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Tello-Mercado AC, Martínez-Guerra BA, Román-Montes CM, Seoane-Hernandez L, Rangel-Cordero A, Martínez-Gamboa RA, Sifuentes-Osornio J, Ponce-de-León A, González Lara MF, Niembro-Ortega MD. Histoplasmosis Beyond Human Immunodeficiency Virus (HIV): Clinical Characteristics and Outcomes in a Non-HIV Population. Open Forum Infect Dis 2024; 11:ofae079. [PMID: 38887483 PMCID: PMC11181178 DOI: 10.1093/ofid/ofae079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 02/13/2024] [Indexed: 06/20/2024] Open
Abstract
Histoplasmosis is an endemic and invasive mycosis caused by Histoplasma capsulatum. We conducted a retrospective study comparing immunosuppressed patients without human immunodeficiency virus (HIV) with a historical cohort of people with HIV and histoplasmosis. We included 199 patients with proven or probable histoplasmosis, of which 25.1% were people without HIV. Diabetes mellitus, chronic kidney disease, hematologic neoplasms, rheumatologic diseases, and transplantations were more frequent among people without HIV (P < .01). Forty-four percent of immunocompromised patients without HIV died within the first 6-week period following their diagnosis. A high suspicion index for histoplasmosis should be kept in immunosuppressed patients.
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Affiliation(s)
- Andrea C Tello-Mercado
- Infectious Diseases Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Bernardo A Martínez-Guerra
- Infectious Diseases Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Carla M Román-Montes
- Infectious Diseases Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Lisset Seoane-Hernandez
- Infectious Diseases Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Andrea Rangel-Cordero
- Clinical Microbiology Laboratory, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Rosa A Martínez-Gamboa
- Clinical Microbiology Laboratory, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - José Sifuentes-Osornio
- General Direction, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Alfredo Ponce-de-León
- Infectious Diseases Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - María F González Lara
- Infectious Diseases Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
- Clinical Microbiology Laboratory, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - María D Niembro-Ortega
- Infectious Diseases Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
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Mendelian Susceptibility to Mycobacterial Disease: Retrospective Clinical and Genetic Study in Mexico. J Clin Immunol 2023; 43:123-135. [PMID: 36044171 PMCID: PMC9428379 DOI: 10.1007/s10875-022-01357-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 08/21/2022] [Indexed: 01/21/2023]
Abstract
Mendelian susceptibility to mycobacterial disease (MSMD) is a rare genetic disorder characterized by impaired immunity against intracellular pathogens, such as mycobacteria, attenuated Mycobacterium bovis-Bacillus Calmette-Guérin (BCG) vaccine strains, and environmental mycobacteria in otherwise healthy individuals. Retrospective study reviewed the clinical, immunological, and genetic characteristics of patients with MSMD in Mexico. Overall, 22 patients diagnosed with MSMD from 2006 to 2021 were enrolled: 14 males (64%) and eight females. After BCG vaccination, 12 patients (70%) developed BCG infection. Furthermore, 6 (22%) patients developed bacterial infections mainly caused by Salmonella, as what is described next in the text is fungal infections, particularly Histoplasma. Seven patients died of disseminated BCG disease. Thirteen different pathogenic variants were identified in IL12RB1 (n = 13), IFNGR1 (n = 3), and IFNGR2 (n = 1) genes. Interleukin-12Rβ1 deficiency is the leading cause of MSMD in our cohort. Morbidity and mortality were primarily due to BCG infection.
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Abstract
Histoplasmosis is one of the commonest endemic mycoses in the Americas yet is often underdiagnosed and neglected as a public health priority. This review outlines the evolving understanding of its epidemiology and the clinical syndromes of histoplasmosis, in addition to up-to-date diagnostic and treatment guidelines. A focus on histoplasmosis in advanced HIV is included. The challenges pertinent to histoplasmosis management in Latin America, with recommendations made through international expert consensus are discussed.
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Affiliation(s)
- Ana Belén Araúz
- Department of Infectious Diseases, Pasteur Suite, Ealing Hospital, London North West University Healthcare NHS Trust, Uxbridge Road, London, UB1 3HW, UK; Infectious Diseases Department, Hospital Santo Tomas, Avenida Balboa, Panama City, Panama
| | - Padmasayee Papineni
- Infectious Diseases Department, Hospital Santo Tomas, Avenida Balboa, Panama City, Panama.
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Staffolani S, Riccardi N, Farina C, Lo Cascio G, Gulletta M, Gobbi F, Rodari P, Ursini T, Bertoli G, Ronzoni N, Bisoffi Z, Angheben A. Acute histoplasmosis in travelers: a retrospective study in an Italian referral center for tropical diseases. Pathog Glob Health 2020; 114:40-45. [PMID: 31959091 DOI: 10.1080/20477724.2020.1716517] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Purpose: Histoplasmosis is a fungal infection acquired through inhalation of Histoplasma capsulatum microconidia, mostly present in the Americas. Both immunocompetent and immunocompromised patients can present a wide spectrum of signs/symptoms, ranging from mild disease to a severe, disseminated infection. The aim of this observational study is to describe histoplasmosis cases diagnosed in travelers and their clinical/radiological and therapeutic pattern.Methods: Retrospective study at the Department of Infectious - Tropical Diseases and Microbiology (DITM) of Negrar, Verona, Italy, between January 2005 and December 2015.Results: Twenty-three cases of acute histoplasmosis were diagnosed, 17 of which belong to the same cluster. Seven of the 23 patients (30.4%) were admitted to hospital, four of whom underwent invasive diagnostic procedures. Thirteen patients (56.5%) received oral itraconazole. All patients recovered, although nine (39.1%) had radiological persisting lung nodules at 12 month follow up.Conclusions: Clinical, laboratory and radiological features of histoplasmosis can mimic other conditions, resulting in unnecessary invasive diagnostic procedures. However, a history of travel to endemic areas and of exposure to risk factors (such as visits to caves and presence of bats) should trigger the clinical suspicion of histoplasmosis. Treatment may be indicated in severe or prolonged disease.
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Affiliation(s)
- Silvia Staffolani
- SOD Malattie Infettive Emergenti e Degli Immunodepressi, Azienda Ospedaliero Universitaria, Ospedali Riuniti di Ancona, Ancona, Italy
| | - Niccolò Riccardi
- Department of Infectious - Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Verona, Italy
| | - Claudio Farina
- UOC Microbiologia e Virologia, Azienda Socio-Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Italy
| | - Giuliana Lo Cascio
- Microbiology and Virology Operating Unit, Department of Pathology and Diagnostic, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Maurizio Gulletta
- Department of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili General Hospital, Brescia, Italy
| | - Federico Gobbi
- Department of Infectious - Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Verona, Italy
| | - Paola Rodari
- Department of Infectious - Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Verona, Italy
| | - Tamara Ursini
- Department of Infectious - Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Verona, Italy
| | - Giulia Bertoli
- Department of Infectious - Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Verona, Italy
| | - Niccolò Ronzoni
- Department of Infectious - Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Verona, Italy.,Department of Clinical and Experimental Medicine, School of Infectious Diseases and Tropical Medicine, University of Sassari, Sassari, Italy
| | - Zeno Bisoffi
- Department of Infectious - Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Verona, Italy.,Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Andrea Angheben
- Department of Infectious - Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Verona, Italy
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Barker BM, Litvintseva AP, Riquelme M, Vargas-Gastélum L. Coccidioides ecology and genomics. Med Mycol 2019; 57:S21-S29. [PMID: 30690605 DOI: 10.1093/mmy/myy051] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2018] [Indexed: 11/13/2022] Open
Abstract
Although the natural history and ecology of Coccidioides spp. have been studied for over 100 years, many fundamental questions about this fungus remain unanswered. Two of the most challenging aspects of the study of Coccidioides have been the undefined ecological niche and the outdated geographic distribution maps dating from midcentury. This review details the history of Coccidioides ecological research, and discusses current strategies and advances in understanding Coccidioides genetics and ecology.
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Affiliation(s)
- Bridget M Barker
- Pathogen and Microbiome Institute, Northern Arizona University, Flagstaff, Arizona, USA
| | | | - Meritxell Riquelme
- Department of Microbiology, Centro de Investigación Científica y Educación Superior de Ensenada (CICESE), Ctra. Ensenada-Tijuana No. 3918, Ensenada, Baja California, 22860, Mexico
| | - Lluvia Vargas-Gastélum
- Department of Microbiology, Centro de Investigación Científica y Educación Superior de Ensenada (CICESE), Ctra. Ensenada-Tijuana No. 3918, Ensenada, Baja California, 22860, Mexico
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Selection of Specific Peptides for Coccidioides spp. Obtained from Antigenic Fractions through SDS-PAGE and Western Blot Methods by the Recognition of Sera from Patients with Coccidioidomycosis. Molecules 2018; 23:molecules23123145. [PMID: 30513599 PMCID: PMC6321320 DOI: 10.3390/molecules23123145] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 11/26/2018] [Accepted: 11/29/2018] [Indexed: 11/17/2022] Open
Abstract
Antigenic fractions of 100, 50, 37, and 28 kDa obtained through the SDS-PAGE method that were more frequently recognized by anti-Coccidioides antibodies in the sera of coccidioidomycosis patients were selected using western blotting. Subsequently, these bands were sequenced, and the obtained proteins were analysed by BLAST to choose peptides specific for Coccidioides spp. from among the shared aligned sequences of related fungi. A peptide specific for C. immitis was selected from the "GPI anchored serine-threonine rich protein OS C. immitis", while from the "uncharacterized protein of C. immitis", we selected a peptide for C. immitis and C. posadasii. These proteins arose from the 100 kDa antigenic fraction. From the protein "fatty acid amide hydrolase 1 of C. posadasii" that was identified from the 50 kDa antigenic fraction, a peptide was selected that recognized C. immitis and C. posadasii. In addition, the analysis of all the peptides (353) of each of the assembled proteins showed that only 35 had 100% identity with proteins of C. immitis and C. posadasii, one had 100% identity with only C. immitis, and one had 100% identity with only C. posadasii. These peptides can be used as diagnostic reagents, vaccines, and antifungals.
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Aranda-Audelo M, Rivera-Martínez NE, Corzo-León DE. Characteristics of Invasive Fungal Infections among HIV Individuals from an Indigenous Origin in Mexico. J Fungi (Basel) 2018; 4:E109. [PMID: 30205586 PMCID: PMC6162685 DOI: 10.3390/jof4030109] [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: 08/17/2018] [Revised: 09/06/2018] [Accepted: 09/07/2018] [Indexed: 11/29/2022] Open
Abstract
In individuals with HIV/AIDS, 47% of the deaths are attributed to invasive fungal infections (IFIs), despite antiretroviral (ARV) therapy. This is a retrospective study carried out in the Hospital Regional de Alta Especialidad Oaxaca (HRAEO), southwest Mexico, where IFIs that occurred during 2016⁻2017 are described. A total of 55 individuals were included. Histoplasmosis (36%) and possible-IFIs in neutropenic fever (20%) were the most frequent cases, followed by cryptococcosis (14%). The HIV/AIDS subpopulation corresponded with 26 cases (47%), all from an indigenous origin. The incidence of IFIs among them was 24% (95% CI = 15⁻33%). The CD4+ T cells median was 35 cells/mL (IQR 12⁻58). Four cases (15%) of unmasking IRIS were identified, three of histoplasmosis and one coccidioidomycosis. Co-infections were found in 52% (12/23), and tuberculosis in 50% (6/12) was the most frequent. The mortality rate was 48%. The general characteristics of the HIV individuals who died were atypical pneumonia (70% vs. 9%, p = 0.01), acute kidney injury, (70% vs. 9%, p = 0.008) and ICU stay (80% vs. 9%, p = 0.002). In conclusion, IFIs are diagnosed in one out of four individuals with HIV/AIDS along with other complicated infectious conditions, leading to major complications and a high mortality rate.
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Affiliation(s)
- Mercedes Aranda-Audelo
- Infectious Diseases Department, Hospital Regional de Alta Especialidad de Oaxaca, Avenida Aldama S/N, Centro, San Bartolo Coyotepec 71256, Oax, Mexico.
| | - Norma E Rivera-Martínez
- Infectious Diseases Department, Hospital Regional de Alta Especialidad de Oaxaca, Avenida Aldama S/N, Centro, San Bartolo Coyotepec 71256, Oax, Mexico.
| | - Dora E Corzo-León
- Medical Research Centre for Medical Mycology, Wellcome Trust Strategic Award, Institute of Medical Science, University of Aberdeen, King's College, Aberdeen AB24 3FX, UK.
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Fernández R, Arenas R, Duarte-Escalante E, Frías-De León MG, Vega Memige ME, Acosta Altamirano G, Reyes-Montes MDR. Diagnosis of coccidioidomycosis in a non-endemic area: Inference of the probable geographic area of an infection. Rev Iberoam Micol 2017; 34:237-240. [PMID: 28784311 DOI: 10.1016/j.riam.2017.03.006] [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: 06/23/2016] [Revised: 01/30/2017] [Accepted: 03/17/2017] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Coccidioidomycosis is one of the most important endemic mycoses in Northern Mexico. However, diagnosing this disease can be challenging, particularly in patients who do not reside in endemic areas. CASE REPORT The case of a Mexican HIV+ patient who developed fever, general malaise, a severe cough, and dyspnea during a stay in Acapulco, Guerrero, Mexico, is presented. Since various diseases are endemic to the state of Guerrero, the doctors originally suspected that the patient had contracted influenza A (H1N1), Q fever, or tuberculosis. All the diagnostic tests for those diseases were negative. The patient had received numerous mosquito bites while staying in Acapulco, and a nodule had appeared on his right cheek. Therefore, malaria, cryptococcosis, and histoplasmosis were also suspected, but those infections were also ruled out through diagnostic tests. A direct microscopic examination was performed using KOH on a sample taken from the cheek nodule. The observation of spherules suggested the presence of a species of Coccidioides. The fungus was isolated, and its identity was confirmed by phenotypic and molecular methods. The geographic area in which the infection was likely acquired was identified by random amplified polymorphic DNA (RAPD) analysis. The results suggested a probable endogenous reactivation. CONCLUSIONS This clinical case illustrates the difficulties associated with diagnosing coccidioidomycosis in non-endemic areas.
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Affiliation(s)
- Ramón Fernández
- Departamento de Dermatología, Hospital General Dr. Manuel Gea González, Calzada de Tlalpan 4800, México, Cd. Mx. 14080, Mexico
| | - Roberto Arenas
- Departamento de Dermatología, Hospital General Dr. Manuel Gea González, Calzada de Tlalpan 4800, México, Cd. Mx. 14080, Mexico
| | - Esperanza Duarte-Escalante
- Departamento de Microbiología y Parasitología, Facultad de Medicina, Universidad Nacional Autónoma de México (UNAM), Ciudad Universitaria No. 3000, México, Cd. Mx. 04510, Mexico
| | - María Guadalupe Frías-De León
- Dirección de Investigación, Hospital Regional de Alta Especialidad Ixtapaluca, Carretera Federal México - Puebla Km. 34.5, Pueblo de Zoquiapan, Ixtapaluca 56530, Mexico
| | - María Elisa Vega Memige
- Departamento de Dermatología, Hospital General Dr. Manuel Gea González, Calzada de Tlalpan 4800, México, Cd. Mx. 14080, Mexico
| | - Gustavo Acosta Altamirano
- Dirección de Investigación, Hospital Regional de Alta Especialidad Ixtapaluca, Carretera Federal México - Puebla Km. 34.5, Pueblo de Zoquiapan, Ixtapaluca 56530, Mexico
| | - María Del Rocío Reyes-Montes
- Departamento de Microbiología y Parasitología, Facultad de Medicina, Universidad Nacional Autónoma de México (UNAM), Ciudad Universitaria No. 3000, México, Cd. Mx. 04510, Mexico.
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Abstract
Among the endemic deep mycoses in Latin America, paracoccidioidomycosis (PCM), caused by thermodimorphic fungi of the Paracoccidioides genus, is a major cause of morbidity. Disease development and its manifestations are associated with both host and fungal factors. Concerning the latter, several recent studies have employed the methodology of gene modulation in P. brasiliensis using antisense RNA (AsRNA) and Agrobacterium tumefaciens-mediated transformation (ATMT) to identify proteins that influence fungus virulence. Our previous observations suggested that paracoccin (PCN), a multidomain fungal protein with both lectin and enzymatic activities, may be a potential P. brasiliensis virulence factor. To explore this, we used AsRNA and ATMT methodology to obtain three independent PCN-silenced P. brasiliensis yeast strains (AsPCN1, AsPCN2, and AsPCN3) and characterized them with regard to P. brasiliensis biology and pathogenicity. AsPCN1, AsPCN2, and AsPCN3 showed relative PCN expression levels that were 60%, 40%, and 60% of that of the wild-type (WT) strain, respectively. PCN silencing led to the aggregation of fungal cells, blocked the morphological yeast-to-mycelium transition, and rendered the yeast less resistant to macrophage fungicidal activity. In addition, mice infected with AsPCN1, AsPCN2, and AsPCN3 showed a reduction in fungal burden of approximately 96% compared with those inoculated with the WT strain, which displayed a more extensive destruction of lung tissue. Finally, mice infected with the PCN-silenced yeast strains had lower mortality than those infected with the WT strain. These data demonstrate that PCN acts as a P. brasiliensis contributory virulence factor directly affecting fungal pathogenesis. The nonexistence of efficient genetic transformation systems has hampered studies in the dimorphic fungus Paracoccidioides brasiliensis, the etiological agent of the most frequent systemic mycosis in Latin America. The recent development of a method for gene expression knockdown by antisense RNA technology, associated with an Agrobacterium tumefaciens-mediated transformation system, provides new strategies for studying P. brasiliensis. Through this technology, we generated yeasts that were silenced for paracoccin (PCN), a P. brasiliensis component that has lectin and enzymatic properties. By comparing the phenotypes of PCN-silenced and wild-type strains of P. brasiliensis, we identified PCN as a virulence factor whose absence renders the yeasts unable to undergo the transition to mycelium and causes a milder pulmonary disease in mice, with a lower mortality rate. Our report highlights the importance of the technology used for P. brasiliensis transformation and demonstrates that paracoccin is a virulence factor acting on fungal biology and pathogenesis.
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Enoch DA, Yang H, Aliyu SH, Micallef C. The Changing Epidemiology of Invasive Fungal Infections. Methods Mol Biol 2017; 1508:17-65. [PMID: 27837497 DOI: 10.1007/978-1-4939-6515-1_2] [Citation(s) in RCA: 238] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Invasive fungal infections (IFI) are an emerging problem worldwide with invasive candidiasis and candidemia responsible for the majority of cases. This is predominantly driven by the widespread adoption of aggressive immunosuppressive therapy among certain patient populations (e.g., chemotherapy, transplants) and the increasing use of invasive devices such as central venous catheters (CVCs). The use of new immune modifying drugs has also opened up an entirely new spectrum of patients at risk of IFIs. While the epidemiology of candida infections has changed in the last decade, with a gradual shift from C. albicans to non-albicans candida (NAC) strains which may be less susceptible to azoles, these changes vary between hospitals and regions depending on the type of population risk factors and antifungal use. In certain parts of the world, the incidence of IFI is strongly linked to the prevalence of other disease conditions and the ecological niche for the organism; for instance cryptococcal and pneumocystis infections are particularly common in areas with a high prevalence of HIV disease. Poorly controlled diabetes is a major risk factor for invasive mould infections. Environmental factors and trauma also play a unique role in the epidemiology of mould infections, with well-described hospital outbreaks linked to the use of contaminated instruments and devices. Blastomycosis is associated with occupational exposure (e.g., forest rangers) and recreational activities (e.g., camping and fishing).The true burden of IFI is probably an underestimate because of the absence of reliable diagnostics and lack of universal application. For example, the sensitivity of most blood culture systems for detecting candida is typically 50 %. The advent of new technology including molecular techniques such as 18S ribosomal RNA PCR and genome sequencing is leading to an improved understanding of the epidemiology of the less common mould and dimorphic fungal infections. Molecular techniques are also providing a platform for improved diagnosis and management of IFI.Many factors affect mortality in IFI, not least the underlying medical condition, choice of therapy, and the ability to achieve early source control. For instance, mortality due to pneumocystis pneumonia in HIV-seronegative individuals is now higher than in seropositive patients. Of significant concern is the progressive increase in resistance to azoles and echinocandins among candida isolates, which appears to worsen the already significant mortality associated with invasive candidiasis. Mortality with mould infections approaches 50 % in most studies and varies depending on the site, underlying disease and the use of antifungal agents such as echinocandins and voriconazole. Nevertheless, mortality for most IFIs has generally fallen with advances in medical technology, improved care of CVCs, improved diagnostics, and more effective preemptive therapy and prophylaxis.
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Affiliation(s)
- David A Enoch
- National Infection Service, Public Health England, Cambridge Microbiology and Public Health Laboratory, Addenbrooke's Hospital, Box 236, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QW, UK.
| | - Huina Yang
- National Infection Service, Public Health England, Cambridge Microbiology and Public Health Laboratory, Addenbrooke's Hospital, Box 236, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QW, UK
| | - Sani H Aliyu
- National Infection Service, Public Health England, Cambridge Microbiology and Public Health Laboratory, Addenbrooke's Hospital, Box 236, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QW, UK
| | - Christianne Micallef
- National Infection Service, Public Health England, Cambridge Microbiology and Public Health Laboratory, Addenbrooke's Hospital, Box 236, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QW, UK
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Extracellular vesicles from Paracoccidioides brasiliensis induced M1 polarization in vitro. Sci Rep 2016; 6:35867. [PMID: 27775058 PMCID: PMC5075875 DOI: 10.1038/srep35867] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 10/07/2016] [Indexed: 02/06/2023] Open
Abstract
Extracellular vesicles (EVs) released by eukaryotes, archaea, and bacteria contain proteins, lipids, polysaccharides, and other molecules. The cargo analysis of EVs shows that they contain virulence factors suggesting a role in the pathogenesis of infection. The proteome, lipidome, RNA content, and carbohydrate composition of EVs from Paracoccidioides brasiliensis and Paracoccidioides lutzii were characterized. However, the effects of P. brasiliensis EVs on the host immune system have not yet been investigated. Herein, we verified that EVs from P. brasiliensis induce the production of proinflammatory mediators by murine macrophages in a dose-dependent manner. Addition of EV to macrophages also promoted transcription of the M1-polarization marker iNOs and diminish that of the M2 markers Arginase-1, Ym-1, and FIZZ-1. Furthermore, the augmented expression of M2-polarization markers, stimulated by IL-4 plus IL-10, was reverted toward an M1 phenotype in response to secondary stimulation with EVs from P. brasiliensis. The ability of EVs from P. brasiliensis to promote M1 polarization macrophages favoring an enhanced fungicidal activity, demonstrated by the decreased CFU recovery of internalized yeasts, with comparable phagocytic efficacy. Our results suggest that EVs from P. brasiliensis can modulate the innate immune response and affect the relationship between P. brasiliensis and host immune cells.
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Freitas MS, Oliveira AF, da Silva TA, Fernandes FF, Gonçales RA, Almeida F, Roque-Barreira MC. Paracoccin Induces M1 Polarization of Macrophages via Interaction with TLR4. Front Microbiol 2016; 7:1003. [PMID: 27458431 PMCID: PMC4932198 DOI: 10.3389/fmicb.2016.01003] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Accepted: 06/13/2016] [Indexed: 11/16/2022] Open
Abstract
The fungal human pathogen Paracoccidioides brasiliensis contains paracoccin (PCN), a multi-domain protein that has lectin and N-acetyl-glucosaminidase activities, which account for its effects on the growth and morphogenesis of the fungus and on the activation of host macrophages through its interaction with TLR N-glycans. With the purpose of detailing the knowledge on the effects of PCN on macrophages, we used recombinant PCN expressed in Pichia pastoris (p-rPCN) to stimulate isolated murine peritoneal macrophages. The activation of these cells manifested through the release of high levels of inflammatory mediators, such as nitric oxide, TNF-α, IL-12p40, and IL-6. Furthermore, peritoneal macrophages stimulated with p-rPCN increased the relative expression of STAT1, SOCS3, and iNOS2 mRNA (M1 polarization markers). However, the expression of Arginase-1, Ym-1, and FIZZ1 (M2 polarization markers) remained at basal levels. Interestingly, the observed M1 macrophages’ polarization triggered by p-rPCN was abolished in cells obtained from knockout Toll-like receptor-4 mice. In this case, the p-rPCN-induced production of pro-inflammatory mediators was blocked too. These results demonstrate that the classical activation of macrophages induced by paracoccin depends on TLR4. Taken together, the results of our study indicate that paracoccin acts as a TLR agonist able to modulate immunity and exerts biological activities that favor its applicability as an immunotherapeutic agent to combat systemic fungal infections.
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Affiliation(s)
- Mateus S Freitas
- Departamento de Biologia Celular e Molecular e Bioagentes Patogênicos, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo Ribeirão Preto, Brazil
| | - Aline F Oliveira
- Departamento de Biologia Celular e Molecular e Bioagentes Patogênicos, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo Ribeirão Preto, Brazil
| | - Thiago A da Silva
- Departamento de Biologia Celular e Molecular e Bioagentes Patogênicos, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo Ribeirão Preto, Brazil
| | - Fabrício F Fernandes
- Departamento de Biologia Celular e Molecular e Bioagentes Patogênicos, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo Ribeirão Preto, Brazil
| | - Relber A Gonçales
- Departamento de Biologia Celular e Molecular e Bioagentes Patogênicos, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo Ribeirão Preto, Brazil
| | - Fausto Almeida
- Departamento de Biologia Celular e Molecular e Bioagentes Patogênicos, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo Ribeirão Preto, Brazil
| | - Maria C Roque-Barreira
- Departamento de Biologia Celular e Molecular e Bioagentes Patogênicos, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo Ribeirão Preto, Brazil
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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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14
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Garcia Garcia SC, Salas Alanis JC, Flores MG, Gonzalez Gonzalez SE, Vera Cabrera L, Ocampo Candiani J. Coccidioidomycosis and the skin: a comprehensive review. An Bras Dermatol 2016; 90:610-9. [PMID: 26560205 PMCID: PMC4631225 DOI: 10.1590/abd1806-4841.20153805] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2014] [Accepted: 07/29/2014] [Indexed: 11/25/2022] Open
Abstract
Coccidioidomycosis is a highly prevalent disease in the Western hemisphere. It is
considered one of the most virulent primary fungal infections. Coccidioides species
live in arid and semi-arid regions, causing mainly pulmonary infection through
inhalation of arthroconidia although many other organs can be affected. Primary
inoculation is rare. Since the first case of coccidioidomycosis was reported in 1892,
the skin has been identified as an important target of this disease. Knowledge of
cutaneous clinical forms of this infection is important and very useful for
establishing prompt diagnosis and treatment. The purpose of this article is to
provide a review of this infection, emphasizing its cutaneous manifestations,
diagnostic methods and current treatment.
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Affiliation(s)
| | | | - Minerva Gomez Flores
- Hospital Universitario Dr. José Eleuterio González, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | | | - Lucio Vera Cabrera
- Hospital Universitario Dr. José Eleuterio González, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Jorge Ocampo Candiani
- Hospital Universitario Dr. José Eleuterio González, Universidad Autónoma de Nuevo León, Monterrey, Mexico
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Deep Fungal Infections, Blastomycosis-Like Pyoderma, and Granulomatous Sexually Transmitted Infections. Dermatol Clin 2016; 33:595-607. [PMID: 26143434 DOI: 10.1016/j.det.2015.03.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Granulomatous diseases are caused by multiple infectious and noninfectious causes. Deep fungal infections can present in the skin or extracutaneously, most commonly with lung manifestations. An Azole or amphotericin B is the universal treatment. Blastomycosis-like pyoderma is a clinically similar condition, which is caused by a combination of hypersensitivity and immunosuppression. Successful treatment has been reported with antibiotics and, more recently, the vitamin A analog, acitretin. Granuloma inguinale and lymphogranuloma venereum cause ulcerative genital lesions with a granulomatous appearance on histology. The Centers for Disease Control and Prevention recommens treatment of these genital infections with doxycycline.
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16
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Common and Dangerous Skin Infections. CURRENT DERMATOLOGY REPORTS 2016. [DOI: 10.1007/s13671-016-0128-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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17
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Asahata-Tago S, Hirai Y, Ainoda Y, Fujita T, Muraosa Y, Kamei K, Wakayama M, Shibuya K, Kikuchi K. Pulmonary Histoplasmosis in a Japanese Man Infected During Travel to Mexico and Management of His Wife's Condition: A Case Report. KANSENSHOGAKU ZASSHI. THE JOURNAL OF THE JAPANESE ASSOCIATION FOR INFECTIOUS DISEASES 2016; 90:83-87. [PMID: 27032179 DOI: 10.11150/kansenshogakuzasshi.90.83] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
We report herein on the case of a 33-year-old Japanese man in whom an abnormal shadow was detected on chest radiography during a medical checkup after a 1-year-stay in Mexico. Chest computed tomography showed a nodule in the left lower lobe adjacent to the visceral pleura. Histopathologic examination of a thoracoscopic partial pulmonary resection specimen showed coagulation necrosis with a number of yeast-like forms on Grocott staining. In addition, serum anti-Histoplasma antibody positivity was detected with an enzyme-linked immunosorbent assay, and Histoplasma-specific nested real-time polymerase chain reaction results were positive in the pulmonary region. Finally, pulmonary histoplasmosis was diagnosed, and treatment with itraconazole was initiated. The patient's wife who had accompanied him to Mexico was asymptomatic and was not found to have histoplasmosis based on diagnostic imaging and serological findings. Although rare in Japan, histoplasmosis should be considered in the differential diagnosis of pulmonary lesions in patients who have returned from travel to endemic areas.
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Martirosyan NL, Skoch JM, Zaninovich O, Zoccali C, Galgiani JN, Baaj AA. A paradigm for the evaluation and management of spinal coccidioidomycosis. Surg Neurol Int 2015; 6:107. [PMID: 26167359 PMCID: PMC4483783 DOI: 10.4103/2152-7806.158979] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2015] [Accepted: 04/24/2015] [Indexed: 12/31/2022] Open
Abstract
Background: Coccidioidomycosis is a fungal infection that is endemic to parts of the Southwestern United States. When infection involves the spine, the treatment strategies can be challenging. We have devised a management protocol for spinal coccidioidomycosis based on a review of the literature and our experience. Methods: The electronic literature search of National Library of Medicine for publications from 1964 to 2014 was performed using the following keywords: Coccidioidomycosis and spine. The search yielded 24 papers. Treatment strategies were summarized into a treatment protocol. Results: A total of 164 cases of spinal coccidioidomycosis were identified, ranging in age from <10 to >80 years. Males (n = 131) and African-Americans (n = 79) were strikingly over-represented. Medical therapy: Once a diagnosis of spinal coccidioidomycosis is established, antifungal therapy should always be started. Antifungal therapy with amphotericin B or azoles like fluconazole. Medical therapy needs to be continued for many years and sometimes indefinitely to reduce disease recurrence or progression. Surgical management is indicated in cases with mechanical instability, neurologic deficit, medically intractable pain, or progression of infection despite antifungal therapy. Conclusions: This work provides a working protocol involving assessment and reassessment for the management of spinal coccidioidomycosis. Medical management with antifungal agents in some cases can provide satisfactory disease control. However, in patients with mechanical instability, neurologic deficit, medically intractable pain or disease progression disease control may only be achieved with surgical debridement and stabilization.
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Affiliation(s)
| | - Jesse M Skoch
- Division of Neurosurgery, University of Arizona, Tucson, Arizona, USA
| | - Orel Zaninovich
- Division of Neurosurgery, University of Arizona, Tucson, Arizona, USA
| | - Carmine Zoccali
- Division of Neurosurgery, University of Arizona, Tucson, Arizona, USA
| | - John N Galgiani
- Valley Fever Center for Excellence, University of Arizona Medical Center, University of Arizona College of Medicine, Tucson, Arizona, USA
| | - Ali A Baaj
- Division of Neurosurgery, University of Arizona, Tucson, Arizona, USA
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Cotino Sánchez A, Torres-Alvarez B, Gurrola Morales T, Méndez Martínez S, Saucedo Gárate M, Castanedo-Cazares JP. Mycosis fungoides-like lesions in a patient with diffuse cutaneous sporotrichosis. Rev Iberoam Micol 2015; 32:200-3. [PMID: 25620646 DOI: 10.1016/j.riam.2014.06.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Revised: 04/22/2014] [Accepted: 06/26/2014] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Sporotrichosis is a subacute or chronic mycosis acquired by traumatic inoculation or inhalation of fungal conidia. It is caused by the dimorphic fungus Sporothrix, which causes different clinical presentations, being the cutaneous and lymphocutaneous variants being the most frequent. The disseminated cutaneous form is a rare presentation occurring in a minority of cases in Mexico. CASE REPORT We report an atypical case of disseminated sporotrichosis in an alcoholic and iatrogenically immunosuppressed patient, whose clinical lesions resembled tumoral-stage mycosis fungoides. Histological examination and culture revealed the presence of Sporothrix schenckii. CONCLUSIONS The patient was treated with itraconazole 200mg per day for 4 months with clinical resolution. To the best of our knowledge, this is the first report of this type of clinical manifestation.
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Affiliation(s)
- Adriana Cotino Sánchez
- Department of Pathology, Hospital General de Durango, Universidad Juárez del Estado de Durango, Durango, Mexico
| | - Bertha Torres-Alvarez
- Department of Dermatology, Hospital Central Dr. Ignacio Morones Prieto, Universidad Autónoma de San Luis Potosí, San Luis Potosí, Mexico
| | - Teodoro Gurrola Morales
- Department of Pathology, Hospital General de Durango, Universidad Juárez del Estado de Durango, Durango, Mexico
| | - Silvia Méndez Martínez
- Department of Pathology, Hospital General de Durango, Universidad Juárez del Estado de Durango, Durango, Mexico
| | - Mauricio Saucedo Gárate
- Department of Pathology, Hospital General de Durango, Universidad Juárez del Estado de Durango, Durango, Mexico
| | - Juan Pablo Castanedo-Cazares
- Department of Dermatology, Hospital Central Dr. Ignacio Morones Prieto, Universidad Autónoma de San Luis Potosí, San Luis Potosí, Mexico.
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Abstract
The first description of dermatophytosis was recorded by Celsus, a Roman encyclopaedist who described a suppurative infection of scalp (‘porrigo’ or ‘kerion of Celsus’) in De Re Medicina (30 A.D.). Throughout the middle ages, several descriptions of dermatophytosis were produced where it is described as ‘tinea’. The keratin-destroying moths which made circular holes in the woollen garments are known as Tinea. Due to similarity in the structure of circular lesion of dermatophytosis on the smooth skin with the circular hole made by moth, Cassius Felix introduced the term ‘tinea’ to describe the lesions. In 1806, Alibert used the term ‘favus’ to describe the honey-like exudate in some scalp infections. However, the fungal aetiology of tinea was first detected by Robert Remak, a Polish physician who first observed the presence of hyphae in the crusts of favus. This detection is also a landmark in medical history because this is the first description of a microbe causing a human disease. He himself did not publish his work, but he permitted the reference of his observations in a dissertation by Xavier Hube in 1837. Remak gave all the credits of his discovery to his mentor Schoenlein who first published the fungal etiological report of favus in 1839. He observed the infectious nature of the favus by autoinoculation into his own hands and also successfully isolated the fungus later (1945) and named Achorion schoenleinii (Trichophyton schoenleinii) in honour of his mentor. In 1844, Gruby described the etiologic agent of tinea endothrix, later became known as Trichophyton tonsurans. The genus Trichophyton was created and described by Malmsten (1845) with its representative species T. tonsurans. Charles Robin identified T. mentagrophytes in 1847 and T. equinum was identified by Matruchot and Dassonville in 1898. Raymond Jacques Adrien Sabouraud (France) first compiled the description of Trichophyton in his book (Les Teignes) in 1910 which was based on his observation in artificial culture. The sexual state of dermatophyte was described by Nannizzi (1927). Emmons (1934) first reported the classification of dermatophytes based on vegetative structures and conidia. Gentles (1958) established the successful treatment of tinea capitis with griseofulvin.
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Sifuentes-Osornio J, Torres-Gonzalez P, Ponce-de-Leon A. Diagnosis and Treatment of Non-European Fungal Infections. CURRENT FUNGAL INFECTION REPORTS 2014. [DOI: 10.1007/s12281-014-0202-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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22
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Johnson L, Gaab EM, Sanchez J, Bui PQ, Nobile CJ, Hoyer KK, Peterson MW, Ojcius DM. Valley fever: danger lurking in a dust cloud. Microbes Infect 2014; 16:591-600. [PMID: 25038397 DOI: 10.1016/j.micinf.2014.06.011] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Revised: 06/23/2014] [Accepted: 06/24/2014] [Indexed: 12/01/2022]
Abstract
Coccidioides immitis and Coccidioides posadasii contribute to the development of Valley Fever. The ability of these fungal pathogens to evade the host immune system creates difficulty in recognition and treatment of this debilitating infection. In this review, we describe the current knowledge of Valley Fever and approaches to improve prevention, detection, and treatment.
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Affiliation(s)
- Larry Johnson
- Department of Molecular Cell Biology, University of California, Merced, CA 95343, USA; Health Sciences Research Institute, University of California, Merced, CA 95343, USA
| | - Erin M Gaab
- Health Sciences Research Institute, University of California, Merced, CA 95343, USA
| | - Javier Sanchez
- Department of Molecular Cell Biology, University of California, Merced, CA 95343, USA; Health Sciences Research Institute, University of California, Merced, CA 95343, USA
| | - Phuong Q Bui
- Department of Molecular Cell Biology, University of California, Merced, CA 95343, USA; Health Sciences Research Institute, University of California, Merced, CA 95343, USA
| | - Clarissa J Nobile
- Department of Molecular Cell Biology, University of California, Merced, CA 95343, USA; Health Sciences Research Institute, University of California, Merced, CA 95343, USA
| | - Katrina K Hoyer
- Department of Molecular Cell Biology, University of California, Merced, CA 95343, USA; Health Sciences Research Institute, University of California, Merced, CA 95343, USA
| | - Michael W Peterson
- Department of Internal Medicine, University of California San Francisco - Fresno, Fresno, CA 93703, USA
| | - David M Ojcius
- Department of Molecular Cell Biology, University of California, Merced, CA 95343, USA; Health Sciences Research Institute, University of California, Merced, CA 95343, USA.
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Duarte-Escalante E, Zúñiga G, Frías-De-León MG, Canteros C, Castañón-Olivares LR, Reyes-Montes MDR. AFLP analysis reveals high genetic diversity but low population structure in Coccidioides posadasii isolates from Mexico and Argentina. BMC Infect Dis 2013; 13:411. [PMID: 24004977 PMCID: PMC3766708 DOI: 10.1186/1471-2334-13-411] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Accepted: 08/30/2013] [Indexed: 01/29/2023] Open
Abstract
Background Coccidioides immitis and C. posadasii cause coccidioidomycosis, a disease that is endemic to North and South America, but for Central America, the incidence of coccidioidomycosis has not been clearly established. Several studies suggest genetic variability in these fungi; however, little definitive information has been discovered about the variability of Coccidioides fungi in Mexico (MX) and Argentina (AR). Thus, the goals for this work were to study 32 Coccidioides spp. isolates from MX and AR, identify the species of these Coccidioides spp. isolates, analyse their phenotypic variability, examine their genetic variability and investigate the Coccidioides reproductive system and its level of genetic differentiation. Methods Coccidioides spp. isolates from MX and AR were taxonomically identified by phylogenetic inference analysis using partial sequences of the Ag2/PRA gene and their phenotypic characteristics analysed. The genetic variability, reproductive system and level of differentiation were estimated using AFLP markers. The level of genetic variability was assessed measuring the percentage of polymorphic loci, number of effective allele, expected heterocygosity and Index of Association (IA). The degree of genetic differentiation was determined by AMOVA. Genetic similarities among isolates were estimated using Jaccard index. The UPGMA was used to contsruct the corresponding dendrogram. Finally, a network of haplotypes was built to evaluate the genealogical relationships among AFLP haplotypes. Results All isolates of Coccidioides spp. from MX and AR were identified as C. posadasii. No phenotypic variability was observed among the C. posadasii isolates from MX and AR. Analyses of genetic diversity and population structure were conducted using AFLP markers. Different estimators of genetic variability indicated that the C. posadasii isolates from MX and AR had high genetic variability. Furthermore, AMOVA, dendrogram and haplotype network showed a small genetic differentiation among the C. posadasii populations analysed from MX and AR. Additionally, the IA calculated for the isolates suggested that the species has a recombinant reproductive system. Conclusions No phenotypic variability was observed among the C. posadasii isolates from MX and AR. The high genetic variability observed in the isolates from MX and AR and the small genetic differentiation observed among the C. posadasii isolates analysed, suggest that this species could be distributed as a single genetic population in Latin America.
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Affiliation(s)
- Esperanza Duarte-Escalante
- Departamento de Microbiología y Parasitología, Facultad de Medicina, Universidad Nacional Autónoma de México (UNAM), Ciudad Universitaria No, 3000, México, D, F, 04510, México.
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Camara-Lemarroy CR, Soto-Garcia AJ, Preciado-Yepez CI, Moreno-Hoyos F, Hernandez-Rodriguez PA, Galarza-Delgado DA. Case of chromoblastomycosis with pulmonary involvement. J Dermatol 2013; 40:746-8. [PMID: 23855624 DOI: 10.1111/1346-8138.12216] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Accepted: 05/15/2013] [Indexed: 01/19/2023]
Abstract
Chromoblastomycosis is a slowly growing chronic cutaneous mycosis associated with a variety of cutaneous lesions. Extra-dermal involvement is rare. A 58-year-old man was admitted to the hospital with nausea, vomiting, weakness and a history of weight loss. On inspection, he had a large verrucous mass in the sacral region, and two large subcutaneous nodules in the anterior thoracic wall. He claimed the lesions were several years old. Biopsy and histological studies were positive for chromoblastomycosis. Routine chest radiography showed hilar enlargement, and a chest computed tomography was ordered. Pulmonary nodules were evident, and endoscopically acquired samples were also positive for chromoblastomycosis. Extra-dermal and systemic involvement in chromoblastomycosis is exceedingly rare and often associated with immunosuppression. There is only one other case of pulmonary chromoblastomycosis reported in the published work.
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25
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El Abd OH, Fusco HN, Gomba L, Lew M, Jenis L. Coccidioidomycosis Infection Presenting With Thoracic Spinal Pain. PM R 2012; 4:450-5. [DOI: 10.1016/j.pmrj.2012.03.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2011] [Revised: 02/22/2012] [Accepted: 03/06/2012] [Indexed: 11/30/2022]
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26
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Sifuentes-Osornio J, Corzo-León DE, Ponce-de-León LA. Epidemiology of Invasive Fungal Infections in Latin America. CURRENT FUNGAL INFECTION REPORTS 2012; 6:23-34. [PMID: 22363832 PMCID: PMC3277824 DOI: 10.1007/s12281-011-0081-7] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
The pathogenic role of invasive fungal infections (IFIs) has increased during the past two decades in Latin America and worldwide, and the number of patients at risk has risen dramatically. Working habits and leisure activities have also been a focus of attention by public health officials, as endemic mycoses have provoked a number of outbreaks. An extensive search of medical literature from Latin America suggests that the incidence of IFIs from both endemic and opportunistic fungi has increased. The increase in endemic mycoses is probably related to population changes (migration, tourism, and increased population growth), whereas the increase in opportunistic mycoses may be associated with the greater number of people at risk. In both cases, the early and appropriate use of diagnostic procedures has improved diagnosis and outcome.
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Affiliation(s)
- Jose Sifuentes-Osornio
- Laboratory of Microbiology, Salvador Zubiran National Institute of Medical Science and Nutrition, 15 Vasco de Quiroga, sección XVI, Tlalpan, México City, ZC 14000 Mexico
| | - Dora E. Corzo-León
- Infectious Diseases, Salvador Zubiran National Institute of Medical Science and Nutrition, México City, Mexico
| | - L. Alfredo Ponce-de-León
- Laboratory of Microbiology, Salvador Zubiran National Institute of Medical Science and Nutrition, 15 Vasco de Quiroga, sección XVI, Tlalpan, México City, ZC 14000 Mexico
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27
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Tiu CT, Cook J, Zea Pineros DF, Rankin LF, Lin YS, Ghitan M, Brichkov I, Shaw JP, Chapnick EK. Pneumothorax in a Young Man in Brooklyn, New York. Clin Infect Dis 2011. [DOI: 10.1093/cid/cir636] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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28
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Berg N, Ryscavage P, Kulesza P. The utility of fine needle aspiration for diagnosis of extrapulmonary coccidioidomycosis: a case report and discussion. Clin Med Res 2011; 9:130-3. [PMID: 21562136 PMCID: PMC3251489 DOI: 10.3121/cmr.2011.993] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Coccidioidomycosis typically presents as pneumonia, but rarely manifests as extrapulmonary disease. We describe a case of coccidioidal infection that presented as a neck mass and was diagnosed by fine needle aspiration (FNA). Initial clinical suspicion was for mycobacterial infection. Several modalities are available for the detection of Coccidioides species, but culture has been the mainstay of diagnosis. FNA provides a relatively noninvasive and effective modality for tissue-based diagnosis based on characteristic histological findings. It allows the additional advantage of early on-site identification, allowing for triage of the specimen, notification of laboratory staff and prompt initiation of treatment. The case herein described is intended to demonstrate an atypical presentation of extrapulmonary coccidioidomycosis and highlight the utility of FNA for diagnosis of such lesions. Clinicians should be aware of the unique advantages of FNA for evaluation of lesions of infectious etiology.
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Affiliation(s)
- Natasha Berg
- Department of Pathology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Patrick Ryscavage
- Division of Infectious Diseases, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Piotr Kulesza
- Department of Pathology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
- Corresponding Author: Piotr Kulesza, MD, PhD, Northwestern Memorial Hospital, Department of Pathology, 303 East Chicago Avenue, Ward 3-140 W127, Chicago, IL 60611, Tel: (312) 926-7002, Fax: (312) 926-6037,
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30
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Bonifaz A, Vázquez-González D, Perusquía-Ortiz AM. Endemic systemic mycoses: coccidioidomycosis, histoplasmosis, paracoccidioidomycosis and blastomycosis. J Dtsch Dermatol Ges 2011; 9:705-14; quiz 715. [PMID: 21722309 DOI: 10.1111/j.1610-0387.2011.07731.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Endemic deep or systemic mycoses are common in specific geographical areas of the world. Coccidioidomycosis is present in semi-desert areas, histoplasmosis and paracoccidioidomycosis in tropical regions and blastomycosis belongs to temperate climates. The two former are widely distributed in the American continent and some tropical regions of the world; the third is limited to Central and South America, and the last to North America and Central and East Africa. These mycoses all have a similar pathogenesis, as the inoculum enters the host through the respiratory tract. Cutaneous manifestations are secondary to lymphatic and hematogenous dissemination. These deep mycoses are exceptional in Europe. Most cases are observed in returning travelers from endemic areas, aid workers, archaeologists, speleologist and immigrants. However, there have been some autochthonous cases of histoplasmosis due to Histoplasma capsulatum var. capsulatum reported in European countries such as Italy and Germany. In this article, we provide up-to-date epidemiological, clinical, diagnostic and therapeutic data on the four most important imported systemic mycoses in Europe.
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Affiliation(s)
- Alexandro Bonifaz
- Departamento de Micología, Servicio de Dermatología, Hospital General de México, Ciudad de México
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31
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Colombo AL, Tobón A, Restrepo A, Queiroz-Telles F, Nucci M. Epidemiology of endemic systemic fungal infections in Latin America. Med Mycol 2011; 49:785-98. [PMID: 21539506 DOI: 10.3109/13693786.2011.577821] [Citation(s) in RCA: 137] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Although endemic mycoses are a frequent health problem in Latin American countries, clinical and epidemiological data remain scarce and fragmentary. These mycoses have a significant impact on public health, and early diagnosis and appropriate treatment remain important. The target population for endemic disease in Latin America is mostly represented by low-income rural workers with limited access to a public or private health system. Unfortunately, diagnostic tools are not widely available in medical centers in Latin America; consequently, by the time patients are diagnosed with fungal infection, many are already severely ill. Among immunocompromised patients, endemic mycoses usually behave as opportunistic infections causing disseminated rather than localized disease. This paper reviews the epidemiology of the most clinically significant endemic mycoses in Latin America: paracoccidioidomycosis, histoplasmosis, and coccidioidomycosis. The burdens of disease, typically affected populations, and clinical outcomes also are discussed.
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Affiliation(s)
- Arnaldo Lopes Colombo
- Division of Infectious Diseases, Department of Medicine, Federal University of São Paulo, São Paulo, Brazil.
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Chen W, Mempel M, Traidl-Hofmann C, Al Khusaei S, Ring J. Gender aspects in skin diseases. J Eur Acad Dermatol Venereol 2011; 24:1378-85. [PMID: 20384686 DOI: 10.1111/j.1468-3083.2010.03668.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Gender differences in medicine have been recognized in anatomy, physiology, as well as in epidemiology and manifestations of various diseases. With respect to skin disorders, males are generally more commonly afflicted with infectious diseases while women are more susceptible to psychosomatic problems, pigmentary disorders, certain hair diseases, and particularly autoimmune as well as allergic diseases. Significantly, more female sex-associated dermatoses can be identified than the male sex-associated dermatoses. Dermatoses in the genital area differ between men and women. Gender differences also exist in the occurrence and prognosis of certain skin malignancies. The mechanisms underlying gender differences in skin diseases remain largely unknown. Differences in the skin structure and physiology, effect of sex hormones, ethnic background, sociocultural behaviour and environmental factors may interact to exert the influences. A better understanding of gender differences in human health and diseases will allow the development of novel concepts for prevention, diagnosis and therapy of skin diseases.
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Affiliation(s)
- W Chen
- Department of Dermatology and Allergy, Helmholtz Zentrum Munchen/TUM, ZAUM-Center for Allergy and Environment, Technische Universität München, Germany.
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Trejo-Chávez A, Ramírez-Romero R, Ancer-Rodríguez J, Nevárez-Garza AM, Rodríguez-Tovar LE. Disseminated paracoccidioidomycosis in a Southern two-toed sloth (Choloepus didactylus). J Comp Pathol 2010; 144:231-4. [PMID: 20961559 DOI: 10.1016/j.jcpa.2010.08.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2010] [Revised: 06/01/2010] [Accepted: 08/30/2010] [Indexed: 11/26/2022]
Abstract
A Southern two-toed sloth (Choloepus didactylus), originally acquired from French Guiana, died while maintained in quarantine in a pet store in Monterrey, Mexico. Large yeast cells with multiple buds compatible with Paracoccidioides brasiliensis were observed in disseminated granulomatous lesions in the lungs, liver, spleen and kidney. Transmission electron microscopical examination supported the diagnosis. This is the first report of paracoccidioidomycosis in a two-toed sloth.
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Affiliation(s)
- A Trejo-Chávez
- Laboratorio Central Regional de Monterrey, Comité para el Fomento y Protección Pecuaria del Estado de Nuevo León, A.C., Terrenos de la Exposición Ganadera, Ciudad Guadalupe, Nuevo León, Mexico
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Abstract
Cutaneous histoplasmosis is an uncommon infection and can occur as a primary infection. A manifestation imitating a cutaneous neoplasm is rare, and eyelid involvement is rarer still. The authors report a case of histoplasmosis that presented as an ulcerated lesion on the lower eyelid margin that clinically resembled a basal cell carcinoma. Given its worldwide distribution, it is important to include this disease in the differential diagnosis of nonhealing eyelid lesions. Biopsy and tissue culture are paramount to establishing the diagnosis. This case describes a rare presentation of histoplasmosis on the eyelid and highlights the importance of histopathologic evaluation.
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35
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Clinical Comparison of Two Mexican Coccidioidins. Mycopathologia 2010; 169:427-30. [DOI: 10.1007/s11046-010-9280-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2009] [Accepted: 01/21/2010] [Indexed: 10/19/2022]
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Rare mycoses of the oral cavity: a literature epidemiologic review. ACTA ACUST UNITED AC 2010; 108:647-55. [PMID: 19836721 DOI: 10.1016/j.tripleo.2009.07.010] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2009] [Revised: 07/08/2009] [Accepted: 07/08/2009] [Indexed: 11/22/2022]
Abstract
Stomatologic fungal infections display different etiologies, pathogenesis, and clinical presentations. The incidence of rare mycoses of oral cavity is very low. These infections can involve both immunocompromised and immmunocompetent patients with common predisposing factors, such as diabetes or suffering from diseases causing immune system impairment. Oral mycoses can cause acute, chronic, and mucocutaneous lesions. Candidiasis is the most common mouth mycosis. Although occasionally primary mouth pathogens, Cryptococcus spp. or filamentous fungi (Aspergillus spp. and zygomycetes) can cause oral mycoses, with the oral localization more commonly secondary to a more serious systemic infection. The diagnosis of oral mycoses is based on clinical examination; for yeasts, culture is necessary to identify the etiologic agents; for filamentous fungi, in particular for zygomycetes and dimorphic, a definitive diagnosis can be made by histologic examination and pertinent stains with or without isolation of the fungus from the same site.
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Affiliation(s)
- Zehra Haider
- Resident in Internal Medicine, Mayo School of Graduate Medical Education, Rochester, MN
| | - Constantine Tsigrelis
- Fellow in Infectious Diseases, Mayo School of Graduate Medical Education, Rochester, MN
| | - Larry M. Baddour
- Adviser to resident and fellow and Consultant in Infectious Diseases, Mayo Clinic, Rochester, MN
- Individual reprints of this article are not available. Address correspondence to Larry M. Baddour, MD, Division of Infectious Diseases, Mayo Clinic, 200 First St SW, Rochester, MN 55905 ().
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