto (ss), H. ohiense, H. mississippiense, and H. suramericanum, and propose the use of species-specific phenotypic traits to aid their identification when genome sequencing is not available. These results have implications not only for evolutionary study of Histoplasma but also for clinicians, as the Histoplasma species could determine the outcome of disease and treatment needed.
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Affiliation(s)
- Victoria E Sepúlveda
- Department of Biology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jonathan A Rader
- Department of Biology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jingbaoyi Janet Li
- Department of Biology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - William E Goldman
- Department of Microbiology and Immunology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Daniel R Matute
- Department of Biology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Gandhi P, Hebert B, Yun A, Bradley J, Moldoveanu B. Histoplasmosis around the world: A global perspective on the presentation, virulence factors, and treatment of histoplasmosis. Am J Med Sci 2024:S0002-9629(24)01283-7. [PMID: 38885929 DOI: 10.1016/j.amjms.2024.06.011] [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: 10/31/2023] [Revised: 04/29/2024] [Accepted: 06/12/2024] [Indexed: 06/20/2024]
Abstract
Histoplasmosis is a systemic infection caused by an endemic dimorphic fungus, Histoplasma capsulatum. Though prevalent in the eastern United States of America, near the Ohio and Mississippi River Valleys, the evidence underlying the global prevalence of histoplasmosis, especially in immunocompromised populations, is underappreciated. This article highlights the global epidemiology, risk factors, microbiology and pathophysiological characteristics, pulmonary and extrapulmonary manifestations, prevention measures, radiographic patterns, diagnostic techniques, and antifungal treatment approaches for Histoplasma capsulatum.
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Affiliation(s)
- Pooja Gandhi
- Division of General Internal Medicine, University of Louisville, Louisville, Kentucky, USA
| | - Brandon Hebert
- Division of General Internal Medicine, University of Louisville, Louisville, Kentucky, USA
| | - Angelica Yun
- Division of General Internal Medicine, University of Louisville, Louisville, Kentucky, USA
| | - James Bradley
- Division of Pulmonary, Critical Care Medicine, and Sleep Disorders, University of Louisville, Louisville, Kentucky, USA.
| | - Bogdan Moldoveanu
- Division of Pulmonary, Critical Care Medicine, and Sleep Disorders, University of Louisville, Louisville, Kentucky, USA
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Zafar MR, Whitfield T, Zaidi SK, Weerakoon S, Paul J, Rautemaa-Richardson R. Histoplasma capsulatum as a cause for prolonged pulmonary illness in an immunocompetent returning traveller from Bangladesh. Med Mycol Case Rep 2024; 44:100647. [PMID: 38634015 PMCID: PMC11021948 DOI: 10.1016/j.mmcr.2024.100647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 04/07/2024] [Accepted: 04/08/2024] [Indexed: 04/19/2024] Open
Abstract
Fungal infections can be challenging to diagnose in returning travellers due to their non-specific clinical manifestations and changing epidemiology. We present a case of progressive disseminated histoplasmosis in a returning traveller from Bangladesh. The patient had a progressive and prolonged respiratory illness necessitating mechanical ventilatory support. The clue to potential fungal aetiology was provided by serum fungal markers - 1-3-β-D-glucan and Aspergillus galactomannan. Diagnosis was eventually made using panfungal PCR on bronchioalveolar lavage fluid.
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Affiliation(s)
- Muhammad Rizwan Zafar
- North Manchester General Hospital, Delaunays Road, Crumpsall, Manchester, M8 5RB, United Kingdom
| | - Thomas Whitfield
- The Royal Oldham Hospital, Rochdale Road, Oldham, OL1 2JH, United Kingdom
| | | | | | - Joel Paul
- The Royal Oldham Hospital, Rochdale Road, Oldham, OL1 2JH, United Kingdom
| | - Riina Rautemaa-Richardson
- Mycology Reference Centre Manchester and Department of Infectious Diseases, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, United Kingdom
- Division of Evolution, Infection and Genomics, Faculty of Biology, Medicine and Health, University of Manchester, Oxford Road, Manchester, M13 9PL, United Kingdom
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Galgiani JN, Kauffman CA. Coccidioidomycosis and Histoplasmosis in Immunocompetent Persons. N Engl J Med 2024; 390:536-547. [PMID: 38324487 DOI: 10.1056/nejmra2306821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Affiliation(s)
- John N Galgiani
- From the Valley Fever Center for Excellence, the Departments of Medicine and Immunobiology, College of Medicine-Tucson, and the BIO5 Institute, University of Arizona, Tucson (J.N.G.); and the Division of Infectious Diseases, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor (C.A.K.)
| | - Carol A Kauffman
- From the Valley Fever Center for Excellence, the Departments of Medicine and Immunobiology, College of Medicine-Tucson, and the BIO5 Institute, University of Arizona, Tucson (J.N.G.); and the Division of Infectious Diseases, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor (C.A.K.)
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Sepúlveda VE, Rader JA, Li J(J, Goldman WE, Matute DR. Phenotypic characterization of cryptic species in the fungal pathogen Histoplasma. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.01.08.574719. [PMID: 38260643 PMCID: PMC10802462 DOI: 10.1101/2024.01.08.574719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
Histoplasmosis is an endemic mycosis that often presents as a respiratory infection in immunocompromised patients. Hundreds of thousands of new infections are reported annually around the world. The etiological agent of the disease, Histoplasma, is a dimorphic fungus commonly found in the soil where it grows as mycelia. Humans can become infected by Histoplasma through inhalation of its spores (conidia) or mycelial particles. The fungi transitions into the yeast phase in the lungs at 37°C. Once in the lungs, yeast cells reside and proliferate inside alveolar macrophages. We have previously described that Histoplasma is composed of at least five cryptic species that differ genetically, and assigned new names to the lineages. Here we evaluated multiple phenotypic characteristics of 12 strains from five phylogenetic species of Histoplasma to identify phenotypic traits that differentiate between these species: H. capsulatum sensu stricto, H. ohiense, H. mississippiense, H. suramericanum, and an African lineage. We report diagnostic traits for two species. The other three species can be identified by a combination of traits. Our results suggest that 1) there are significant phenotypic differences among the cryptic species of Histoplasma, and 2) that those differences can be used to positively distinguish those species in a clinical setting and for further study of the evolution of this fungal pathogen.
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Affiliation(s)
| | | | | | - William E. Goldman
- Department of Microbiology and Immunology, University of North Carolina at Chapel Hill
| | - Daniel R. Matute
- Department of Biology, University of North Carolina at Chapel Hill
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Oli A, Poudel S, Ranabhat A. Disseminated adrenal histoplasmosis in an immunocompetent adult from Nepal: a case report. Ann Med Surg (Lond) 2023; 85:5228-5231. [PMID: 37811102 PMCID: PMC10553013 DOI: 10.1097/ms9.0000000000001240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 08/16/2023] [Indexed: 10/10/2023] Open
Abstract
Introduction Histoplasmosis is caused by the environmental fungus Histoplasma capsulatum. In immunocompromised patients, histoplasmosis can present as a disseminated infection that can involve the liver, lymph nodes, lungs, and adrenal glands. Disseminated histoplasmosis affecting the adrenal glands in an immunocompetent individual is a rare infection. Case presentation A 53-year-old male without HIV complained of weight loss of 15 kg in 6 months. Computed tomography (CT) scan of the abdomen was done, which showed bilateral adrenal gland hyperplasia with hepatosplenomegaly. Endoscopic ultrasound fine needle aspiration of the adrenal gland revealed numerous budding yeast forms of Histoplasma intracellularly within the macrophages. A diagnosis of disseminated adrenal histoplasmosis was made. Liposomal amphotericin B and itraconazole therapy was started. Discussion Disseminated histoplasmosis is commonly present in immunocompromised individuals. Immunocompetent individuals may also present with the disseminated form of the disease, which typically involves the adrenal glands. CT scan of the abdomen shows bulky adrenal glands with normal configuration, peripheral enhancement, and central hypodensities due to necrosis and/or hemorrhage. This might be a common presentation in other disseminated infections. Therefore, a definitive visualization of H. capsulatum in tissue specimens is the best method to confirm the diagnosis in a patient. Conclusion Physicians must be suspicious of disseminated adrenal histoplasmosis in patients presenting with enlarged adrenal glands, even in immunocompetent individuals who are from endemic regions. Histopathological or cytological evaluation is the best method to establish a diagnosis.
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Affiliation(s)
- Aadhar Oli
- Kathmandu Medical College and Teaching Hospital, Kathmandu
| | - Shila Poudel
- Manipal College of Medical Sciences, Pokhara, Nepal
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Kusmiati T, Burhan E, Sugiyono RI, Arlinda D, Naysilla AM, Wibisono BH, El Khair R, Candrawati NW, Sinaga BYM, Djaharrudin I, Lokida D, Kosasih H, Susanto NH, Butar Butar DP, Adawiyah R, Fatril AE, Karyana M, Denning DW, Wahyuningsih R. The seroprevalence of anti-Histoplasma capsulatum IgG antibody among pulmonary tuberculosis patients in seven referral tuberculosis hospitals in Indonesia. PLoS Negl Trop Dis 2023; 17:e0011575. [PMID: 37729126 PMCID: PMC10511117 DOI: 10.1371/journal.pntd.0011575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 08/06/2023] [Indexed: 09/22/2023] Open
Abstract
BACKGROUND Histoplasma capsulatum exposure is rarely suspected in Indonesia. Pulmonary histoplasmosis can occur simultaneously with pulmonary tuberculosis (TB) or as an alternative diagnosis in clinically-diagnosed TB patients with no microbiological evidence of TB. This study aimed to determine the seroprevalence of anti-H. capsulatum IgG antibody among pulmonary TB patients. METHODOLOGY This was a sub-study of 306 participants from a prospective cohort pulmonary TB study conducted at seven TB referral hospitals in Indonesia. The study population was presumptive pulmonary TB adult patients who underwent microbiological TB examinations and were categorized as drug-sensitive (DS), drug-resistant (DR), and clinically-diagnosed TB. Anti-H. capsulatum IgG antibody levels at baseline were measured using MVista Histoplasma Ab enzyme immunoassays. Data were summarized using descriptive statistics. Bivariate and multivariate logistic regression analysis were performed to assess factors associated with anti-H. capsulatum IgG antibody positive result. RESULTS 12.7% (39/306) of pulmonary TB patients were positive for anti-H. capsulatum IgG antibodies (DR-TB patients (15.9%, 18/114), DS-TB (13.0%, 15/115), and clinically-diagnosed TB (7.8%, 6/77)). The median unit value of anti-H. capsulatum IgG antibody for all positive samples was 15.7 (IQR 10.2-28.9) EU. This median unit value was higher in clinically-diagnosed TB patients compared to DS-TB or DR-TB patients (38.1 (IQR 25.6-46.6) EU, 19.7 (IQR 12.3-28.9) EU, and 10.9 (IQR 9.2-15.4), respectively). There were 10 patients (3.3%) with anti-H. capsulatum IgG antibody levels above 30 EU. Factors associated with the anti-H. capsulatum IgG antibody positive result were malignancies (OR 4.88, 95% CI 1.09-21.69, p = 0.037) and cavitary lesions (OR 2.27, 95% CI 1.09-4.70, p = 0.028). CONCLUSIONS Our results provide evidence of exposure to H. capsulatum among pulmonary TB patients in Indonesia. Further studies are needed to provide a comprehensive picture of this fungal disease in other populations and regions to enhance awareness among clinicians and public health officials.
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Affiliation(s)
- Tutik Kusmiati
- Department of Pulmonology, Soetomo Hospital, Surabaya, Indonesia
| | - Erlina Burhan
- Department of Pulmonology, Persahabatan Hospital, Jakarta, Indonesia
| | - Retna Indah Sugiyono
- Indonesia Clinical Research Center (INA-CRC), Health Policy Agency, Ministry of Health, Jakarta, Indonesia
| | - Dona Arlinda
- Indonesia Clinical Research Center (INA-CRC), Health Policy Agency, Ministry of Health, Jakarta, Indonesia
| | - Adhella Menur Naysilla
- Indonesia Clinical Research Center (INA-CRC), Health Policy Agency, Ministry of Health, Jakarta, Indonesia
| | | | - Riat El Khair
- Department of Clinical Pathology and Laboratory Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Sardjito Hospital, Yogyakarta, Indonesia
| | - Ni Wayan Candrawati
- Department of Pulmonology, Faculty of Medicine, Universitas Udayana, Prof. IGNG. Ngoerah General Hospital, Bali, Indonesia
| | | | - Irawaty Djaharrudin
- Department of Pulmonology, Faculty of Medicine, Universitas Hasanuddin, Wahidin Sudirohussodo Hospital, Makassar, Indonesia
| | - Dewi Lokida
- Department of Clinical Pathology, Tangerang District Hospital, Banten, Indonesia
| | - Herman Kosasih
- Indonesia Clinical Research Center (INA-CRC), Health Policy Agency, Ministry of Health, Jakarta, Indonesia
| | - Nugroho Harry Susanto
- Indonesia Clinical Research Center (INA-CRC), Health Policy Agency, Ministry of Health, Jakarta, Indonesia
| | - Deni Pepy Butar Butar
- Indonesia Clinical Research Center (INA-CRC), Health Policy Agency, Ministry of Health, Jakarta, Indonesia
| | - Robiatul Adawiyah
- Department of Parasitology, Universitas Indonesia, Jakarta, Indonesia
| | - Ayu Eka Fatril
- Department of Parasitology, Universitas Indonesia, Jakarta, Indonesia
| | - Muhammad Karyana
- Indonesia Clinical Research Center (INA-CRC), Health Policy Agency, Ministry of Health, Jakarta, Indonesia
| | - David W. Denning
- Manchester Fungal Infection Group, The University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Retno Wahyuningsih
- Department of Parasitology, Universitas Indonesia, Jakarta, Indonesia
- Department of Parasitology, Faculty of Medicine, Universitas Kristen Indonesia, Jakarta, Indonesia
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Yglesias Dimadi II, Clinton Hidalgo M, Hernández Chavarría VI, Min Kim H, Castro Torres GR. Disseminated Histoplasmosis in an Indigenous Child With Malnutrition: A Case Report. Cureus 2023; 15:e41493. [PMID: 37551207 PMCID: PMC10404342 DOI: 10.7759/cureus.41493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2023] [Indexed: 08/09/2023] Open
Abstract
Histoplasmosis is a mycosis caused by Histoplasma capsulatum, a dimorphic fungus endemic to areas with nitrogen-rich soil, like the one contaminated with bird and bat excrement. Patients with a deficient immune response are especially at risk for developing invasive infections, such as disseminated histoplasmosis, and secondary immunodeficiency can be a consequence of malnutrition. This case report presents a 15-month-old male infant with malnutrition who presented with signs and symptoms of disseminated histoplasmosis, including fever, malaise, weight loss, cough, and diarrhea. The infant came from a geographic area where histoplasmosis is endemic, and he was a member of a cultural group with a higher prevalence of histoplasmosis than the general population. On physical examination, hepatosplenomegaly, lymphadenopathy, and lung crackles were found, which are common in most patients with histoplasmosis. The keystone of diagnosis of H. capsulatum infection is antigen detection, but the criterion standard is isolation of the organism from body specimens through laboratory culture. Histological diagnosis is especially useful for rapid diagnosis. Treatment of disseminated histoplasmosis in the pediatric population consists of deoxycholate amphotericin B for four to six weeks followed by itraconazole to complete a total of three months of treatment. Despite the involvement of multiple organ systems, the patient recovered satisfactorily after the completion of amphotericin B treatment for one month and the resolution of his malnourishment.
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Affiliation(s)
| | | | | | - Hery Min Kim
- General Medicine, Universidad de Costa Rica, San Jose, CRI
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Santos AS, Borges Dos Anjos LR, Costa VAF, Freitas VAQ, Zara ALDSA, Costa CR, Neves BJ, Silva MDRR. In silico-chemogenomic repurposing of new chemical scaffolds for histoplasmosis treatment. J Mycol Med 2023; 33:101363. [PMID: 36842411 DOI: 10.1016/j.mycmed.2023.101363] [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: 09/27/2022] [Revised: 01/10/2023] [Accepted: 02/10/2023] [Indexed: 02/13/2023]
Abstract
BACKGROUND Histoplasmosis is a systemic form of endemic mycosis to the American continent and may be lethal to people living with HIV/AIDS. The drugs available for treating histoplasmosis are limited, costly, and highly toxic. New drug development is time-consuming and costly; hence, drug repositioning is an advantageous strategy for discovering new therapeutic options. OBJECTIVE This study was conducted to identify drugs that can be repositioned for treating histoplasmosis in immunocompromised patients. METHODS Homologous proteins among Histoplasma capsulatum strains were selected and used to search for homologous targets in the DrugBank and Therapeutic Target Database. Essential genes were selected using Saccharomyces cerevisiae as a model, and functional regions of the therapeutic targets were analyzed. The antifungal activity of the selected drugs was verified, and homology modeling and molecular docking were performed to verify the interactions between the drugs with low inhibitory concentration values and their corresponding targets. RESULTS We selected 149 approved drugs with potential activity against histoplasmosis, among which eight were selected for evaluating their in vitro activity. For drugs with low minimum inhibitory concentration values, such as mebendazole, everolimus, butenafine, and bifonazole, molecular docking studies were performed. A chemogenomic framework revealed lanosterol 14-α-demethylase, squalene monooxygenase, serine/threonine-protein kinase mTOR, and the β-4B tubulin chain of H. capsulatum, respectively, as the protein targets of the drugs. CONCLUSIONS Our strategy can be used to identify promising antifungal targets, and drugs with repositioning potential for treating H. capsulatum.
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Affiliation(s)
- Andressa Santana Santos
- Institute of Tropical Pathology and Public Health (IPTSP), Federal University of Goiás, Goiânia, Brazil
| | | | | | | | | | - Carolina Rodrigues Costa
- Institute of Tropical Pathology and Public Health (IPTSP), Federal University of Goiás, Goiânia, Brazil
| | - Bruno Junior Neves
- Laboratory of Cheminformatics (LabChem), Faculty of Pharmacy, Federal University of Goiás, Goiânia, Brazil
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Kuate MPN, Ekeng BE, Kwizera R, Mandengue C, Bongomin F. Histoplasmosis overlapping with HIV and tuberculosis in sub-Saharan Africa: challenges and research priorities. Ther Adv Infect Dis 2021; 8:20499361211008675. [PMID: 33889408 PMCID: PMC8040546 DOI: 10.1177/20499361211008675] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 03/20/2021] [Indexed: 11/15/2022] Open
Abstract
Histoplasmosis, tuberculosis and HIV are all highly prevalent in sub-Saharan Africa (SSA). Co-occurrence of two or more of these infections has been reported in several populations of patients, especially those with advanced HIV infection where these opportunistic infections contribute to a significant morbidity and mortality. With a high burden of pulmonary tuberculosis (PTB) secondary to HIV in SSA, histoplasmosis is commonly misdiagnosed as smear-negative PTB in HIV patients due to similar clinical and radiological presentations. This is also partly the result of the lack of trained clinical and laboratory personnel to make a definite diagnosis of histoplasmosis. There is a low index of clinical suspicion for histoplasmosis, and cases are mostly discovered accidently and documented through case reports and case series. Similarly, the high cost and lack of fungal diagnostics in most SSA countries makes it difficult to make a diagnosis. There is a need to build local capacity for mycology so that patients are managed to improve on the index of clinical suspicion and diagnostic capabilities. Moreover, simple accurate point-of-care diagnostic tests and first-line antifungal treatment for histoplasmosis are not available in many SSA countries. This review describes the existence of co-infections of histoplasmosis, tuberculosis and HIV in SSA, highlighting the challenges and research priorities.
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Affiliation(s)
| | - Bassey Ewa Ekeng
- Department of Medical Microbiology & Parasitology, University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Richard Kwizera
- Translational Research Laboratory, Department of Research, Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Christine Mandengue
- Department of Internal Medicine, Dermatology Unit, Université des Montagnes, Bangangte, Cameroon
| | - Felix Bongomin
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Gulu University, P.O. Box 166, Gulu, Uganda
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Current and New Perspectives in the Diagnosis of Blastomycosis and Histoplasmosis. J Fungi (Basel) 2020; 7:jof7010012. [PMID: 33383637 PMCID: PMC7823406 DOI: 10.3390/jof7010012] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 12/22/2020] [Accepted: 12/24/2020] [Indexed: 12/12/2022] Open
Abstract
The diagnosis of blastomycosis and histoplasmosis can be difficult for clinicians who rarely see infections caused by these environmentally restricted dimorphic fungi. Historically, the diagnosis of blastomycosis has been established by culture and sometimes by histopathologic identification. Currently, antigen detection in urine and serum has been shown to aid in the rapid diagnosis of blastomycosis, and newer antibody assays are likely to contribute to our diagnostic capability in the near future. The gold standard for the diagnosis of histoplasmosis has been culture of the organism from involved tissues, aided in some patients by histopathological verification of the typical yeast forms in tissues. Antigen detection has contributed greatly to the ability of clinicians to rapidly establish the diagnosis of histoplasmosis, especially in severely ill and immunocompromised patients, and antibody testing for Histoplasma capsulatum provides important adjunctive diagnostic capability for several forms of both acute and chronic histoplasmosis. For both of these endemic mycoses, novel molecular tests are under active investigation, but remain available in only a few reference laboratories. In this review, we provide a synopsis of diagnostic test options that aid in establishing whether a patient has blastomycosis or histoplasmosis.
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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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Linder KA, Kauffman CA. Histoplasmosis: Epidemiology, Diagnosis, and Clinical Manifestations. CURRENT FUNGAL INFECTION REPORTS 2019. [DOI: 10.1007/s12281-019-00341-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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