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Zerbato V, Di Bella S, Pol R, D’Aleo F, Angheben A, Farina C, Conte M, Luzzaro F, Luzzati R, Principe L. Endemic Systemic Mycoses in Italy: A Systematic Review of Literature and a Practical Update. Mycopathologia 2023; 188:307-334. [PMID: 37294504 PMCID: PMC10386973 DOI: 10.1007/s11046-023-00735-z] [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: 12/17/2022] [Accepted: 04/02/2023] [Indexed: 06/10/2023]
Abstract
Endemic systemic mycoses such as blastomycosis, coccidioidomycosis, histoplasmosis, talaromycosis, paracoccidioidomycosis are emerging as an important cause of morbidity and mortality worldwide. We conducted a systematic review on endemic systemic mycoses reported in Italy from 1914 to nowadays. We found out: 105 cases of histoplasmosis, 15 of paracoccidioidomycosis, 10 of coccidioidomycosis, 10 of blastomycosis and 3 of talaromycosis. Most cases have been reported in returning travelers and expatriates or immigrants. Thirtytwo patients did not have a story of traveling to an endemic area. Fortysix subjects had HIV/AIDS. Immunosuppression was the major risk factor for getting these infections and for severe outcomes. We provided an overview on microbiological characteristics and clinical management principles of systemic endemic mycoses with a focus on the cases reported in Italy.
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Affiliation(s)
- Verena Zerbato
- Infectious Diseases Unit, Trieste University Hospital (ASUGI), Piazza dell’Ospitale 1, 34125 Trieste, Italy
| | - Stefano Di Bella
- Clinical Department of Medical, Surgical and Health Sciences, Trieste University, 34149 Trieste, Italy
| | - Riccardo Pol
- Infectious Diseases Unit, Trieste University Hospital (ASUGI), Piazza dell’Ospitale 1, 34125 Trieste, Italy
| | - Francesco D’Aleo
- Microbiology and Virology Unit, Great Metropolitan Hospital “Bianchi Melacrino Morelli”, 89124 Reggio Calabria, Italy
| | - Andrea Angheben
- Department of Infectious, Tropical Diseases and Microbiology, IRCCS Sacro Cuore - Don Calabria Hospital, 37024 Negrar di Valpolicella, Verona, Italy
| | - Claudio Farina
- Microbiology and Virology Laboratory, ASST “Papa Giovanni XXIII”, 24127 Bergamo, Italy
| | - Marco Conte
- Microbiology and Virology Unit, Great Metropolitan Hospital “Bianchi Melacrino Morelli”, 89124 Reggio Calabria, Italy
| | - Francesco Luzzaro
- Clinical Microbiology and Virology Unit, “A. Manzoni” Hospital, 23900 Lecco, Italy
| | | | - Roberto Luzzati
- Clinical Department of Medical, Surgical and Health Sciences, Trieste University, 34149 Trieste, Italy
| | - Luigi Principe
- Clinical Pathology and Microbiology Unit, “S. Giovanni di Dio” Hospital, 88900 Crotone, Italy
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Gastélum-Cano JM, Dautt-Castro M, García-Galaz A, Felix-Murray K, Rascón-Careaga A, Cano-Rangel MA, Islas-Osuna MA. The clinical laboratory evolution in coccidioidomycosis detection: Future perspectives. J Mycol Med 2021; 31:101159. [PMID: 34157512 DOI: 10.1016/j.mycmed.2021.101159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 05/22/2021] [Accepted: 05/25/2021] [Indexed: 11/18/2022]
Abstract
Coccidioidomycosis is a systemic disease caused by the fungi Coccidioides immitis and C. posadasii. It is a prevalent disease in arid regions with high temperatures and low precipitations in America. Coccidioidomycosis is a highly endemic disease of US-Mexico border states but commonly underdiagnosed. The diagnosis of coccidiomycosis is not easy due to the lack of specific symptoms; it is usually an integral approach, including clinical laboratory tests as an essential part of the diagnosis. Nevertheless, despite various laboratory tests available, affordability can be a limitation, mainly in developing countries. This review's objectives are 1) to learn the different laboratory approaches that arose and their application for clinical diagnosis; 2) to discuss their advantages and weaknesses, and finally, 3) propose what is on the horizon for future advances in clinical laboratory diagnosis of coccidioidomycosis. It has been a long way in laboratory tests evolution to detect coccidioidomycosis from tissue microscopy to Real-Time PCR. However, there is a delay in technology adoption for Coccidioides spp. detection in the clinical laboratory. The molecular Point of Care Testing (POCT) technology has reached us in our trench while research in PCR variants stills on-going. None of the currently existing scientific literature in coccidioidomycosis research has mentioned it. However, this trend in infectious and non-infectious disease diagnosis will continue in that way in order to offer better options for an easy and fast diagnosis. Undoubtedly, the implementation of molecular POCT for Coccidioides spp. would save resources in health care attention and improve access to diagnostic tools.
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Affiliation(s)
- José María Gastélum-Cano
- Lab. de Genética y Biología Molecular, Centro de Investigación en Alimentación y Desarrollo A.C. (CIAD, A.C.) Gustavo Enrique Astiazarán Rosas No. 46. La Victoria, Hermosillo, Sonora 83304, Mexico
| | - Mitzuko Dautt-Castro
- Instituto Potosino de Investigación Científica y Tecnológica A.C. (IPICYT). Camino a la Presa de San José No. 2055. Lomas 4ta Sección, San Luis Potosí, S.L.P. 78216, Mexico
| | - Alfonso García-Galaz
- Lab. de Microbiología Molecular, Centro de Investigación en Alimentación y Desarrollo A.C. (CIAD, A.C.) Gustavo Enrique Astiazarán Rosas No. 46. La Victoria, Hermosillo, Sonora 83304, Mexico
| | - Katya Felix-Murray
- Universidad de Sonora. Blvd. Luis Encinas y Rosales S/N. Col. Centro, Hermosillo, Sonora 83000, Mexico
| | - Antonio Rascón-Careaga
- Universidad de Sonora. Blvd. Luis Encinas y Rosales S/N. Col. Centro, Hermosillo, Sonora 83000, Mexico
| | - Manuel A Cano-Rangel
- Hospital Infantil del Estado de Sonora (HIES), Reforma 355. Ley 57, Hermosillo, Sonora 83100, Mexico
| | - María A Islas-Osuna
- Lab. de Genética y Biología Molecular, Centro de Investigación en Alimentación y Desarrollo A.C. (CIAD, A.C.) Gustavo Enrique Astiazarán Rosas No. 46. La Victoria, Hermosillo, Sonora 83304, Mexico.
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Rodríguez-Morales AJ, Suárez JA, Risquez A, Delgado-Noguera L, Paniz-Mondolfi A. The current syndemic in Venezuela: Measles, malaria and more co-infections coupled with a breakdown of social and healthcare infrastructure. Quo vadis? Travel Med Infect Dis 2019; 27:5-8. [DOI: 10.1016/j.tmaid.2018.10.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 10/10/2018] [Accepted: 10/11/2018] [Indexed: 11/30/2022]
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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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Donovan FM, Zangeneh TT, Malo J, Galgiani JN. Top Questions in the Diagnosis and Treatment of Coccidioidomycosis. Open Forum Infect Dis 2017; 4:ofx197. [PMID: 29670928 PMCID: PMC5903411 DOI: 10.1093/ofid/ofx197] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 09/09/2017] [Indexed: 02/06/2023] Open
Abstract
Revised and greatly expanded treatment guidelines for coccidioidomycosis were published last year by the Infectious Diseases Society of America. We have selected 4 questions that commonly arise in the management of patients suspected of this disease and for which there remain divided opinions.
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Affiliation(s)
- Fariba M Donovan
- The Valley Fever Center for Excellence and Department of Medicine, University of Arizona College of Medicine, Tucson, Arizona
| | - Tirdad T Zangeneh
- The Valley Fever Center for Excellence and Department of Medicine, University of Arizona College of Medicine, Tucson, Arizona
| | - Joshua Malo
- The Valley Fever Center for Excellence and Department of Medicine, University of Arizona College of Medicine, Tucson, Arizona
| | - John N Galgiani
- The Valley Fever Center for Excellence and Department of Medicine, University of Arizona College of Medicine, Tucson, Arizona
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Duong TN, Waldman SE. Importance of a Travel History in Evaluation of Respiratory Infections. CURRENT EMERGENCY AND HOSPITAL MEDICINE REPORTS 2016; 4:141-152. [PMID: 32226655 PMCID: PMC7100244 DOI: 10.1007/s40138-016-0109-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
PURPOSE OF REVIEW International travel has increased at a fast pace and will continue to rapidly rise. Concomitantly, with this increase in travel is the increase in post travel-related diseases, such as respiratory illnesses. Identifying the cause of the posttravel respiratory illness is a complex challenge for many healthcare professionals because similar presentations occur for both infectious and noninfectious causes. Not only is diagnosis important but also transmission prevention. In the last two decades, there have been several severe infectious respiratory syndromes that have spread through international travel causing epidemics in many countries. RECENT FINDINGS A detailed travel history with the chronology of symptoms paired with the patient's medical risk factors and exposures along with some basic knowledge of infectious respiratory illnesses will help facilitate clinical decision making. This framework will help create a broad, but appropriate differential diagnosis to guide clinical workup, prevent delays in diagnosis, and implement the appropriate precautions to prevent transmission if appropriate. SUMMARY The foundation to diagnosing a travel-related respiratory illness lies within integrating the patient's travel history, comorbid conditions, clinical presentation, exposures, and mode of transmission. A timely and accurate diagnosis benefits not only the patient but also the surrounding community to prevent further individual transmission, epidemics, and pandemics.
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Affiliation(s)
- Theresa N. Duong
- Division of Hospital Medicine, Department of Internal Medicine, University of California, Davis Medical Center, Sacramento, CA USA
| | - Sarah E. Waldman
- Division of Infectious Diseases, Department of Internal Medicine, University of California, Davis Medical Center, Sacramento, CA USA
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Tortorano AM, Carminati G, Tosoni A, Tintelnot K. Primary Cutaneous Coccidioidomycosis in an Italian Nun Working in South America and Review of Published Literature. Mycopathologia 2015; 180:229-35. [PMID: 25935662 DOI: 10.1007/s11046-015-9895-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Accepted: 04/21/2015] [Indexed: 11/29/2022]
Abstract
Coccidioidomycosis is a systemic disease caused by the dimorphic fungus Coccidioides, endemic in parts of the Southwestern USA and Central and South America. Two species, Coccidioides immitis and Coccidioides posadasii, were differentiated. Primary cutaneous coccidioidomycosis (PCC) has been reported rarely. An unusual case of PCC characterized by a persistent solitary lesion diagnosed in Italy in an immunocompetent Italian nun living in Argentina is described. The isolate was identified by sequence analysis as C. posadasii. Antibody screening was negative. A total of 39 cases of PCC have been reported in the literature. Infections occurred as a consequence of traumatic implantation in a natural setting in endemic areas or of accidental inoculation in laboratory workers. Importance of accurate investigation of travel history and of occupational hazards to laboratory workers is outlined.
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Affiliation(s)
- A M Tortorano
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Pascal 36, 20133, Milan, Italy,
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Nenoff P, Reinel D, Krüger C, Grob H, Mugisha P, Süß A, Mayser P. Tropen- und Reise-assoziierte Dermatomykosen. Hautarzt 2015; 66:522-32. [DOI: 10.1007/s00105-015-3635-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Rodriguez-Morales AJ, Jiménez-Canizales CE, Mondragón-Cardona A, Taype-Rondán A, Vargas-Gandica JA. So, if I travel to "Venezuela", can I get coccidioidomycosis? Infection 2014; 42:1067-8. [PMID: 25274025 DOI: 10.1007/s15010-014-0687-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2014] [Accepted: 09/22/2014] [Indexed: 11/30/2022]
Affiliation(s)
- A J Rodriguez-Morales
- Research Group and Incubator Public Health and Infection, Faculty of Health Sciences, UniversidadTecnologica de Pereira, Pereira, 660001, Risaralda, Colombia,
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