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Kontogiannis D, Di Lorenzo A, Zaçe D, Benvenuto D, Moccione M, Muratore G, Giacalone ML, Montagnari G, Carnevale L, Mulas T, Coppola L, Campogiani L, Sarmati L, Iannetta M. Histoplasmosis in patients living with HIV in Europe: review of literature. Front Microbiol 2024; 15:1418530. [PMID: 38993488 PMCID: PMC11238259 DOI: 10.3389/fmicb.2024.1418530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Accepted: 06/12/2024] [Indexed: 07/13/2024] Open
Abstract
Histoplasma capsulatum (var. capsulatum Hcc and duboisii Hcd), is a dimorphic fungus that causes histoplasmosis. It usually affects people coming from endemic areas, causing a variety of clinical manifestations up to progressive disseminated histoplasmosis (PDH), especially among people living with HIV (PLWH). We conducted a systematic review to assess histoplasmosis burden of PLWH in Europe. The review follows PRISMA guidelines, with protocol registered in PROSPERO (CRD42023429779). Seventy-eight articles were selected, including 109 patients (32 women). On overall, median age was 37 years. Forty-six patients were Americans, 39 Africans, 17 Europeans, 5 Asians, in 2 cases nationality was not specified. Cases were mainly diagnosed in Italy (28.4%), France (17.3%) and Spain (17.4%), with a north-south gradient. Six cases lacked epidemiologic links with endemic areas. Concerning CDC HIV staging at diagnosis, the information was available for 60 PLWH (55%) and all subjects were at stage C3 except for two subjects at stage B3. PDH was the AIDS-presenting illness in 39 patients. Most patients had a PDH (80.7%); other common extrapulmonary forms were isolated cutaneous histoplasmosis (7.3%), or lymphatic localization (2.7%). In 30 cases, the diagnosis was made by analyzing only one sample. For the remaining 79 cases, multiple samples were collected from each patient. Regarding the biological sample more frequently used for the diagnosis of histoplasmosis, bronchoalveolar lavage sample was taken from 39 patients, and tested positive in 51.3% of cases; 36 patients underwent a skin biopsy which was positive in 86.1% of cases and 28 patients performed bone-marrow biopsy, which led to the diagnosis of histoplasmosis in 92.9% of cases. The identification of Histoplasma capsulatum was available in 97 PLWH through examination of different samples: Hcc and Hcd were identified in 89 and 8 PLWH, respectively. Concerning therapies, 67.9% were treated with liposomal amphotericin B, 18.3% with itraconazole, 10 died pre-treatment. The overall mortality rate was 23.6%. Non-survivors exhibited more frequently gastrointestinal symptoms (p = 0.017), while cutaneous signs correlated with better survival (p = 0.05). Untreated patients faced higher mortality (p < 0.001). Histoplasmosis should be considered amongst opportunistic infection in PLWH, even in Europe, especially if patients originate from or have travelled to endemic areas. Systematic review registration: The registration number is CRD42023429779.
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Affiliation(s)
- Dimitra Kontogiannis
- Department of Systems Medicine, Infectious Disease Clinic, Tor Vergata University, Rome, Italy
| | - Andrea Di Lorenzo
- Department of Systems Medicine, Infectious Disease Clinic, Tor Vergata University, Rome, Italy
| | - Drieda Zaçe
- Department of Systems Medicine, Infectious Disease Clinic, Tor Vergata University, Rome, Italy
| | - Domenico Benvenuto
- Department of Systems Medicine, Infectious Disease Clinic, Tor Vergata University, Rome, Italy
| | - Martina Moccione
- Department of Systems Medicine, Infectious Disease Clinic, Tor Vergata University, Rome, Italy
| | - Gianmarco Muratore
- Department of Systems Medicine, Infectious Disease Clinic, Tor Vergata University, Rome, Italy
| | - Maria L. Giacalone
- Department of Systems Medicine, Infectious Disease Clinic, Tor Vergata University, Rome, Italy
| | - Giulia Montagnari
- Department of Systems Medicine, Infectious Disease Clinic, Tor Vergata University, Rome, Italy
| | - Laura Carnevale
- Department of Systems Medicine, Infectious Disease Clinic, Tor Vergata University, Rome, Italy
| | - Tiziana Mulas
- Infectious Disease Clinic, Policlinico Tor Vergata, Rome, Italy
| | - Luigi Coppola
- Infectious Disease Clinic, Policlinico Tor Vergata, Rome, Italy
| | | | - Loredana Sarmati
- Department of Systems Medicine, Infectious Disease Clinic, Tor Vergata University, Rome, Italy
- Infectious Disease Clinic, Policlinico Tor Vergata, Rome, Italy
| | - Marco Iannetta
- Department of Systems Medicine, Infectious Disease Clinic, Tor Vergata University, Rome, Italy
- Infectious Disease Clinic, Policlinico Tor Vergata, Rome, Italy
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Antinori S, Giacomelli A, Corbellino M, Torre A, Schiuma M, Casalini G, Parravicini C, Milazzo L, Gervasoni C, Ridolfo AL. Histoplasmosis Diagnosed in Europe and Israel: A Case Report and Systematic Review of the Literature from 2005 to 2020. J Fungi (Basel) 2021; 7:481. [PMID: 34198597 PMCID: PMC8231918 DOI: 10.3390/jof7060481] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 06/07/2021] [Accepted: 06/10/2021] [Indexed: 12/22/2022] Open
Abstract
Human histoplasmosis is a mycosis caused by two distinct varieties of a dimorphic fungus: Histoplasma capsulatum var. capsulatum and H. capsulatum var. duboisii. In Europe, it is usually imported by migrants and travellers, although there have been some autochthonous cases, especially in Italy; however, most European physicians are unfamiliar with its clinical and pathological picture, particularly among immunocompromised patients without HIV infection. This systematic review of all the cases of histoplasmosis reported in Europe and Israel between 2005 and 2020 identified 728 cases diagnosed in 17 European countries and Israel described in 133 articles. The vast majority were imported (mainly from Central and South America), but there were also seven autochthonous cases (six in Europe and one in Israel). The patients were prevalently males (60.4%), and their ages ranged from 2 to 86 years. The time between leaving an endemic region and the diagnosis of histoplasmosis varied from a few weeks to more than 40 years. Progressive disseminated histoplasmosis was the most frequent clinical picture among people living with HIV infection (89.5%) or a different immunocompromising condition (57.1%), but it was also recorded in 6.2% of immunocompetent patients. Twenty-eight cases were caused by Histoplasma duboisii. Immunocompromised patients without HIV infection had the worst outcomes, with a mortality rate of 32%.
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Affiliation(s)
- Spinello Antinori
- Luigi Sacco Department of Biomedical and Clinical Sciences, Università di Milano, 20157 Milan, Italy; (A.G.); (M.S.); (G.C.)
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, 20157 Milan, Italy; (M.C.); (A.T.); (L.M.); (C.G.); (A.L.R.)
| | - Andrea Giacomelli
- Luigi Sacco Department of Biomedical and Clinical Sciences, Università di Milano, 20157 Milan, Italy; (A.G.); (M.S.); (G.C.)
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, 20157 Milan, Italy; (M.C.); (A.T.); (L.M.); (C.G.); (A.L.R.)
| | - Mario Corbellino
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, 20157 Milan, Italy; (M.C.); (A.T.); (L.M.); (C.G.); (A.L.R.)
| | - Alessandro Torre
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, 20157 Milan, Italy; (M.C.); (A.T.); (L.M.); (C.G.); (A.L.R.)
| | - Marco Schiuma
- Luigi Sacco Department of Biomedical and Clinical Sciences, Università di Milano, 20157 Milan, Italy; (A.G.); (M.S.); (G.C.)
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, 20157 Milan, Italy; (M.C.); (A.T.); (L.M.); (C.G.); (A.L.R.)
| | - Giacomo Casalini
- Luigi Sacco Department of Biomedical and Clinical Sciences, Università di Milano, 20157 Milan, Italy; (A.G.); (M.S.); (G.C.)
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, 20157 Milan, Italy; (M.C.); (A.T.); (L.M.); (C.G.); (A.L.R.)
| | | | - Laura Milazzo
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, 20157 Milan, Italy; (M.C.); (A.T.); (L.M.); (C.G.); (A.L.R.)
| | - Cristina Gervasoni
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, 20157 Milan, Italy; (M.C.); (A.T.); (L.M.); (C.G.); (A.L.R.)
| | - Anna Lisa Ridolfo
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, 20157 Milan, Italy; (M.C.); (A.T.); (L.M.); (C.G.); (A.L.R.)
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Hernandez H, Erives VH, Martinez LR. Coccidioidomycosis: Epidemiology, Fungal Pathogenesis, and Therapeutic Development. CURRENT TROPICAL MEDICINE REPORTS 2019; 6:132-144. [PMID: 34367879 DOI: 10.1007/s40475-019-00184-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Purpose of Review Coccidioidomycosis can result from the inhalation of infectious spores of Coccidioides species (spp.) immitis or posadasii. Clinical manifestations range from mild flu-like disease to severe disseminated infection that can require life-long therapy. Burden of this mycosis is high in the southwest region of the USA where it is well characterized, and in many areas of Mexico and Latin America where it is inadequately characterized. Here, we provide historical data and current knowledge on Coccidioides spp. pathogenesis as well as recent progress in therapeutic and vaccine development against coccidioidomycosis. Recent Findings The virulence mechanisms of Coccidioides spp. are largely unknown; however, production and regulation of a spherule glycoprotein, ammonium production, and melanization have all been proposed as integral factors in Coccidioides spp.' pathogenesis. Therapeutic options are limited and not 100% effective, but individualized treatment with triazoles or amphotericin B over the course of pulmonary or disseminated infection can be effective in resolution of coccidioidomycosis. Human immunization has not been achieved but efforts are ongoing. Summary Advances in therapeutic and vaccine development are imperative for the prevention and treatment of coccidioidomycosis, especially for those individuals at risk either living or traveling to or from endemic areas.
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Affiliation(s)
- Hazael Hernandez
- Department of Biological Sciences, The Border Biomedical Research Center, The University of Texas at El Paso, 500 W. University Ave., Bioscience Research Building, Room 2.170, El Paso, TX 79968-9991, USA
| | - Victor H Erives
- Department of Biological Sciences, The Border Biomedical Research Center, The University of Texas at El Paso, 500 W. University Ave., Bioscience Research Building, Room 2.170, El Paso, TX 79968-9991, USA
| | - Luis R Martinez
- Department of Biological Sciences, The Border Biomedical Research Center, The University of Texas at El Paso, 500 W. University Ave., Bioscience Research Building, Room 2.170, El Paso, TX 79968-9991, USA
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Novel Treatment of Disseminated Coccidioidomycosis in a Dog with Voriconazole. Case Rep Vet Med 2018; 2018:1785748. [PMID: 29955433 PMCID: PMC6005294 DOI: 10.1155/2018/1785748] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2017] [Accepted: 03/01/2018] [Indexed: 11/18/2022] Open
Abstract
A dog with disseminated coccidioidomycosis involving the vertebral, cutaneous, and pulmonary systems was treated successfully with voriconazole after failing traditional therapy with fluconazole and terbinafine. This report is the first to describe the successful management of refractory coccidioidomycosis with voriconazole in a dog.
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Diaz JH. Travel-related risk factors for coccidioidomycosis. J Travel Med 2018; 25:5001358. [PMID: 29796604 DOI: 10.1093/jtm/tay027] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 03/25/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND Coccidioidomycosis is a regionally endemic systemic mycosis with unique risk factors. Since people travel for business or pleasure, and often in conjunction with their avocations or hobbies, the objectives of this review were to describe these and other risk factors for coccidioidomycosis; to alert travel medicine clinicians to the different presenting manifestations of coccidioidomycosis; and to recommend effective treatment, disease control and prevention strategies. METHODS To meet the objectives of this review, Internet search engines were queried with the keywords as medical subject headings over the study period, 1970-2017. RESULTS The principle transmission mechanism of coccidioidomycosis is by deep inhalation of aerosolized arthroconidia with resulting symptomatic pulmonary infections ranging from febrile influenza-like illnesses to fatal disseminated mycoses. In addition to residency or travel in endemic areas, persons immunocompromised by advancing age, pregnancy, cancer, corticosteroid therapy, diabetes, organ transplantation and human immunodeficiency virus infection are at significantly increased risks of contracting coccidioidomycosis. Persons of African, Asian, Filipino and Hispanic descent are also at increased risks of contracting coccidioidomycosis. Hobbies associated with coccidioidomycosis have included armadillo hunting, model airplane flying and archaeological digging. Occupational risk factors for coccidioidomycosis include endemic exposures during military maneuvers, outdoor track and field events, road construction, solar-power and wind-power farm construction, archaeological excavation and prison work. CONCLUSIONS Coccidioidomycosis is more common in endemic and non-endemic areas than previously recognized and can result in considerable morbidity and mortality. Coccidioidomycosis is increasingly imported from endemic areas in the Western Hemisphere to non-endemic areas worldwide. Increased awareness of disease risk factors among the public and the international healthcare community will improve the timely diagnosis and treatment of coccidioidomycosis and prevent disease progression, dissemination and deaths in residents in and in travellers returning from endemic regions. A vaccine for the primary prevention of coccidioidomycosis would be cost-effective.
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Affiliation(s)
- James H Diaz
- Environmental and Occupational Health Sciences, School of Public Health and School of Medicine, Louisiana State University Health Sciences Center (LSUHSC), Office 2020 Gravier Street, Third Floor, New Orleans, LA 70112, USA
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An imported case of acute pulmonary coccidioidomycosis in an Italian traveller. Infection 2014; 42:921-4. [DOI: 10.1007/s15010-014-0614-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2014] [Accepted: 03/05/2014] [Indexed: 10/25/2022]
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Kantarcioglu AS, Sandoval-Denis M, Aygun G, Kiraz N, Akman C, Apaydin H, Karaman E, Guarro J, de Hoog GS, Gurel MS. First imported coccidioidomycosis in Turkey: A potential health risk for laboratory workers outside endemic areas. Med Mycol Case Rep 2014; 3:20-5. [PMID: 24567896 PMCID: PMC3930961 DOI: 10.1016/j.mmcr.2014.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2013] [Revised: 12/19/2013] [Accepted: 01/10/2014] [Indexed: 12/03/2022] Open
Abstract
Coccidioidomycosis caused by Coccidioides immitis or Coccidioides posadasii is endemic in arid climate zones in America, travel-related cases have been reported. We report the first documented case of coccidioidomycosis in Turkey, overviewing reported cases in Europe and underlying difficulties of differential diagnosis outside endemic regions. The patient was an otherwise healthy 41-year-old man who travelled endemic areas. Laboratory diagnosis was based on direct microscopy of two subsequent subcutaneous biopsy specimens and culture and confirmed molecularly. Laboratory personnel should become aware that BioSafety Level-3 organisms may become more frequent and widespread.
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Affiliation(s)
- A Serda Kantarcioglu
- Cerrahpasa Medical Faculty, Department of Medical Microbiology, Deep Mycosis Laboratory, Istanbul University, Istanbul 34098, Turkey
| | - M Sandoval-Denis
- Unitat de Microbiologia, Facultat de Medicina i Ciencies de la Salut, IISPV, Universitat Rovira i Virgili, 43201 Reus, Spain
| | - Gokhan Aygun
- Cerrahpasa Medical Faculty, Department of Medical Microbiology, Deep Mycosis Laboratory, Istanbul University, Istanbul 34098, Turkey
| | - Nuri Kiraz
- Cerrahpasa Medical Faculty, Department of Medical Microbiology, Deep Mycosis Laboratory, Istanbul University, Istanbul 34098, Turkey
| | - Canan Akman
- Cerrahpasa Medical Faculty, Department of Radiology, Istanbul University, Istanbul 34098, Turkey
| | - Hulya Apaydin
- Cerrahpasa Medical Faculty, Department of Neurology, Istanbul University, Istanbul 34098, Turkey
| | - Emin Karaman
- Cerrahpasa Medical Faculty, Department of Otorhinolaryngology, Istanbul University, Istanbul 34098, Turkey
| | - Josep Guarro
- Unitat de Microbiologia, Facultat de Medicina i Ciencies de la Salut, IISPV, Universitat Rovira i Virgili, 43201 Reus, Spain
| | | | - M S Gurel
- Department of Dermatology, Samatya Training and Research Hospital, Istanbul 34098, Turkey
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Abstract
The incidence, mortality, and epidemiology of human immunodeficiency virus (HIV)-associated pulmonary infections have changed as a result of effective antiretroviral and prophylaxis antimicrobial therapy. The clinical presentation, radiographic abnormalities, and treatment of pneumonia from various uncommon pathogens in patients with AIDS can be different from those in immunocompetent patients. Advances in invasive and noninvasive testing and molecular biological techniques have improved the diagnosis and prognosis of pulmonary infections in patients infected with HIV. This review focuses on pulmonary infections from nontuberculosis mycobacteria, cytomegalovirus, fungi (aspergillosis, cryptococcosis, endemic fungi), and parasites (toxoplasmosis), and uncommon bacterial pneumonia (nocardiosis, rhodococcosis) in these patients.
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Affiliation(s)
- Jakrapun Pupaibool
- Division of Infectious Diseases, Mayo Clinic College of Medicine, Rochester, MN 55905, USA
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Gobbi F, Angheben A, Farina C, Buonfrate D, Postiglione C, Rossanese A, Anselmi M, Savio C, Gobbo M, Bisoffi Z. Coccidioidomycosis: first imported case in Italy. J Travel Med 2012; 19:192-4. [PMID: 22530829 DOI: 10.1111/j.1708-8305.2012.00599.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We report a case of pulmonary coccidioidomycosis imported from the United States to Italy. This disease should enter in the differential diagnosis of any febrile patient (especially if presenting with pulmonary symptoms, with or without hypereosinophilia) coming from Coccidioides immitis endemic areas.
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Affiliation(s)
- Federico Gobbi
- Centre for Tropical Diseases, Hospital Sacro Cuore-Don Calabria, Negrar, Verone, Italy.
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Goegebuer T, Nackaerts K, Himpe U, Verbeken E, Lagrou K. Coccidioidomycosis: an unexpected diagnosis in a patient with persistent cough. Acta Clin Belg 2009; 64:235-8. [PMID: 19670565 DOI: 10.1179/acb.2009.042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Coccidioidomycosis is an endemic fungal infection of the new world caused by Coccidioides immitis. Because of its low incidence in the European continent, the disease is not well known in Belgium. A 34-year-old male was referred by his general physician with a chronic cough and a nodular infiltrate on chest X-ray. Because a malignant tumour was suspected, a diagnostic work-up was performed and, finally, a broad excision of the pulmonary lesion was carried out. The unsuspected diagnosis of chronic coccidioidomycosis was eventually made based on identification of the filamentous fungus in mycological culture of the lung tissue, and the presence of the typical spherules with endospores upon histopathologic examination. The patient later admitted to have been travelling to Arizona frequently in the past year for professional reasons. Coccidioides spp. should always be considered as a possible aetiologic agent of pulmonary infection in former residents and recent travellers to regions where the fungus is endemic.
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Coccidioïdomycose : une maladie d’importation d’actualité en France. Med Mal Infect 2008; 38:336-42. [DOI: 10.1016/j.medmal.2007.08.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2007] [Accepted: 08/28/2007] [Indexed: 11/21/2022]
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Buot G, Bachmeyer C, Haettich-Pialoux B, Bélangé G, Thiébaut JB, Dupont B, Binet O. Coccidioïdomycose révélée par des lésions cutanées spécifiques survenues après une dérivation ventriculo-cardiaque pour méningite chronique. Presse Med 2008; 37:970-4. [DOI: 10.1016/j.lpm.2007.06.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2006] [Revised: 04/12/2007] [Accepted: 06/04/2007] [Indexed: 11/24/2022] Open
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Ralph A, Raines M, Rode JW, Currie BJ. Histoplasmosis in two aboriginal patients from Australia's tropical Northern Territory. Trans R Soc Trop Med Hyg 2006; 100:888-90. [PMID: 16483624 DOI: 10.1016/j.trstmh.2005.10.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2005] [Revised: 10/09/2005] [Accepted: 10/10/2005] [Indexed: 11/21/2022] Open
Abstract
Endemic histoplasmosis occurs uncommonly in Australia and has not previously been reported in the tropical Northern Territory, nor in Aboriginal Australian patients. We report one suspected and one confirmed case of severe disseminated histoplasmosis in Aboriginal Australians from the Northern Territory. Underlying illness included chronic cardiac disease and Type 1 diabetes mellitus, respectively, and neither patient was infected with HIV. The clinical presentations resembled malignancy. Diagnosis of histoplasmosis was made on the basis of bowel histology in Case 1, demonstrating characteristic yeasts, and lymph node histology and culture in Case 2. Histoplasmosis should be considered in relevant clinical situations, even in HIV-negative patients who have not left Australia.
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Affiliation(s)
- Anna Ralph
- Department of Medicine, Royal Darwin Hospital, Casuarina, Northern Territory, 0811, Australia.
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