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Friesen JN, Allman A, Abu Saleh O. 50-Year-Old Man With Fevers, Cough, and Night Sweats. Mayo Clin Proc 2024; 99:821-826. [PMID: 38551539 DOI: 10.1016/j.mayocp.2023.07.030] [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] [Received: 06/01/2023] [Revised: 07/21/2023] [Accepted: 07/26/2023] [Indexed: 05/05/2024]
Affiliation(s)
- Joelle N Friesen
- Resident in Internal Medicine, Mayo Clinic School of Graduate Medical Education, Rochester, MN
| | - Alexandra Allman
- Resident in Internal Medicine, Mayo Clinic School of Graduate Medical Education, Rochester, MN
| | - Omar Abu Saleh
- Advisor to residents and Consultant in Infectious Disease, Mayo Clinic, Rochester, MN.
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2
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Kapoor N, Dietz C, Buettner BP. An Incarcerated Individual With Weight Loss and Interstitial Pulmonary Infiltrates. JAMA 2024; 331:522-523. [PMID: 38190148 DOI: 10.1001/jama.2023.24260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2024]
Abstract
A man with HIV had syncopal episodes and hypoxemia after recent exposure to SARS-CoV-2; computed tomography revealed diffuse bilateral pulmonary micronodular opacities, a 2.2-cm nodule in the lingula, and mediastinal and hilar lymphadenopathy. What is the diagnosis and what would you do next?
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Affiliation(s)
- Nilesh Kapoor
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas
| | - Christina Dietz
- Division of Hospital Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus
| | - Benjamin P Buettner
- Division of Hospital Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus
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3
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Barrs VR, Beczkowski PM, Talbot JJ, Hobi S, Teoh SN, Hernandez Muguiro D, Shubitz LF, Sandy J. Invasive Fungal Infections and Oomycoses in Cats: 1. Diagnostic approach. J Feline Med Surg 2024; 26:1098612X231219696. [PMID: 38189288 PMCID: PMC10949879 DOI: 10.1177/1098612x231219696] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2024]
Abstract
CLINICAL RELEVANCE In contrast to superficial fungal infections, such as dermatophytosis, invasive fungal infections (IFIs) are characterised by penetration of tissues by fungal elements. Disease can spread locally within a region or can disseminate haematogenously or via the lymphatics. The environment is the most common reservoir of infection. Since fungal spores are airborne, indoor cats are also susceptible to IFIs. Some environmental fungi are ubiquitous and present globally, while others are endemic or hyperendemic within specific geographic regions. Zoonotic pathogens include Microsporum canis, Sporothrix schenckii and Sporothrix brasiliensis. AIM In the first of a two-part article series, the approach to the investigation of feline IFIs and oomycoses is reviewed. As well as tips for diagnosis, and information on the ecological niche and distribution of fungal pathogens, the review covers clinical presentation of the most common IFIs, including cryptococcosis, histoplasmosis, blastomycosis, coccidioidomycosis, sporotrichosis, phaeohyphomycosis, aspergillosis and dermatophytic pseudomycetoma, as well as the oomycoses pythiosis, lagenidiosis and paralagenidiosis. In Part 2, the spectrum of activity, mechanisms of action, pharmacokinetic and pharmacodynamic properties and adverse effects of antifungal drugs are reviewed, and the treatment and prognosis for specific IFIs and oomycoses are discussed. EVIDENCE BASE The review draws on published evidence and the authors' combined expertise in feline medicine, mycology, dermatology, clinical pathology and anatomical pathology.
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Affiliation(s)
- Vanessa R Barrs
- Department of Veterinary Clinical Sciences, Jockey Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, Kowloon Tong, Hong Kong, SAR China
- Centre for Animal Health and Welfare, City University of Hong Kong, Kowloon Tong, Hong Kong, SAR China
| | - Paweł M Beczkowski
- Department of Veterinary Clinical Sciences, Jockey Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, Kowloon Tong, Hong Kong, SAR China
| | | | - Stefan Hobi
- Department of Veterinary Clinical Sciences, Jockey Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, Kowloon Tong, Hong Kong, SAR China
| | - Shu Ning Teoh
- Veterinary Specialists Aotearoa, Henderson, Auckland, New Zealand
| | | | - Lisa F Shubitz
- Valley Fever Center for Excellence, The University of Arizona, AZ, USA
| | - Jeanine Sandy
- Department of Veterinary Clinical Sciences, Jockey Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, Kowloon Tong, Hong Kong, SAR China
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4
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López LF, Tobón ÁM, Cáceres DH, Chiller T, Litvintseva AP, Gade L, González Á, Gómez BL. Application of Real-Time PCR Assays for the Diagnosis of Histoplasmosis in Human FFPE Tissues Using Three Molecular Targets. J Fungi (Basel) 2023; 9:700. [PMID: 37504689 PMCID: PMC10381543 DOI: 10.3390/jof9070700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 06/15/2023] [Accepted: 06/19/2023] [Indexed: 07/29/2023] Open
Abstract
Histoplasmosis is a fungal infection caused by the thermally dimorphic fungus Histoplasma capsulatum. This infection causes significant morbidity and mortality in people living with HIV/AIDS, especially in countries with limited resources. Currently used diagnostic tests rely on culture and serology but with some limitations. No molecular assays are commercially available and the results from different reports have been variable. We aimed to evaluate quantitative real-time PCR (qPCR) targeting three protein-coding genes of Histoplasma capsulatum (100-kDa, H and M antigens) for detection of this fungus in formalin-fixed paraffin-embedded (FFPE) samples from patients with proven histoplasmosis. The sensitivity of 100-kDa, H and M qPCR assays were 93.9%, 91% and 57%, respectively. The specificity of 100-kDa qPCR was 93% when compared against samples from patients with other mycoses and other infections, and 100% when samples from patients with non-infectious diseases were used as controls. Our findings demonstrate that real-time PCR assays targeting 100-kDa and H antigen showed the most reliable results and can be successfully used for diagnosing this mycosis when testing FFPE samples.
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Affiliation(s)
- Luisa F López
- Medical and Experimental Mycology Group, Corporación para Investigaciones Biológicas (CIB), Medellín 050034, Colombia
| | - Ángela M Tobón
- Instituto Colombiano de Medicina Tropical, Universidad CES, Medellín 055450, Colombia
| | - Diego H Cáceres
- Medical and Experimental Mycology Group, Corporación para Investigaciones Biológicas (CIB), Medellín 050034, Colombia
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | - Tom Chiller
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | | | - Lalitha Gade
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | - Ángel González
- Basic and Applied Microbiology Research Group (MICROBA), School of Microbiology, Universidad de Antioquia, Medellín 050010, Colombia
| | - Beatriz L Gómez
- Studies in Translational Microbiology and Emerging Diseases (MICROS) Research Group, School of Medicine and Health Sciences, Universidad del Rosario, Bogota 111221, Colombia
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5
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McKissic DA, Lee W, Weinberg JB, Stillwell T. Daily Fevers, Pancytopenia, and Elevated Transaminase Levels in a 5-month-old Boy. Pediatr Rev 2022; 43:717-720. [PMID: 36450638 DOI: 10.1542/pir.2021-004969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Affiliation(s)
| | | | - Jason B Weinberg
- Department of Pediatrics.,Department of Microbiology and Immunology, University of Michigan, Ann Arbor, MI
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Abstract
Purpose of Review Recent Findings Summary
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Sood A, Raman DK, Sinha A, Vasudevan B. Cutaneous manifestations leading to a diagnosis of a case of severe disseminated histoplasmosis in a human immunodeficiency virus-positive child. Indian J Sex Transm Dis AIDS 2022; 43:185-188. [PMID: 36743122 PMCID: PMC9891009 DOI: 10.4103/ijstd.ijstd_59_22] [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: 06/19/2022] [Accepted: 06/20/2022] [Indexed: 11/17/2022] Open
Abstract
This 9-year-old boy who was human immunodeficiency virus positive since birth presented with raised skin lesions, breathlessness, and cough and was treated as a case of disseminated tuberculosis. When no improvement was seen, he was referred to the dermatologist whose examination revealed papulonodular lesions with crusting over the face and extremities. Based on clinical suspicion of histoplasmosis, investigations done revealed a CD4 count of 3 cells/μL and histopathological features of histoplasmosis along with the disseminated disease. Cutaneous manifestations thus led to an early diagnosis of the case and a good prognostic outcome.
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Affiliation(s)
- Aradhana Sood
- Department of Dermatology, Base Hospital, Lucknow, Uttar Pradesh, India
| | - Deep Kumar Raman
- Department of Pathology, Base Hospital, Lucknow, Uttar Pradesh, India
| | - Asmita Sinha
- Department of Dermatology, Base Hospital, Lucknow, Uttar Pradesh, India
| | - Biju Vasudevan
- Department of Dermatology, Armed Forces Medical College, Pune, Maharashtra, India
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8
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Evaluation of the Anti-Histoplasma capsulatum Activity of Indole and Nitrofuran Derivatives and Their Pharmacological Safety in Three-Dimensional Cell Cultures. Pharmaceutics 2022; 14:pharmaceutics14051043. [PMID: 35631629 PMCID: PMC9147190 DOI: 10.3390/pharmaceutics14051043] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 05/04/2022] [Accepted: 05/09/2022] [Indexed: 11/25/2022] Open
Abstract
Histoplasma capsulatum is a fungus that causes histoplasmosis. The increased evolution of microbial resistance and the adverse effects of current antifungals help new drugs to emerge. In this work, fifty-four nitrofurans and indoles were tested against the H. capsulatum EH-315 strain. Compounds with a minimum inhibitory concentration (MIC90) equal to or lower than 7.81 µg/mL were selected to evaluate their MIC90 on ATCC G217-B strain and their minimum fungicide concentration (MFC) on both strains. The quantification of membrane ergosterol, cell wall integrity, the production of reactive oxygen species, and the induction of death by necrosis–apoptosis was performed to investigate the mechanism of action of compounds 7, 11, and 32. These compounds could reduce the extracted sterol and induce necrotic cell death, similarly to itraconazole. Moreover, 7 and 11 damaged the cell wall, causing flaws in the contour (11), or changing the size and shape of the fungal cell wall (7). Furthermore, 7 and 32 induced reactive oxygen species (ROS) formation higher than 11 and control. Finally, the cytotoxicity was measured in two models of cell culture, i.e., monolayers (cells are flat) and a three-dimensional (3D) model, where they present a spheroidal conformation. Cytotoxicity assays in the 3D model showed a lower toxicity in the compounds than those performed on cell monolayers. Overall, these results suggest that derivatives of nitrofurans and indoles are promising compounds for the treatment of histoplasmosis.
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Synthesis and Evaluation of the Antifungal and Toxicological Activity of Nitrofuran Derivatives. Pharmaceutics 2022; 14:pharmaceutics14030593. [PMID: 35335969 PMCID: PMC8950151 DOI: 10.3390/pharmaceutics14030593] [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: 02/08/2022] [Revised: 02/28/2022] [Accepted: 03/04/2022] [Indexed: 11/17/2022] Open
Abstract
Fungal diseases affect more than 1 billion people worldwide. The constant global changes, the advent of new pandemics, and chronic diseases favor the diffusion of fungal pathogens such as Candida, Cryptococcus, Aspergillus, Trichophyton, Histoplasma capsulatum, and Paracoccidioides brasiliensis. In this work, a series of nitrofuran derivatives were synthesized and tested against different fungal species; most of them showed inhibitory activity, fungicide, and fungistatic profile. The minimal inhibitory concentration (MIC90) values for the most potent compounds range from 0.48 µg/mL against H. capsulatum (compound 11) and P. brasiliensis (compounds 3 and 9) to 0.98 µg/mL against Trichophyton rubrum and T. mentagrophytes (compounds 8, 9, 12, 13 and 8, 12, 13, respectively), and 3.9 µg/mL against Candida and Cryptococcus neoformans strains (compounds 1 and 5, respectively). In addition, all compounds showed low toxicity when tested in vitro on lung cell lines (A549 and MRC-5) and in vivo in Caenorhabditis elegans larvae. Many of them showed high selectivity index values. Thus, these studied nitrofuran derivatives proved to be potent against different fungal species, characterized by low toxicity and high selectivity; for these reasons, they may become promising compounds for the treatment of mycoses.
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Freire M, Carvalho V, Spener R, da Silva CR, da Silva Neto JR, Carlos Ferreira L, Nogueira PA. Hemophagocytic Syndrome in a Patient with HIV and Histoplasmosis: A not so Rare Correlation. Clin Med Insights Pathol 2022; 15:2632010X221118059. [PMID: 36051652 PMCID: PMC9425888 DOI: 10.1177/2632010x221118059] [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: 10/29/2021] [Accepted: 07/15/2022] [Indexed: 11/18/2022] Open
Abstract
Hemophagocytic lymphohistiocytosis (HLH) is a disorder that occurs due to unsuitable monocyte activation in a variety of infections. In human immunodeficiency virus (HIV) infections, patients with advanced immunossupression associated with opportunistic infections are at increased risk of developing HLH. We describe a clinical case of a 33-year-old male student diagnosed with HIV who was hospitalized for investigation of asthenia and dyspnea, accompanied by adynamia, decreased motor force in the left leg, dysphagia, and dysfluency. His general condition was regular, he was pale, feverish, and had normal cardiac and pulmonary auscultation. Physical examination revealed ulcerated lesions in the perianal region and hepatosplenomegaly without palpable lymph node enlargement. Laboratory parameters showed pancytopenia, a slight increase in liver function accompanied by high lactate dehydrogenase, and hiperferritinemia. The initial diagnosis was disseminated histoplasmosis, thus amphotericin B deoxycholate was empirically prescribed while waiting on myeloculture and blood cultures for fungi and mycobacteria. Other clinical procedures were blood transfusion, resumption of antiretroviral therapy (ART) and secondary prophylaxis. Myeloculture blood cultures of fungi and mycobacteria were negative. Patient evolved well in relation to the initial complaints and showed partial clinical and laboratory improvement. However, 23 days after hospitalization, he developed a febrile episode accompanied by chills and a convulsive crisis. The patient was transferred to the intensive unit care and developed septic shock and respiratory failure. He died 25 days after the onset of the condition. After the postmortem examination, histopathology revealed countless rounded fungal structures compatible with Histoplasma sp., which were observed in the peripancreatic lymph node, liver, and spleen, in addition to hemophagocytosis in the splenic parenchyma. We thus conclude that when the patient met criteria for HLH, such as fever, hepatosplenomegaly, hiperferritinemia, and pancytopenia, the evolution was fast due to the aggressive and rapidly fatal nature of HLH, despite anti-fungal and corticoid treatment. Therefore, this case report reinforces the need to consider hemophagocytic syndrome in patients with HIV and disseminated histoplasmosis, especially where histoplasmosis is highly endemic, in order for the treatment be started early when there is high clinical suspicion.
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Affiliation(s)
- Monique Freire
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil.,Programa de Pós-graduação em Ciências da Saúde, Universidade Federal do Amazonas, Manaus, Brazil
| | - Viviane Carvalho
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | - Renata Spener
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | - Christiane Rodrigues da Silva
- Programa de Pós-graduação em Biologia da Realação Patogeno Hospedeiro, Instituto Leônidas e Maria Deane, Manaus, Brazil
| | | | - Luiz Carlos Ferreira
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil.,Programa de Pós-graduação em Ciências da Saúde, Universidade Federal do Amazonas, Manaus, Brazil
| | - Paulo Afonso Nogueira
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil.,Programa de Pós-graduação em Biologia da Realação Patogeno Hospedeiro, Instituto Leônidas e Maria Deane, Manaus, Brazil
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11
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An Immunocompetent Woman with Pulmonary Granulomatous Vasculitis. Ann Am Thorac Soc 2021; 18:1907-1911. [PMID: 34723760 DOI: 10.1513/annalsats.202101-066cc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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12
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New Histoplasma Diagnostic Assays Designed via Whole Genome Comparisons. J Fungi (Basel) 2021; 7:jof7070544. [PMID: 34356923 PMCID: PMC8305531 DOI: 10.3390/jof7070544] [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: 05/16/2021] [Revised: 06/25/2021] [Accepted: 06/25/2021] [Indexed: 12/16/2022] Open
Abstract
Histoplasmosis is a systemic fungal disease caused by the pathogen Histoplasma spp. that results in significant morbidity and mortality in persons with HIV/AIDS and can also affect immunocompetent individuals. Although some PCR and antigen-detection assays have been developed, conventional diagnosis has largely relied on culture, which can take weeks. Our aim was to provide a proof of principle for rationally designing and standardizing PCR assays based on Histoplasma-specific genomic sequences. Via automated comparisons of aligned genome contigs/scaffolds and gene (sub)sequences, we identified protein-coding genes that are present in existing sequences of Histoplasma strains but not in other genera. Two of the genes, PPK and CFP4, were used for designing primer sets for conventional and real-time PCR assays. Both resulted in a 100% analytical specificity in vitro and detected 62/62 H. capsulatum isolates using purified DNA. We also obtained positive detections of 2/2 confirmed H. capsulatum clinical FFPE (formalin-fixed paraffin-embedded) samples using both primer sets. Positive control plasmid 10-fold serial dilutions confirmed the analytical sensitivity of the assays. The findings suggest that these novel primer sets should allow for detection sensitivity and reduce false positive results/cross-reactions. New assays for detecting pathogenic fungi, constructed along these lines, could be simple and affordable to implement.
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Vascular homografts as bypass grafts for superior vena cava syndrome due to idiopathic fibrosing mediastinitis. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2021; 7:335-338. [PMID: 34041423 PMCID: PMC8144109 DOI: 10.1016/j.jvscit.2021.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 03/28/2021] [Indexed: 11/21/2022]
Abstract
Fibrosing mediastinitis can lead to superior vena cava obstruction by generating a fibroinflammatory mass in the mediastinum. Surgical caval reconstruction with conduits could be indicated for cases of unsuccessful or technically unfeasible endovascular stenting and angioplasty. The use of cryopreserved vascular homografts seems to be better than prosthetic conduits for mid- and long-term patency, as was observed in the case we have described in the present report.
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14
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Demkowicz R, Procop GW. Clinical Significance and Histologic Characterization of Histoplasma Granulomas. Am J Clin Pathol 2021; 155:581-587. [PMID: 33089308 DOI: 10.1093/ajcp/aqaa159] [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: 11/12/2022] Open
Abstract
OBJECTIVES To clarify the clinical significance and degree of resolution (ie, grade) of Histoplasma granulomas in routinely reviewed surgical pathology specimens and the clinical outcomes of patients with this diagnosis, with an emphasis on those not receiving antifungal therapy. METHODS We performed a retrospective medical record, laboratory data, and surgical pathology slide review of patients with Histoplasma granulomas following institutional review board approval. RESULTS Clinical, pathologic, and laboratory data from 62 patients with Histoplasma granulomas were available for review. Of these, 1 of 19 (5%) fungal cultures, 4 of 12 (33%) fungal serologic studies, 0 of 9 Histoplasma urinary antigen tests, and 0 of 2 Histoplasma serum antigen tests were positive. All but 3 of the Histoplasma granulomas were either in the resolving (grade 2) or resolved (grade 3) stage of resolution. None of the patients, including those who did not receive antifungal therapy after the histologic diagnosis, developed progressive or disseminated histoplasmosis. CONCLUSIONS These findings, which are supportive of clinical guidelines, suggest that patients with old, hyalinized Histoplasma granulomas do not benefit from further laboratory studies or antifungal therapy. The proposed grading of Histoplasma granulomas informs clinicians of the stage of resolution of an excised lesion, which informs therapeutic decisions and thus is recommended.
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Affiliation(s)
- Ryan Demkowicz
- Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH
| | - Gary W Procop
- Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH
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Shen Q, Rappleye CA. Living Within the Macrophage: Dimorphic Fungal Pathogen Intracellular Metabolism. Front Cell Infect Microbiol 2020; 10:592259. [PMID: 33178634 PMCID: PMC7596272 DOI: 10.3389/fcimb.2020.592259] [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: 08/06/2020] [Accepted: 09/15/2020] [Indexed: 12/19/2022] Open
Abstract
Histoplasma and Paracoccidioides are related thermally dimorphic fungal pathogens that cause deadly mycoses (i.e., histoplasmosis and paracoccidioidomycosis, respectively) primarily in North, Central, and South America. Mammalian infection results from inhalation of conidia and their subsequent conversion into pathogenic yeasts. Macrophages in the lung are the first line of defense, but are generally unable to clear these fungi. Instead, Histoplasma and Paracoccidioides yeasts survive and proliferate within the phagosomal compartment of host macrophages. Growth within macrophages requires strategies for acquisition of sufficient nutrients (e.g., carbon, nitrogen, and essential trace elements and co-factors) from the nutrient-depleted phagosomal environment. We review the transcriptomic and recent functional genetic studies that are defining how these intracellular fungal pathogens tune their metabolism to the resources available in the macrophage phagosome. In addition, recent studies have shown that the nutritional state of the macrophage phagosome is not static, but changes upon activation of adaptive immune responses. Understanding the metabolic requirements of these dimorphic pathogens as they thrive within host cells can provide novel targets for therapeutic intervention.
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Affiliation(s)
- Qian Shen
- Department of Biology, Rhodes College, Memphis, TN, United States
| | - Chad A Rappleye
- Department of Microbiology, Ohio State University, Columbus, OH, United States
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16
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Buitrago MJ, Martín-Gómez MT. Timely Diagnosis of Histoplasmosis in Non-endemic Countries: A Laboratory Challenge. Front Microbiol 2020; 11:467. [PMID: 32269555 PMCID: PMC7109444 DOI: 10.3389/fmicb.2020.00467] [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: 11/15/2019] [Accepted: 03/04/2020] [Indexed: 12/18/2022] Open
Abstract
Human histoplasmosis is a fungal infection caused by the inhalation of microconidia of the thermally dimorphic fungi Histoplasma capsulatum. Autochthonous cases of histoplasmosis have been diagnosed in almost every country, but it is considered an endemic infection in specific areas of the world. Many of them are popular travel destinations or the source of migratory movements. Thus, the vast majority of the registered cases in non-endemic countries are imported. They correspond to people having been exposed to the fungus in endemic locations as immigrants, expatriates, transient workers or tourists, with reported cases also associated to organ donation. Misdiagnosis and delays in initiation of treatment are not uncommon in cases of imported histoplasmosis. They are associated to high fatality-rates specially in patients with compromised cellular immunity in which progressive disseminated forms develop. The diagnosis of this infection in non-endemic countries is hampered by the lack of clinical suspicion and a dearth of available diagnostic tools adequate to offer rapid and accurate results. Non-culture-based assays such as nucleic-acid amplification tests present as a suitable alternative in this situation, offering improved sensitivity and specificity, shortened turnaround time, and increased biosafety by avoiding culture manipulation. In non-endemic regions, molecular techniques are being used mainly in laboratories from countries that have registered an increase in the incidence of imported cases. However, the number of published techniques is limited and lack consensus. Efforts are currently under way to standardize nucleic acid amplification-based techniques for its implementation in areas registering a rising number of imported cases.
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Affiliation(s)
- María José Buitrago
- Mycology Reference Laboratory, National Centre of Microbiology, Instituto de Salud Carlos III, Madrid, Spain
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17
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Thompson‐Souza GA, Santos GMP, Silva JC, Muniz VS, Braga YAV, Figueiredo RT, Melo RCN, Santos ALS, Pinto MR, Neves JS. Histoplasma capsulatum
‐induced extracellular DNA trap release in human neutrophils. Cell Microbiol 2020; 22:e13195. [DOI: 10.1111/cmi.13195] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Revised: 02/12/2020] [Accepted: 02/13/2020] [Indexed: 01/08/2023]
Affiliation(s)
| | | | - Juliana C. Silva
- Institute of Biomedical Sciences/Institute of Microbiology Paulo de GóesFederal University of Rio de Janeiro Rio de Janeiro Brazil
| | - Valdirene S. Muniz
- Institute of Biomedical SciencesFederal University of Rio de Janeiro Rio de Janeiro Brazil
| | - Yasmim A. V. Braga
- Institute of Biomedical Sciences/Institute of Microbiology Paulo de GóesFederal University of Rio de Janeiro Rio de Janeiro Brazil
| | - Rodrigo T. Figueiredo
- Institute of Biomedical Sciences/Campus of Duque de CaxiasFederal University of Rio de Janeiro Rio de Janeiro Brazil
| | - Rossana C. N. Melo
- Laboratory of Cellular Biology, Department of Biology, Institute of Biological SciencesFederal University of Juiz de Fora Juiz de Fora Brazil
| | - André L. S. Santos
- Institute of Microbiology Paulo de GóesFederal University of Rio de Janeiro Rio de Janeiro Brazil
| | - Marcia R. Pinto
- Biomedical InstituteFluminense Federal University Niterói Brazil
| | - Josiane S. Neves
- Institute of Biomedical SciencesFederal University of Rio de Janeiro Rio de Janeiro Brazil
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18
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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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19
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Histoplasmosis Outbreaks in Brazil: Lessons to Learn About Preventing Exposure. Mycopathologia 2019; 185:881-892. [PMID: 31845177 DOI: 10.1007/s11046-019-00389-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 09/23/2019] [Indexed: 12/18/2022]
Abstract
Histoplasmosis is considered the most common invasive opportunistic fungal disease in the Americas, with outbreaks and micro-epidemics reported for over 80 years. In Brazil, this disease has been described since 1946, reaching a remarkable incidence in the population, especially during the HIV-AIDS pandemic. In this study, published and unpublished outbreaks and micro-epidemics of histoplasmosis in Brazil were revisited by accessing different database sources and evaluating epidemiological and clinical features. We have found reports spanning 1946-2017, across 10 Brazilian states and with involvement of 370 humans and 2 dogs, and 13 disseminated cases and 3 deaths were reported. Rio de Janeiro had the largest number of outbreaks (n = 20/40; 50%) reported in this study. The majority of outbreaks and micro-epidemics was reported in caves (n = 21/40; 52.5%), followed by reports in abandoned/deactivated sites (n = 6/40; 15%), mines (n = 5/40; 12.5%), chicken coops (n = 4/40; 10%). Histoplasmosis is a serious health issue in Brazil considering the attractive and growing market of ecotourism throughout more than 7000 caves, and all levels of poultry farming activity are important to raise awareness about how dangerous this neglected disease can be and establish ways to decrease exposure to contaminated environmental sources through adequate preventive measures.
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20
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Neutropenic Fever and a Diffuse Hyperpigmented Papular Rash: Answer. Am J Dermatopathol 2019; 41:951-952. [PMID: 31764234 DOI: 10.1097/dad.0000000000001269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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21
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Bongomin F, Kwizera R, Denning DW. Getting Histoplasmosis on the Map of International Recommendations for Patients with Advanced HIV Disease. J Fungi (Basel) 2019; 5:E80. [PMID: 31480775 PMCID: PMC6787619 DOI: 10.3390/jof5030080] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 08/23/2019] [Accepted: 08/30/2019] [Indexed: 01/10/2023] Open
Abstract
Progressive disseminated histoplasmosis, caused by H. capsulatum, is a life-threatening illness and is an AIDS-defining opportunistic infection. It is neglected, worryingly under-diagnosed, and often misdiagnosed as cancer or tuberculosis with fatal consequences. Globally, over 100,000 cases of disseminated histoplasmosis have been estimated. In 2017, the World Health Organization (WHO) noted that disseminated histoplasmosis is a significant cause of mortality in AIDS patients. Through the rigorous efforts of the Global Action Fund for Fungal Infections (GAFFI) and partners, in 2019, the Histoplasma antigen test was included on the 2nd Edition of the WHO List of Essential Diagnostics. The drugs used in the treatment of histoplasmosis (amphotericin B and itraconazole) are on the WHO Essential Medicine List. The Manaus Declaration on histoplasmosis in the Americas and the Caribbean, where histoplasmosis kills more people with HIV than tuberculosis, advocates for universal access to rapid testing for histoplasmosis and availability of essential drugs for the treatment of histoplasmosis in every country by 2025. Hyperendemic areas are present in the Americas, Caribbean, Southeast Asia, and Latin America. In conclusion, histoplasmosis remains an important clinical and public health problem. To reduce HIV-associated mortality, disseminated histoplasmosis must be addressed through advocacy, increased awareness, and universal access to essential diagnostics and antifungal agents.
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Affiliation(s)
- Felix Bongomin
- Department of Medical Microbiology & Immunology, Faculty of Medicine, Gulu University, P.O. Box 166, Gulu, Uganda.
- Global Action Fund for Fungal Infections, Rue Le Corbusier 12, 1208 Geneva, Switzerland.
| | - Richard Kwizera
- Infectious Diseases Institute, College of Health Sciences, Makerere University, P.O. Box 22418, Kampala, Uganda
- Makerere University Lung Institute, College of Health Sciences, Makerere University, P.O. Box 7749, Kampala, Uganda
| | - David W Denning
- Global Action Fund for Fungal Infections, Rue Le Corbusier 12, 1208 Geneva, Switzerland
- The National Aspergillosis Centre, Wythenshawe Hospital, The University of Manchester, Manchester Academic Health Science Centre, Manchester, M23 9LT, UK
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22
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Gómez LF, Arango M, McEwen JG, Gómez OM, Zuluaga A, Peláez CA, Acevedo JM, Taylor ML, Jiménez MDP. Molecular epidemiology of Colombian Histoplasma capsulatum isolates obtained from human and chicken manure samples. Heliyon 2019; 5:e02084. [PMID: 31372546 PMCID: PMC6660563 DOI: 10.1016/j.heliyon.2019.e02084] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 06/11/2019] [Accepted: 07/09/2019] [Indexed: 12/12/2022] Open
Abstract
The thermally dimorphic fungus Histoplasma capsulatum is the causative agent of histoplasmosis, one of the most prevalent endemic mycosis in the Americas. In tropical regions, agro-ecosystems require organic matter replacement, therefore, the use of organic fertilizers has increased disregarding the fact that certain number of such fertilizers might be contaminated with the fungus, and with their handling resulting in human cases and even outbreaks of histoplasmosis. Additionally, in Colombia, chicken manure is the most common raw material used in the production of organic fertilizers. In this work, we reported the isolation of this fungus from chicken manure, and genetically compared with 42 clinical isolates. The genetically compared environmental isolates grouped together with the clinical ones. Our result suggests that chicken manure may be one of H. capsulatum infection sources. Also, the phylogenetic analyses done with other H. capsulatum isolates indicate that the Colombian isolates are widely distributed in the relational tree thus reveling towards the great genetic diversity among the H. capsulatum Colombian isolates.
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Affiliation(s)
- Luisa F Gómez
- Grupo de Micología Médica, Departamento de Microbiología y Parasitología, Facultad de Medicina, Universidad de Antioquia, Medellín, Antioquia, Colombia.,Posgrado de Biología, Instituto de Biología, Facultad de Ciencias Exactas y Naturales, Universidad de Antioquia, Medellín, Antioquia, Colombia
| | - Myrtha Arango
- Grupo de Micología Médica, Departamento de Microbiología y Parasitología, Facultad de Medicina, Universidad de Antioquia, Medellín, Antioquia, Colombia
| | - Juan G McEwen
- Grupo de Micología Médica, Departamento de Microbiología y Parasitología, Facultad de Medicina, Universidad de Antioquia, Medellín, Antioquia, Colombia.,Grupo de Biología Celular y Molecular, Corporación para Investigaciones Biológicas (CIB), Universidad de Antioquia, Medellín, Antioquia, Colombia
| | - Oscar M Gómez
- Posgrado de Biología, Instituto de Biología, Facultad de Ciencias Exactas y Naturales, Universidad de Antioquia, Medellín, Antioquia, Colombia.,Grupo de Biología Celular y Molecular, Corporación para Investigaciones Biológicas (CIB), Universidad de Antioquia, Medellín, Antioquia, Colombia
| | - Alejandra Zuluaga
- Grupo de Micología Médica y Experimental, Corporación para Investigaciones Biológicas (CIB). Universidad de Antioquia, Medellín, Antioquia, Colombia
| | - Carlos A Peláez
- Grupo Interdisciplinario de Estudios Moleculares, (GIEM), Instituto de Química, Facultad de Ciencias Exactas y Naturales, Universidad de Antioquia, Medellín, Antioquia, Colombia
| | - Jose M Acevedo
- Grupo Interdisciplinario de Estudios Moleculares, (GIEM), Instituto de Química, Facultad de Ciencias Exactas y Naturales, Universidad de Antioquia, Medellín, Antioquia, Colombia
| | - María L Taylor
- Laboratorio de Inmunología de Hongos, Departamento de Microbiología y Parasitología, Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México, México
| | - María Del P Jiménez
- Grupo de Micología Médica, Departamento de Microbiología y Parasitología, Facultad de Medicina, Universidad de Antioquia, Medellín, Antioquia, Colombia
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23
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Valero C, Buitrago MJ, Gago S, Quiles-Melero I, García-Rodríguez J. A matrix-assisted laser desorption/ionization time of flight mass spectrometry reference database for the identification of Histoplasma capsulatum. Med Mycol 2019; 56:307-314. [PMID: 28992262 DOI: 10.1093/mmy/myx047] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 05/31/2017] [Indexed: 11/12/2022] Open
Abstract
The isolation of the pathogenic fungus Histoplasma capsulatum from cultures together with the visualization of typical intracellular yeast in tissues are the gold standard methods for diagnosis of histoplasmosis. However, cultures are time-consuming, require level 3 containment and experienced personnel, and usually call for an additional confirmation test. Matrix-Assisted Laser Desorption Ionization Time of Flight Mass Spectrometry (MALDI-ToF MS) has been established as a suitable tool for microbial identification in several clinical laboratories. A reference database has been constructed for the identification of H. capsulatum by MALDI-ToF MS by using six H. capsulatum strains previously identified by molecular methods. For validation, 63 fungal strains belonging to the Collection of the Spanish National Centre for Microbiology were tested against the new reference database combined with other commercial and in-house databases. In a blind assay, all H. capsulatum strains (n = 30) were correctly identified by the database and 86.6% had scores above 1.7. Considering both phases of the fungus for the same strain, the most reliable results were obtained with the mycelial phase, with only 13.3% of isolates having scores below 1.7. The new database was able to identify both morphological phases of the fungus. MALDI-ToF technology yields a prompt and simple identification from H. capsulatum yeast forms and early mycelial cultures. It allows for reducing response time and decreasing risk in fungus manipulation.
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Affiliation(s)
- Clara Valero
- Servicio de Micología, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - María J Buitrago
- Servicio de Micología, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - Sara Gago
- Servicio de Micología, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
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24
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Disseminated histoplasmosis presenting as dental lesion in the absence of a vital organ, the thymus. IDCases 2019; 18:e00635. [PMID: 31692524 PMCID: PMC6804924 DOI: 10.1016/j.idcr.2019.e00635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 09/04/2019] [Indexed: 11/20/2022] Open
Abstract
We present a case report of a patient who has rare anatomical anomalies and presented with an oral lesion that led to a diagnosis of disseminated histoplasmosis. The case brings forth important clinical considerations for a diagnosis of histoplasmosis.
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25
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Turgut M, Challa S, Akhaddar A. Histopathology. FUNGAL INFECTIONS OF THE CENTRAL NERVOUS SYSTEM 2019. [PMCID: PMC7123394 DOI: 10.1007/978-3-030-06088-6_6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
During the last 30 years, advances in intensive and critical care units, organ transplantation, concomitant use of immunosuppressive drugs, and increasing prevalence of chronic diseases, malnutrition, and other debilitating conditions, as well as the human immunodeficiency virus pandemic, have increased the incidence of systemic mycotic diseases, the most serious form of fungal diseases are the ones that comprise the central nervous system, representing the most dangerous clinical situations. In those cases, starting an adequate therapy through a rapid and assertive diagnosis is absolutely necessary. Considering the fastidious microbiological nature of some fungi (longtime requirement, specific culture conditions, and biohazard issues), as well as the lack of alternative testing availability, a rapid diagnosis is always challenging. When a tissue or liquid specimen is available, its pathological analysis constitutes a rapid and cost-effective way to provide a presumptive or definitive diagnosis of an invasive fungal infection; however, microbiologists, pathologists, and clinicians need to be aware of the limitations of microscopical diagnosis. In this chapter, we review the usual histological presentation of the most frequent central nervous system fungal infections.
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Affiliation(s)
- Mehmet Turgut
- Department of Neurosurgery, Aydın Adnan Menderes University, School of Medicine, Aydın, Turkey
| | - Sundaram Challa
- Department of Pathology, Basavatarakam Indo-American Hospital & Research Institute, Hyderabad, Telangana India
| | - Ali Akhaddar
- Department of Neurosurgery, Avicenne Military Hospital, Mohammed V University in Rabat, Marrakech, Morocco
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26
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Nel JS, Bartelt LA, van Duin D, Lachiewicz AM. Endemic Mycoses in Solid Organ Transplant Recipients. Infect Dis Clin North Am 2018; 32:667-685. [PMID: 30146029 DOI: 10.1016/j.idc.2018.04.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The endemic mycoses are a group of thermally dimorphic fungal pathogens occupying a specific geographic range. In North America, the chief endemic mycoses are histoplasmosis, coccidioidomycosis, and blastomycosis. Endemic fungi can cause serious infections in solid organ transplant recipients from primary infection, reactivation of latent disease, or donor-derived infection.
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Affiliation(s)
- Jeremy S Nel
- Division of Infectious Diseases, University of North Carolina, CB 7030, 130 Mason Farm Road, Chapel Hill, NC 27599, USA
| | - Luther A Bartelt
- Division of Infectious Diseases, University of North Carolina, CB 7030, 130 Mason Farm Road, Chapel Hill, NC 27599, USA
| | - David van Duin
- Division of Infectious Diseases, University of North Carolina, CB 7030, 130 Mason Farm Road, Chapel Hill, NC 27599, USA
| | - Anne M Lachiewicz
- Division of Infectious Diseases, University of North Carolina, CB 7030, 130 Mason Farm Road, Chapel Hill, NC 27599, USA.
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27
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Guimarães AJ, de Cerqueira MD, Zamith-Miranda D, Lopez PH, Rodrigues ML, Pontes B, Viana NB, DeLeon-Rodriguez CM, Rossi DCP, Casadevall A, Gomes AMO, Martinez LR, Schnaar RL, Nosanchuk JD, Nimrichter L. Host membrane glycosphingolipids and lipid microdomains facilitate Histoplasma capsulatum internalisation by macrophages. Cell Microbiol 2018; 21:e12976. [PMID: 30427108 DOI: 10.1111/cmi.12976] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 09/03/2018] [Accepted: 09/17/2018] [Indexed: 12/17/2022]
Abstract
Recognition and internalisation of intracellular pathogens by host cells is a multifactorial process, involving both stable and transient interactions. The plasticity of the host cell plasma membrane is fundamental in this infectious process. Here, the participation of macrophage lipid microdomains during adhesion and internalisation of the fungal pathogen Histoplasma capsulatum (Hc) was investigated. An increase in membrane lateral organisation, which is a characteristic of lipid microdomains, was observed during the first steps of Hc-macrophage interaction. Cholesterol enrichment in macrophage membranes around Hc contact regions and reduced levels of Hc-macrophage association after cholesterol removal also suggested the participation of lipid microdomains during Hc-macrophage interaction. Using optical tweezers to study cell-to-cell interactions, we showed that cholesterol depletion increased the time required for Hc adhesion. Additionally, fungal internalisation was significantly reduced under these conditions. Moreover, macrophages treated with the ceramide-glucosyltransferase inhibitor (P4r) and macrophages with altered ganglioside synthesis (from B4galnt1-/- mice) showed a deficient ability to interact with Hc. Coincubation of oligo-GM1 and treatment with Cholera toxin Subunit B, which recognises the ganglioside GM1, also reduced Hc association. Although purified GM1 did not alter Hc binding, treatment with P4 significantly increased the time required for Hc binding to macrophages. The content of CD18 was displaced from lipid microdomains in B4galnt1-/- macrophages. In addition, macrophages with reduced CD18 expression (CD18low ) were associated with Hc at levels similar to wild-type cells. Finally, CD11b and CD18 colocalised with GM1 during Hc-macrophage interaction. Our results indicate that lipid rafts and particularly complex gangliosides that reside in lipid rafts stabilise Hc-macrophage adhesion and mediate efficient internalisation during histoplasmosis.
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Affiliation(s)
- Allan J Guimarães
- Department of Microbiology and Parasitology, Biomedical Institute, Fluminense Federal University, Rio de Janeiro, Brazil.,Departments of Medicine (Division of Infectious Diseases) and Microbiology and Immunology, Albert Einstein College of Medicine, Bronx, New York
| | - Mariana Duarte de Cerqueira
- Department of General Microbiology, Microbiology Institute, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Daniel Zamith-Miranda
- Department of General Microbiology, Microbiology Institute, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Pablo H Lopez
- Department of Pharmacology and Molecular Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Marcio L Rodrigues
- Department of General Microbiology, Microbiology Institute, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.,Instituto Carlos Chagas, Fundação Oswaldo Cruz (Fiocruz), Curitiba, Brazil
| | - Bruno Pontes
- LPO-COPEA, Institute of Biomedical Sciences, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Nathan B Viana
- LPO-COPEA, Institute of Biomedical Sciences, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.,LPO-COPEA, Institute of Physics, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Carlos M DeLeon-Rodriguez
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Diego Conrado Pereira Rossi
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Arturo Casadevall
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Andre M O Gomes
- Program of Structural Biology, Institute of Medical Biochemistry Leopoldo de Meis and National Institute of Science and Technology of Structural Biology and Bioimaging, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Luis R Martinez
- Biological Sciences, The University of Texas at El Paso, El Paso, Texas
| | - Ronald L Schnaar
- Department of Pharmacology and Molecular Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Joshua D Nosanchuk
- Departments of Medicine (Division of Infectious Diseases) and Microbiology and Immunology, Albert Einstein College of Medicine, Bronx, New York
| | - Leonardo Nimrichter
- Department of General Microbiology, Microbiology Institute, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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28
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Oladele RO, Ayanlowo OO, Richardson MD, Denning DW. Histoplasmosis in Africa: An emerging or a neglected disease? PLoS Negl Trop Dis 2018; 12:e0006046. [PMID: 29346384 PMCID: PMC5773084 DOI: 10.1371/journal.pntd.0006046] [Citation(s) in RCA: 108] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Histoplasmosis in Africa has markedly increased since the advent of the HIV/AIDS epidemic but is under-recognised. Pulmonary histoplasmosis may be misdiagnosed as tuberculosis (TB). In the last six decades (1952-2017), 470 cases of histoplasmosis have been reported. HIV-infected patients accounted for 38% (178) of the cases. West Africa had the highest number of recorded cases with 179; the majority (162 cases) were caused by Histoplasma capsulatum var. dubuosii (Hcd). From the Southern African region, 150 cases have been reported, and the majority (119) were caused by H. capsulatum var. capsulatum (Hcc). There have been 12 histoplasmin skin test surveys with rates of 0% to 35% positivity. Most cases of Hcd presented as localised lesions in immunocompetent persons; however, it was disseminated in AIDS patients. Rapid diagnosis of histoplasmosis in Africa is only currently possible using microscopy; antigen testing and PCR are not available in most of Africa. Treatment requires amphotericin B and itraconazole, both of which are not licensed or available in several parts of Africa.
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Affiliation(s)
- Rita O. Oladele
- Department of Medical Microbiology and Parasitology, Faculty of Basic Medical Sciences, College of Medicine, University of Lagos, Lagos, Nigeria
- Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Olusola O. Ayanlowo
- Department of Medicine, Faculty of Clinical Sciences, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Malcolm D. Richardson
- Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
- Mycology Reference Centre Manchester, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - David W. Denning
- Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
- National Aspergillosis Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, United Kingdom
- Global Action Fund for Fungal Infections, Geneva, Switzerland
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29
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López LF, Muñoz CO, Cáceres DH, Tobón ÁM, Loparev V, Clay O, Chiller T, Litvintseva A, Gade L, González Á, Gómez BL. Standardization and validation of real time PCR assays for the diagnosis of histoplasmosis using three molecular targets in an animal model. PLoS One 2017; 12:e0190311. [PMID: 29287097 PMCID: PMC5747470 DOI: 10.1371/journal.pone.0190311] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 12/12/2017] [Indexed: 12/04/2022] Open
Abstract
Histoplasmosis is considered one of the most important endemic and systemic mycoses worldwide. Until now few molecular techniques have been developed for its diagnosis. The aim of this study was to develop and evaluate three real time PCR (qPCR) protocols for different protein-coding genes (100-kDa, H and M antigens) using an animal model. Fresh and formalin-fixed and paraffin-embedded (FFPE) lung tissues from BALB/c mice inoculated i.n. with 2.5x106Histoplasma capsulatum yeast or PBS were obtained at 1, 2, 3, 4, 8, 12 and 16 weeks post-infection. A collection of DNA from cultures representing different clades of H. capsulatum (30 strains) and other medically relevant pathogens (36 strains of related fungi and Mycobacterium tuberculosis) were used to analyze sensitivity and specificity. Analytical sensitivity and specificity were 100% when DNAs from the different strains were tested. The highest fungal burden occurred at first week post-infection and complete fungal clearance was observed after the third week; similar results were obtained when the presence of H. capsulatum yeast cells was demonstrated in histopathological analysis. In the first week post-infection, all fresh and FFPE lung tissues from H. capsulatum-infected animals were positive for the qPCR protocols tested except for the M antigen protocol, which gave variable results when fresh lung tissue samples were analyzed. In the second week, all qPCR protocols showed variable results for both fresh and FFPE tissues. Samples from the infected mice at the remaining times post-infection and uninfected mice (controls) were negative for all protocols. Good agreement was observed between CFUs, histopathological analysis and qPCR results for the 100-kDa and H antigen protocols. We successfully standardized and validated three qPCR assays for detecting H. capsulatum DNA in fresh and FFPE tissues, and conclude that the 100-kDa and H antigen molecular assays are promising tests for diagnosing this mycosis.
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Affiliation(s)
- Luisa F. López
- Medical and Experimental Mycology Group, Corporación para Investigaciones Biológicas (CIB), Medellín, Colombia
| | - César O. Muñoz
- Medical and Experimental Mycology Group, Corporación para Investigaciones Biológicas (CIB), Medellín, Colombia
| | - Diego H. Cáceres
- Medical and Experimental Mycology Group, Corporación para Investigaciones Biológicas (CIB), Medellín, Colombia
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Ángela M. Tobón
- Medical and Experimental Mycology Group, Corporación para Investigaciones Biológicas (CIB), Medellín, Colombia
| | - Vladimir Loparev
- Biotechnology Core Facility Branch, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Oliver Clay
- School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia
- Cell and Molecular Biology Group, Corporación para Investigaciones Biológicas (CIB), Medellín, Colombia
| | - Tom Chiller
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Anastasia Litvintseva
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Lalitha Gade
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Ángel González
- Basic and Applied Microbiology Research Group (MICROBA), School of Microbiology, Universidad de Antioquia, Medellín, Colombia
| | - Beatriz L. Gómez
- Medical and Experimental Mycology Group, Corporación para Investigaciones Biológicas (CIB), Medellín, Colombia
- School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia
- * E-mail:
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30
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Pereira PAT, Assis PA, Prado MKB, Ramos SG, Aronoff DM, de Paula-Silva FWG, Sorgi CA, Faccioli LH. Prostaglandins D 2 and E 2 have opposite effects on alveolar macrophages infected with Histoplasma capsulatum. J Lipid Res 2017; 59:195-206. [PMID: 29217623 DOI: 10.1194/jlr.m078162] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 12/05/2017] [Indexed: 01/05/2023] Open
Abstract
Prostaglandin E2 (PGE2) suppresses macrophage effector mechanisms; however, little is known about the function of PGD2 in infected alveolar macrophages (AMs). Using serum-opsonized Histoplasma capsulatum (Ops-H. capsulatum) in vitro, we demonstrated that AMs produced PGE2 and PGD2 in a time-dependent manner, with PGE2 levels exceeding those of PGD2 by 48 h postinfection. Comparison of the effects of both exogenous PGs on AMs revealed that PGD2 increased phagocytosis and killing through the chemoattractant receptor-homologous molecule expressed on Th2 lymphocytes receptor, whereas PGE2 had opposite effects, through E prostanoid (EP) receptor 2 (EP2)/EP4-dependent mechanisms. Moreover, PGD2 inhibited phospholipase C-γ (PLC-γ) phosphorylation, reduced IL-10 production, and increased leukotriene B4 receptor expression. In contrast, exogenous PGE2 treatment reduced PLC-γ phosphorylation, p38 and nuclear factor κB activation, TNF-α, H2O2, and leukotriene B4, but increased IL-1β production. Using specific compounds to inhibit the synthesis of each PG in vitro and in vivo, we found that endogenous PGD2 contributed to fungicidal mechanisms and controlled inflammation, whereas endogenous PGE2 decreased phagocytosis and killing of the fungus and induced inflammation. These findings demonstrate that, although PGD2 acts as an immunostimulatory mediator to control H. capsulatum infection, PGE2 has immunosuppressive effects, and the balance between these two PGs may limit collateral immune damage at the expense of microbial containment.
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Affiliation(s)
- Priscilla A T Pereira
- Departamento de Análises Clínicas, Toxicológicas e Bromatológicas, Faculdade de Ciências Farmacêuticas de Ribeirão Preto Universidade de São Paulo, 14040-903 Ribeirão Preto, São Paulo, Brazil
| | - Patrícia A Assis
- Departamento de Análises Clínicas, Toxicológicas e Bromatológicas, Faculdade de Ciências Farmacêuticas de Ribeirão Preto Universidade de São Paulo, 14040-903 Ribeirão Preto, São Paulo, Brazil
| | - Morgana K B Prado
- Departamento de Análises Clínicas, Toxicológicas e Bromatológicas, Faculdade de Ciências Farmacêuticas de Ribeirão Preto Universidade de São Paulo, 14040-903 Ribeirão Preto, São Paulo, Brazil
| | - Simone G Ramos
- Departamento de Patologia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, 14040-903 Ribeirão Preto, São Paulo, Brazil
| | - David M Aronoff
- Department of Medicine, Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN 37232
| | - Francisco W G de Paula-Silva
- Departamento de Análises Clínicas, Toxicológicas e Bromatológicas, Faculdade de Ciências Farmacêuticas de Ribeirão Preto Universidade de São Paulo, 14040-903 Ribeirão Preto, São Paulo, Brazil
| | - Carlos A Sorgi
- Departamento de Análises Clínicas, Toxicológicas e Bromatológicas, Faculdade de Ciências Farmacêuticas de Ribeirão Preto Universidade de São Paulo, 14040-903 Ribeirão Preto, São Paulo, Brazil
| | - Lúcia H Faccioli
- Departamento de Análises Clínicas, Toxicológicas e Bromatológicas, Faculdade de Ciências Farmacêuticas de Ribeirão Preto Universidade de São Paulo, 14040-903 Ribeirão Preto, São Paulo, Brazil
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Maltos AL, Maia E, Oliveira CDCHBD. Disseminated histoplasmosis diagnosed in a peripheral blood smear. Rev Soc Bras Med Trop 2017; 50:148. [PMID: 28327821 DOI: 10.1590/0037-8682-0189-2016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 07/08/2016] [Indexed: 11/21/2022] Open
Affiliation(s)
- André Luiz Maltos
- Serviço de Patologia Clínica, Hospital de Clínicas, Universidade Federal do Triângulo Mineiro, Uberaba, MG, Brasil
| | - Evaldo Maia
- Serviço de Patologia Clínica, Hospital de Clínicas, Universidade Federal do Triângulo Mineiro, Uberaba, MG, Brasil
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32
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Shaikh MS, Majeed Memon A. Disseminated histoplasmosis in an immuno-competent young male: Role of bone marrow examination in rapid diagnosis. Diagn Cytopathol 2017; 46:273-276. [PMID: 29024456 DOI: 10.1002/dc.23834] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 09/06/2017] [Accepted: 09/27/2017] [Indexed: 11/06/2022]
Abstract
Fungal infections are usually seen in elderly or immuno-compromised individuals particularly with human immunodeficiency virus infection. In immuno-competent individuals, they seldom present with overt clinical symptoms. In such cases diagnosis is made by combination of tests along with direct microscopic visualization of the organism. We present a case of immuno-competent individual who presented with unexplained fever and found to have Histoplasma capsulatum infection on bone marrow examination.
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Affiliation(s)
- Muhammad Shariq Shaikh
- Section of Hematology and Transfusion Medicine, Department of Pathology and Laboratory Medicine, The Aga Khan University Hospital, Karachi, 74800, Pakistan
| | - Ayesha Majeed Memon
- Section of Hematology and Transfusion Medicine, Department of Pathology and Laboratory Medicine, The Aga Khan University Hospital, Karachi, 74800, Pakistan
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McCarthy MW, Kalasauskas D, Petraitis V, Petraitiene R, Walsh TJ. Fungal Infections of the Central Nervous System in Children. J Pediatric Infect Dis Soc 2017; 6:e123-e133. [PMID: 28903523 DOI: 10.1093/jpids/pix059] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Accepted: 07/04/2017] [Indexed: 01/03/2023]
Abstract
Although uncommon in children, fungal infections of the central nervous system can be devastating and difficult to treat. A better understanding of basic mycologic, immunologic, and pharmacologic processes has led to important advances in the diagnosis and management of these diseases, but their mortality rates remain unacceptably high. In this focused review, we examine the epidemiology and clinical features of the most common fungal pathogens of the central nervous system in children and explore recent advances in diagnosis and antifungal therapy.
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Affiliation(s)
- Matthew W McCarthy
- Division of General Internal Medicine, Weill Cornell Medicine of Cornell University, New York, New York
| | - Darius Kalasauskas
- Department of Neurosurgery, University Medical Center, Johannes Gutenberg University, Mainz, Germany.,Transplantation-Oncology Infectious Diseases Program, Division of Infectious Diseases, Department of Medicine, Weill Cornell Medicine of Cornell University, New York, New York
| | - Vidmantas Petraitis
- Transplantation-Oncology Infectious Diseases Program, Division of Infectious Diseases, Department of Medicine, Weill Cornell Medicine of Cornell University, New York, New York.,Institute of Infectious Disease and Pathogenic Microbiology, Prienai, Lithuania
| | - Ruta Petraitiene
- Transplantation-Oncology Infectious Diseases Program, Division of Infectious Diseases, Department of Medicine, Weill Cornell Medicine of Cornell University, New York, New York.,Institute of Infectious Disease and Pathogenic Microbiology, Prienai, Lithuania
| | - Thomas J Walsh
- Transplantation-Oncology Infectious Diseases Program, Division of Infectious Diseases, Department of Medicine, Weill Cornell Medicine of Cornell University, New York, New York.,Departments of Pediatrics, and Microbiology & Immunology, Weill Cornell Medicine of Cornell University, New York, New York
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Samayoa B, Roy M, Cleveland AA, Medina N, Lau-Bonilla D, Scheel CM, Gomez BL, Chiller T, Arathoon E. High Mortality and Coinfection in a Prospective Cohort of Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome Patients with Histoplasmosis in Guatemala. Am J Trop Med Hyg 2017; 97:42-48. [PMID: 28719316 DOI: 10.4269/ajtmh.16-0009] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Histoplasmosis is one of the most common and deadly opportunistic infections among persons living with human immunodeficiency virus (HIV)/acquired immune deficiency syndrome in Latin America, but due to limited diagnostic capacity in this region, few data on the burden and clinical characteristics of this disease exist. Between 2005 and 2009, we enrolled patients ≥ 18 years of age with suspected histoplasmosis at a hospital-based HIV clinic in Guatemala City. A case of suspected histoplasmosis was defined as a person presenting with at least three of five clinical or radiologic criteria. A confirmed case of histoplasmosis was defined as a person with a positive culture or urine antigen test for Histoplasma capsulatum. Demographic and clinical data were also collected and analyzed. Of 263 enrolled as suspected cases of histoplasmosis, 101 (38.4%) were confirmed cases. Median time to diagnosis was 15 days after presentation (interquartile range [IQR] = 5-23). Crude overall mortality was 43.6%; median survival time was 19 days (IQR = 4-69). Mycobacterial infection was diagnosed in 70 (26.6%) cases; 26 (25.7%) histoplasmosis cases were coinfected with mycobacteria. High mortality and short survival time after initial symptoms were observed in patients with histoplasmosis. Mycobacterial coinfection diagnoses were frequent, highlighting the importance of pursuing diagnoses for both diseases.
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Affiliation(s)
- Blanca Samayoa
- Facultad de Ciencias Químicas y Farmacia, Universidad de San Carlos de Guatemala, Guatemala, Guatemala.,Clinica Familiar "Luis Ángel García," Hospital General San Juan de Dios/Asociación de Salud Integral, Guatemala, Guatemala
| | - Monika Roy
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Narda Medina
- Clinica Familiar "Luis Ángel García," Hospital General San Juan de Dios/Asociación de Salud Integral, Guatemala, Guatemala
| | - Dalia Lau-Bonilla
- Clinica Familiar "Luis Ángel García," Hospital General San Juan de Dios/Asociación de Salud Integral, Guatemala, Guatemala
| | | | - Beatriz L Gomez
- Corporación para Investigaciones Biológicas, Medellín, Colombia.,School of Medicine, Universidad del Rosario, Bogota, Colombia
| | - Tom Chiller
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Eduardo Arathoon
- Clinica Familiar "Luis Ángel García," Hospital General San Juan de Dios/Asociación de Salud Integral, Guatemala, Guatemala
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Abstract
The discovery of HIV was largely due to the presence of Pneumocystis pneumonia (PCP) in young patients that did not have the usual known causes of immune deficiencies in the early 1980s. Currently, treatment with highly active anti-retroviral therapy (HAART) and the use of prophylaxis for PCP have lowered the frequency of fungal infections; however, these infections continue to cause morbidity and mortality in those patients that fall out or are not in care. The frequency of specific fungal diseases in HIV patients will depend on the prevalence of fungi in the particular geographic location. Nowadays, superficial and invasive Candida infections, PCP, and cryptococci are the most frequent fungal infections seen in HIV positive patients worldwide. The role of pathology in diagnosing fungal infections is crucial because a lesion may be biopsied without obtaining mycology cultures, certain organisms may take several weeks to grow, or the sample sent to the mycology laboratory may not have the organism. Following we will describe fungal infections that are particularly frequent in HIV infected patients and their key pathological features.
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Affiliation(s)
- Jeannette Guarner
- Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA, United States.
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Wanta BT, Tyner HL, Bohman JK, Baddour LM. Successful Treatment of Refractory Hypoxemia Secondary to Disseminated Histoplasmosis Using Extracorporeal Membrane Oxygenation Support. ACTA ACUST UNITED AC 2017; 7:161-164. [PMID: 27258180 DOI: 10.1213/xaa.0000000000000374] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Refractory hypoxemia secondary to acute respiratory distress syndrome (ARDS) is associated with high mortality. Extracorporeal membraneoxygenation (ECMO) is an accepted strategy for treating refractory hypoxemia in patients with ARDS but is relatively contraindicated in the setting of systemic infections. We present a case of successful ECMO use in a host with refractory hypoxemia secondary to disseminated histoplasmosis with fungemia and discuss our management approach to this difficult patient.
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Affiliation(s)
- Brendan T Wanta
- From the *Division of Anesthesia and Critical Care Medicine, Department of Anesthesiology, †Division of Infectious Diseases, Department of Medicine, and ‡Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
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Chaudhuri R, Ramachandran S. Immunoinformatics as a Tool for New Antifungal Vaccines. Methods Mol Biol 2017; 1625:31-43. [PMID: 28584981 DOI: 10.1007/978-1-4939-7104-6_3] [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: 06/07/2023]
Abstract
Immunoinformatics aids in screening for vaccine candidates, which can be experimentally tested for their efficacy. This chapter describes methods to use immunoinformatics to screen fungal vaccines candidates. Surface-localized molecules called adhesins could elicit immune response and serve as efficient vaccine candidates. The screening process is patterned on two steps, namely, a First Layer screen mostly used for value addition and prioritization based on characteristics of known antigens and a Second Layer highly focussed on core immunoinformatics analysis involving the binding and interactions of the molecules of the immune system. Together they offer a comprehensive objective evaluation of vaccine candidates selection in silico for fungal pathogens.
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Affiliation(s)
| | - Srinivasan Ramachandran
- CSIR-Institute of Genomics and Integrative Biology, Room 130, Mathura Road, Near Sukhdev Vihar DTC Bus Depot, New Delhi, 110 025, India.
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38
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McCarthy MW, Walsh TJ. Molecular diagnosis of invasive mycoses of the central nervous system. Expert Rev Mol Diagn 2016; 17:129-139. [PMID: 27936983 DOI: 10.1080/14737159.2017.1271716] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
INTRODUCTION In September 2012, the Centers for Disease Control and Prevention (CDC) began investigating an outbreak of fungal meningitis among patients who had received contaminated preservative-free methyl prednisolone acetate injections from the New England Compounding Center in Framingham, Massachusetts. Thousands of patients were potentially exposed to tainted corticosteroids, but establishing the diagnosis of fungal meningitis during the nationwide outbreak was difficult because little was known about the natural history of the disease. Areas covered: The challenges associated with this outbreak highlighted the need for rapid and reliable methodologies to assist in the diagnosis of invasive mycoses of the central nervous system (IMCNS), which may be devastating and difficult to treat. In this paper, we review the causative agents of these potentially-lethal infections, which include cryptococcal meningitis, cerebral aspergillosis, and hematogenous Candida meningoencephalitis. Expert commentary: While microscopy, culture, and histopathologic identification of fungal pathogens remain the gold standard for diagnosis, new platforms and species-specific assays have recently emerged, including lateral flow immunoassays (LFA), matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS), and multiplex PCR in conjunction with magnetic resonance (MR) to potentially aid in the diagnosis of IMCNS.
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Affiliation(s)
- Matthew William McCarthy
- a Hospital Medicine , Joan and Sanford I Weill Medical College of Cornell University , New York , NY , USA
| | - Thomas J Walsh
- b Transplantation-Oncology Infectious Diseases Program , Weill Cornell Medical Center , New York , NY , USA
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Correia FGS, Alencar CH, Damasceno LS, Ramos IC, Pontes LB, Leitão TDMJS. Spatial distribution of disseminated histoplasmosis and AIDS co-infection in an endemic area of Northeastern Brazil. Rev Soc Bras Med Trop 2016; 49:227-31. [PMID: 27192593 DOI: 10.1590/0037-8682-0327-2015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2015] [Accepted: 03/14/2016] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The spatial distribution of disseminated histoplasmosis (DH) and acquired immunodeficiency syndrome (AIDS) co-infection in adult residents of Fortaleza, Ceará, Brazil was evaluated. METHODS Socio-demographic data for the DH/AIDS cases were obtained from a reference hospital, and socio-environmental indicators were obtained from an official Brazilian institute. Kernel analysis and local indicators of spatial autocorrelation (LISA) cluster maps were used to estimate the case density within the city. RESULTS DH/AIDS cases were concentrated in the Northwestern and Southwestern peripheral areas of the city, related with low human development indices, but different from AIDS cases distribution. CONCLUSION Risk factors other than AIDS infection must affect histoplasmosis development in this area.
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Affiliation(s)
| | - Carlos Henrique Alencar
- Departamento de Saúde Coletiva, Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza, Ceará, Brazil
| | - Lisandra Serra Damasceno
- Departamento de Saúde Coletiva, Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza, Ceará, Brazil
| | - Isadora Cavalcanti Ramos
- Departamento de Saúde Coletiva, Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza, Ceará, Brazil
| | - Lícia Borges Pontes
- Departamento de Saúde Coletiva, Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza, Ceará, Brazil
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Abstract
Continued occurrence, particularly in work-related settings, highlights the need to increase awareness of this disease. Histoplasmosis has been described as the most common endemic mycosis in the United States. However, histoplasmosis is not nationally notifiable. Its presumed geographic distribution is largely derived from skin test surveys performed during the 1940s, and information about its local features comes primarily from outbreak investigations. We conducted a literature review to assess epidemiologic features of histoplasmosis outbreaks in the United States. During 1938–2013, a total of 105 outbreaks involving 2,850 cases were reported in 26 states and the territory of Puerto Rico. Common exposure settings were chicken coops and buildings or other structures undergoing renovation or demolition. Birds, bats, or their droppings were reported to be present in 77% of outbreak settings, and workplace exposures were reported in 41% of outbreaks. The continued occurrence of histoplasmosis outbreaks, particularly work-related ones involving known disturbance of bird or bat droppings, highlights the need to increase awareness of the disease.
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Abstract
Dimorphic fungi cause several endemic mycoses which range from subclinical respiratory infections to life-threatening systemic disease. Pathogenic-phase cells of Histoplasma, Blastomyces, Paracoccidioides and Coccidioides escape elimination by the innate immune response with control ultimately requiring activation of cell-mediated immunity. Clinical management of disease relies primarily on antifungal compounds; however, dimorphic fungal pathogens create a number of challenges for antifungal drug therapy. In addition to the drug toxicity issues known for current antifungals, barriers to efficient drug treatment of dimorphic fungal infections include natural resistance to the echinocandins, residence of fungal cells within immune cells, the requirement for systemic delivery of drugs, prolonged treatment times, potential for latent infections, and lack of optimized standardized methodology for in vitro testing of drug susceptibilities. This review will highlight recent advances, current therapeutic options, and new compounds on the horizon for treating infections by dimorphic fungal pathogens.
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Affiliation(s)
| | - Chad A Rappleye
- a Department of Microbiology , Ohio State University , Columbus , OH , USA
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Lovell JP, Foruraghi L, Freeman AF, Uzel G, Zerbe CS, Su H, Hsu AP, Holland SM. Persistent nodal histoplasmosis in nuclear factor kappa B essential modulator deficiency: Report of a case and review of infection in primary immunodeficiencies. J Allergy Clin Immunol 2016; 138:903-905. [PMID: 27266944 PMCID: PMC5391257 DOI: 10.1016/j.jaci.2016.02.040] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 12/29/2015] [Accepted: 02/04/2016] [Indexed: 10/21/2022]
Abstract
In the absence of acquired or secondary immunosuppression, mutations causing failure to properly activate the IL-12/IFN-γ pathway, NF-κB, or STAT3 should be excluded in patients presenting with severe histoplasmosis.
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Affiliation(s)
- Jana P Lovell
- Laboratory of Clinical Infectious Diseases, Division of Intramural Research, National Institute of Allergy and Infectious Disease, National Institutes of Health, Bethesda, Md
| | - Ladan Foruraghi
- Laboratory of Clinical Infectious Diseases, Division of Intramural Research, National Institute of Allergy and Infectious Disease, National Institutes of Health, Bethesda, Md
| | - Alexandra F Freeman
- Laboratory of Clinical Infectious Diseases, Division of Intramural Research, National Institute of Allergy and Infectious Disease, National Institutes of Health, Bethesda, Md
| | - Gulbu Uzel
- Laboratory of Clinical Infectious Diseases, Division of Intramural Research, National Institute of Allergy and Infectious Disease, National Institutes of Health, Bethesda, Md
| | - Christa S Zerbe
- Laboratory of Clinical Infectious Diseases, Division of Intramural Research, National Institute of Allergy and Infectious Disease, National Institutes of Health, Bethesda, Md
| | - Helen Su
- Laboratory of Host Defenses, Division of Intramural Research, National Institute of Allergy and Infectious Disease, National Institutes of Health, Bethesda, Md
| | - Amy P Hsu
- Laboratory of Clinical Infectious Diseases, Division of Intramural Research, National Institute of Allergy and Infectious Disease, National Institutes of Health, Bethesda, Md
| | - Steven M Holland
- Laboratory of Clinical Infectious Diseases, Division of Intramural Research, National Institute of Allergy and Infectious Disease, National Institutes of Health, Bethesda, Md.
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Brilhante RSN, Caetano ÉP, Lima RACD, Marques FJDF, Castelo-Branco DDSCM, Melo CVSD, Guedes GMDM, Oliveira JSD, Camargo ZPD, Moreira JLB, Monteiro AJ, Bandeira TDJPG, Cordeiro RDA, Rocha MFG, Sidrim JJC. Terpinen-4-ol, tyrosol, and β-lapachone as potential antifungals against dimorphic fungi. Braz J Microbiol 2016; 47:917-924. [PMID: 27520529 PMCID: PMC5052391 DOI: 10.1016/j.bjm.2016.07.015] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 02/11/2016] [Indexed: 11/02/2022] Open
Abstract
This study aimed to evaluate the in vitro antifungal activity of terpinen-4-ol, tyrosol, and β-lapachone against strains of Coccidioides posadasii in filamentous phase (n=22) and Histoplasma capsulatum in both filamentous (n=40) and yeast phases (n=13), using the broth dilution methods as described by the Clinical and Laboratory Standards Institute, to determine the minimum inhibitory concentration (MIC) and minimum fungicidal concentration (MFC) of these compounds. The mechanisms of action of these compounds were also investigated by analyzing their effect on cell membrane permeability and ergosterol synthesis. The MIC and MFCf these compounds against C. posadasii, mycelial H. capsulatum, and yeast-like H. capsulatum, were in the following ranges: 350-5720μg/mL, 20-2860μg/mL, and 40-1420μg/mL, respectively for terpinen-4-ol; 250-4000μg/mL, 30-2000μg/mL, and 10-1000μg/mL, respectively, for tyrosol; and 0.48-7.8μg/mL, 0.25-16μg/mL, and 0.125-4μg/mL, respectively for β-lapachone. These compounds showed a decrease in MIC when the samples were subjected to osmotic stress, suggesting that the compounds acted on the fungal membrane. All the compounds were able to reduce the ergosterol content of the fungal strains. Finally, tyrosol was able to cause a leakage of intracellular molecules.
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Affiliation(s)
- Raimunda Sâmia Nogueira Brilhante
- Federal University of Ceará, Fortaleza, Postgraduate Program in Medical Microbiology, Specialized Medical Mycology Center, CE, Brazil; Federal University of Ceará, Fortaleza, Postgraduate Program in Medical Sciences, CE, Brazil.
| | - Érica Pacheco Caetano
- Federal University of Ceará, Fortaleza, Postgraduate Program in Medical Microbiology, Specialized Medical Mycology Center, CE, Brazil
| | - Rita Amanda Chaves de Lima
- Federal University of Ceará, Fortaleza, Postgraduate Program in Medical Microbiology, Specialized Medical Mycology Center, CE, Brazil
| | | | | | - Charlline Vládia Silva de Melo
- Federal University of Ceará, Fortaleza, Postgraduate Program in Medical Microbiology, Specialized Medical Mycology Center, CE, Brazil
| | - Glaucia Morgana de Melo Guedes
- Federal University of Ceará, Fortaleza, Postgraduate Program in Medical Microbiology, Specialized Medical Mycology Center, CE, Brazil
| | - Jonathas Sales de Oliveira
- Federal University of Ceará, Fortaleza, Postgraduate Program in Medical Microbiology, Specialized Medical Mycology Center, CE, Brazil
| | - Zoilo Pires de Camargo
- Federal University of São Paulo, Department of Microbiology, Immunology and Parasitology, Cellular Biology Division, São Paulo, SP, Brazil
| | - José Luciano Bezerra Moreira
- Federal University of Ceará, Fortaleza, Postgraduate Program in Medical Microbiology, Specialized Medical Mycology Center, CE, Brazil
| | - André Jalles Monteiro
- Federal University of Ceará, Fortaleza, Department of Statistics and Applied Mathematics, Fortaleza, CE, Brazil
| | | | - Rossana de Aguiar Cordeiro
- Federal University of Ceará, Fortaleza, Postgraduate Program in Medical Microbiology, Specialized Medical Mycology Center, CE, Brazil; Federal University of Ceará, Fortaleza, Postgraduate Program in Medical Sciences, CE, Brazil
| | - Marcos Fábio Gadelha Rocha
- Federal University of Ceará, Fortaleza, Postgraduate Program in Medical Microbiology, Specialized Medical Mycology Center, CE, Brazil; State University of Ceará, Fortaleza, Postgraduate Program in Veterinary Sciences, Forteleza, CE, Brazil
| | - José Júlio Costa Sidrim
- Federal University of Ceará, Fortaleza, Postgraduate Program in Medical Microbiology, Specialized Medical Mycology Center, CE, Brazil; Federal University of Ceará, Fortaleza, Postgraduate Program in Medical Sciences, CE, Brazil
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Salt E, Wiggins AT, Rayens MK, Huaman MA, Mannino D, Schwieterman P, Merkley SA, Jones AR, Crofford LJ. Risk Factors for Targeted Fungal and Mycobacterial Infections in Patients Taking Tumor Necrosis Factor Inhibitors. Arthritis Rheumatol 2016; 68:597-603. [PMID: 26474379 DOI: 10.1002/art.39468] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 10/01/2015] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To identify predictors of the receipt of medical care, including the receipt of pre-drug screening, for diagnostically targeted fungal or mycobacterial infections among patients prescribed a tumor necrosis factor inhibitor (TNFi). METHODS We conducted a case-control study using deidentified patient health claims information from a data set representing a commercially insured US population of 15 million patients annually from January 1, 2007 to December 31, 2009. Descriptive statistics as well as a 2-sample t-test, chi-square test of association, Fisher's exact test, and multivariate logistic regression were used for data analysis. RESULTS A total of 30,772 patients received a TNFi during the study period. Of these, 158 patients (0.51%) developed targeted fungal and/or mycobacterial infections (cases). The median number of infections per case was 1.0 (interquartile range 1.0-2.0). Tuberculosis was diagnosed in 61% of cases, followed by histoplasmosis in 60%, nontuberculous mycobacterial infections in 11%, coccidioidomycosis in 10%, unspecified fungal infection in 8%, blastomycosis in 4%, cryptococcal infection in 3%, and pneumocystosis in 2%. Compared to controls (n = 474), a higher proportion of cases were prescribed prednisone (55% versus 37%; P < 0.001). Patients who were prescribed prednisone during the study period were twice as likely as those not taking prednisone to seek medical care attributable to a targeted fungal or mycobacterial infection (odds ratio 2.03; P < 0.001). CONCLUSION Development of a targeted fungal or mycobacterial infection among patients taking a TNFi is rare. Concomitant use of prednisone predicted development of such infections.
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Brilhante RSN, Bittencourt PV, Lima RAC, Castelo-Branco D, Oliveira JS, Pinheiro A, Cordeiro R, Camargo ZP, Sidrim JJC, Rocha MFG. Coccidioidomycosis and Histoplasmosis in Equines: An Overview to Support the Accurate Diagnosis. J Equine Vet Sci 2016. [DOI: 10.1016/j.jevs.2016.02.230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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46
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Ling X, Huang Z, Wang J, Xie J, Feng M, Chen Y, Abbas F, Tu J, Wu J, Sun C. Development of an itraconazole encapsulated polymeric nanoparticle platform for effective antifungal therapy. J Mater Chem B 2016; 4:1787-1796. [DOI: 10.1039/c5tb02453f] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Schematic illustration of the construction andin vivotrafficking of ITZ-NPs.
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Nett RJ, Skillman D, Riek L, Davis B, Blue SR, Sundberg EE, Merriman JR, Hahn CG, Park BJ. Histoplasmosis in Idaho and Montana, USA, 2012-2013. Emerg Infect Dis 2015; 21:1071-2. [PMID: 25989199 PMCID: PMC4451912 DOI: 10.3201/eid2106.141367] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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48
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Furuie JL, Sun J, do Nascimento MMF, Gomes RR, Waculicz-Andrade CE, Sessegolo GC, Rodrigues AM, Galvão-Dias MA, de Camargo ZP, Queiroz-Telles F, Najafzadeh MJ, de Hoog SG, Vicente VA. Molecular identification of Histoplasma capsulatum using rolling circle amplification. Mycoses 2015; 59:12-9. [PMID: 26578301 DOI: 10.1111/myc.12426] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Revised: 09/30/2015] [Accepted: 10/03/2015] [Indexed: 12/01/2022]
Abstract
Histoplasmosis is a systemic fungal disease that occurs worldwide, causing symptomatic infection mostly in immunocompromised hosts. Etiological agent is the dimorphic fungus, Histoplasma capsulatum, which occurs in soil contaminated with bird or bat droppings. Major limitation in recognition of H. capsulatum infections is the low awareness, since other diseases may have similar symptomatology. The molecular methods have gained importance because of unambiguous diagnostic ability and efficiency. The aim of this study was to develop and evaluate a padlock probe in view of rolling circle amplification (RCA) detection method which targets ITS (Internal Transcribed Spacer) rDNA of H. capsulatum enabling rapid and specific detection of the fungus in clinical samples. Two padlock probes were designed and one of these (HcPL2) allowed specific amplification of H. capsulatum DNA while no cross-reactivity was observed with fungi used as negative controls. This method proved to be effective for H. capsulatum specific identification and demonstrated to be faster than the traditional method of microbiological identification.
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Affiliation(s)
- Jason L Furuie
- Bioprocess Engineering and Biotechnology Department, Post-Graduation Program of Bioprocess Engineering and Biotechnology, Federal University of Paraná, Curitiba, Brazil
| | - Jiufeng Sun
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
| | - Mariana M F do Nascimento
- Basic Pathology Department, Post-Graduation Program of Microbiology, Parasitology and Pathology, Federal University of Paraná, Curitiba, Brazil
| | - Renata R Gomes
- Basic Pathology Department, Post-Graduation Program of Microbiology, Parasitology and Pathology, Federal University of Paraná, Curitiba, Brazil
| | - Caroline E Waculicz-Andrade
- Basic Pathology Department, Post-Graduation Program of Microbiology, Parasitology and Pathology, Federal University of Paraná, Curitiba, Brazil
| | | | - Anderson M Rodrigues
- Cellular Biology Division, Microbiology, Immunology and Parasitology Department, Federal University of São Paulo, São Paulo, Brazil
| | | | - Zoilo P de Camargo
- Cellular Biology Division, Microbiology, Immunology and Parasitology Department, Federal University of São Paulo, São Paulo, Brazil
| | - Flávio Queiroz-Telles
- Basic Pathology Department, Post-Graduation Program of Microbiology, Parasitology and Pathology, Federal University of Paraná, Curitiba, Brazil.,Clinical Hospital of the Federal University of Paraná, Curitiba, Brazil
| | - Mohammad J Najafzadeh
- Parasitology and Mycology Department, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Sybren G de Hoog
- Basic Pathology Department, Post-Graduation Program of Microbiology, Parasitology and Pathology, Federal University of Paraná, Curitiba, Brazil.,CBS-KNAW Fungal Biodiversity Centre, Utrecht, The Netherlands
| | - Vania A Vicente
- Bioprocess Engineering and Biotechnology Department, Post-Graduation Program of Bioprocess Engineering and Biotechnology, Federal University of Paraná, Curitiba, Brazil.,Basic Pathology Department, Post-Graduation Program of Microbiology, Parasitology and Pathology, Federal University of Paraná, Curitiba, Brazil
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49
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Brilhante RSN, Caetano EP, Lima RAC, Castelo Branco DSCM, Serpa R, Oliveira JS, Monteiro AJ, Rocha MFG, Cordeiro RA, Sidrim JJC. In vitro antifungal activity of miltefosine and levamisole: their impact on ergosterol biosynthesis and cell permeability of dimorphic fungi. J Appl Microbiol 2015; 119:962-9. [PMID: 26178247 DOI: 10.1111/jam.12891] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Revised: 06/09/2015] [Accepted: 06/25/2015] [Indexed: 12/26/2022]
Abstract
AIMS This study aimed to evaluate the in vitro activity of miltefosine and levamisole against strains of Coccidioides posadasii in the filamentous phase and strains of Histoplasma capsulatum in filamentous and yeast phases. METHODS AND RESULTS Strains of C. posadasii in the filamentous phase (n = 22) and strains of H. capsulatum in filamentous (n = 40) and yeast phases (n = 13) were, respectively, submitted to broth macrodilution and broth microdilution methods, as described by the Clinical and Laboratory Standards Institute, to determine the minimum inhibitory concentration (MIC) and the minimum fungicidal concentration (MFC) of miltefosine and levamisole. The effect of the drugs on cell membrane permeability under osmotic stress conditions and total ergosterol production were also assessed, along with quantification of extravasated molecules. The results show the inhibitory effect of levamisole and miltefosine against C. posadasii and H. capsulatum and the effect of these drugs on ergosterol synthesis and the permeability of the plasma membrane using subinhibitory concentrations against strains subjected to osmotic stress. Levamisole was also able to cause the release of nucleic acids. CONCLUSIONS Miltefosine and levamisole are capable of inhibiting the in vitro growth of C. posadasii and H. capsulatum, probably by altering the permeability of the cellular membrane. SIGNIFICANCE AND IMPACT OF THE STUDY This work presents alternatives for the treatment of histoplasmosis and coccidioidomycosis, raising the possibility of the use of miltefosine and levamisole as adjuvants in antifungal therapy, providing perspectives for the design of in vivo studies.
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Affiliation(s)
- R S N Brilhante
- Specialized Medical Mycology Center, Postgraduate Program in Medical Microbiology, Federal University of Ceará, Fortaleza, CE, Brazil.,Postgraduate Program in Medical Sciences, Federal University of Ceará, Fortaleza, CE, Brazil
| | - E P Caetano
- Specialized Medical Mycology Center, Postgraduate Program in Medical Microbiology, Federal University of Ceará, Fortaleza, CE, Brazil
| | - R A C Lima
- Specialized Medical Mycology Center, Postgraduate Program in Medical Microbiology, Federal University of Ceará, Fortaleza, CE, Brazil
| | - D S C M Castelo Branco
- Specialized Medical Mycology Center, Postgraduate Program in Medical Microbiology, Federal University of Ceará, Fortaleza, CE, Brazil
| | - R Serpa
- Specialized Medical Mycology Center, Postgraduate Program in Medical Microbiology, Federal University of Ceará, Fortaleza, CE, Brazil
| | - J S Oliveira
- Specialized Medical Mycology Center, Postgraduate Program in Medical Microbiology, Federal University of Ceará, Fortaleza, CE, Brazil
| | - A J Monteiro
- Department of Statistics and Applied Mathematics, Federal University of Ceará, Fortaleza, CE, Brazil
| | - M F G Rocha
- Specialized Medical Mycology Center, Postgraduate Program in Medical Microbiology, Federal University of Ceará, Fortaleza, CE, Brazil.,Postgraduate Program in Veterinary Sciences, State University of Ceará, Fortaleza, CE, Brazil
| | - R A Cordeiro
- Specialized Medical Mycology Center, Postgraduate Program in Medical Microbiology, Federal University of Ceará, Fortaleza, CE, Brazil.,Postgraduate Program in Medical Sciences, Federal University of Ceará, Fortaleza, CE, Brazil
| | - J J C Sidrim
- Specialized Medical Mycology Center, Postgraduate Program in Medical Microbiology, Federal University of Ceará, Fortaleza, CE, Brazil.,Postgraduate Program in Medical Sciences, Federal University of Ceará, Fortaleza, CE, Brazil
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50
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Negroni R. Classic Histoplasmosis. Med Mycol 2015. [DOI: 10.1201/b18707-12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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