1
|
Sekiguchi WK, Oliveira VFD, Cavassin FB, Taborda M, Kono Magri ASG, Cruz ICLVD, Vidal JE, Falci DR, de Miranda Godoy CS, Soares RDBA, de Oliveira CS, Mendes AVA, Breda GL, Rego CM, Félix MA, Katopodis PP, da Silva do Ó JR, Abrão MPL, Baú-Carneiro JL, Pereira TTT, Queiroz-Telles F, Chaves Magri MM. A multicentre study of amphotericin B treatment for histoplasmosis: assessing mortality rates and adverse events. J Antimicrob Chemother 2024:dkae264. [PMID: 39074040 DOI: 10.1093/jac/dkae264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Accepted: 07/11/2024] [Indexed: 07/31/2024] Open
Abstract
BACKGROUND Progressive disseminated histoplasmosis is a significant issue in Latin America, particularly in Brazil, contributing to high mortality rates. OBJECTIVES Our objectives were to comprehensively describe histoplasmosis treatment with various amphotericin B (AmB) formulations, including mortality rates, adverse effects and risk factors for mortality. METHODS This multicentre retrospective cohort study (January 2014-December 2019) evaluated medical records of patients with proven or probable histoplasmosis treated with at least two doses of AmB in seven tertiary medical centres in Brazil. We assessed risk factors associated with death during hospitalization using univariate and multivariate analyses. RESULTS The study included 215 patients, mostly male (n = 158, 73%) with HIV infection (n = 187, 87%), and a median age of 40 years. Only 11 (5%) patients initiated treatment with liposomal amphotericin B (L-AmB). Amphotericin B deoxycholate (D-AmB) was administered to 159 (74%) patients without changes in the treatment. The overall mortality during hospitalization was 23% (50/215). Variables independently associated with mortality were use of D-AmB (OR 4.93) and hospitalization in ICU (OR 9.46). There was a high incidence of anaemia (n = 19, 90%), acute kidney injury (n = 96, 59%), hypokalaemia (n = 73, 55%) and infusion reactions (n = 44, 20%) during treatment. CONCLUSIONS We found that D-AmB was the main formulation, which was also associated with a higher mortality rate. Lipid formulations of AmB have become more readily available in the public health system in Brazil. Further studies to evaluate the effectiveness of L-AmB will likely show improvements in the treatment outcomes for patients with disseminated histoplasmosis.
Collapse
Affiliation(s)
- William Kazunori Sekiguchi
- Infectious and Parasitic Diseases Division, Faculdade de Medicina, Hospital das Clínicas (HCFMUSP), Universidade de São Paulo, São Paulo, SP, Brazil
| | - Vítor Falcão de Oliveira
- Infectious and Parasitic Diseases Division, Faculdade de Medicina, Hospital das Clínicas (HCFMUSP), Universidade de São Paulo, São Paulo, SP, Brazil
| | - Francelise Bridi Cavassin
- Internal Medicine and Health Sciences Department, Universidade Federal do Paraná (UFPR), Curitiba, PR, Brazil
| | - Mariane Taborda
- Infectious and Parasitic Diseases Division, Faculdade de Medicina, Hospital das Clínicas (HCFMUSP), Universidade de São Paulo, São Paulo, SP, Brazil
| | - Adriana Satie Gonçalves Kono Magri
- Infectious and Parasitic Diseases Division, Faculdade de Medicina, Hospital das Clínicas (HCFMUSP), Universidade de São Paulo, São Paulo, SP, Brazil
| | - Isabela Carvalho Leme Vieira da Cruz
- Infectious and Parasitic Diseases Division, Faculdade de Medicina, Hospital das Clínicas (HCFMUSP), Universidade de São Paulo, São Paulo, SP, Brazil
| | - Jose Ernesto Vidal
- Infectious and Parasitic Diseases Division, Faculdade de Medicina, Hospital das Clínicas (HCFMUSP), Universidade de São Paulo, São Paulo, SP, Brazil
- Infectious Diseases Department, Instituto de Infectologia Emílio Ribas (IIER), São Paulo, SP, Brazil
| | - Diego Rodrigues Falci
- Infectious Diseases Department, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil
| | | | | | - Carla Sakuma de Oliveira
- Infectious Diseases Department, Hospital Universitário do Oeste do Paraná (HUOP), Cascavel, PR, Brazil
| | | | - Giovanni Luís Breda
- Infectious Diseases Department, Hospital de Clínicas da Universidade Federal do Paraná (HC/UFPR), Curitiba, PR, Brazil
| | - Caroline Martins Rego
- Infectious Diseases Department, Instituto de Infectologia Emílio Ribas (IIER), São Paulo, SP, Brazil
| | - Maíra Araujo Félix
- Infectious Diseases Department, Instituto de Infectologia Emílio Ribas (IIER), São Paulo, SP, Brazil
| | - Paula Pacheco Katopodis
- Medical Education and Research Department, Pontifícia Universidade Católica de Goiás, Goiânia, GO, Brazil
| | - Julia Raquel da Silva do Ó
- Medical Education and Research Department, Pontifícia Universidade Católica de Goiás, Goiânia, GO, Brazil
| | | | | | | | - Flávio Queiroz-Telles
- Infectious Diseases Department, Hospital de Clínicas da Universidade Federal do Paraná (HC/UFPR), Curitiba, PR, Brazil
- Public Health Department, Universidade Federal do Paraná (UFPR), Curitiba, PR, Brazil
| | - Marcello Mihailenko Chaves Magri
- Infectious and Parasitic Diseases Division, Faculdade de Medicina, Hospital das Clínicas (HCFMUSP), Universidade de São Paulo, São Paulo, SP, Brazil
| |
Collapse
|
2
|
Aissaoui H, Bourne-Watrin M, Lemarie B, Guillot G, Aboikoni A, Chhorn P, Gaudard D, Hadj-Amara G, Manasse R, Ouedraogo M, Salloum C, Demar M, Epelboin L, Kallel H, Adenis A, Nacher M, Drak Alsibai K, Louvel D. Histoplasmosis in Non-HIV Infected Patients: Another Neglected Infection in French Guiana. J Fungi (Basel) 2024; 10:400. [PMID: 38921386 PMCID: PMC11205039 DOI: 10.3390/jof10060400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 05/27/2024] [Accepted: 05/28/2024] [Indexed: 06/27/2024] Open
Abstract
(1) Background: Only a few studies on histoplasmosis in immunocompetent patients have been reported in French Guiana. Therefore, we conducted a detailed clinical description of hospitalized patients suffering with histoplasmosis among non-HIV patients. (2) Methods: This is a single-center, retrospective study conducted at Cayenne Hospital Center between 2008 and 2022. (3) Results: Our cohort was composed of 31 (91%) adults (>18 years of age) and 3 (9%) children, with a sex ratio, M:F, of 1:2. The median age was higher among the women than among the men (70 versus 54 years). The collection of respiratory samples constituted the majority of the performed examinations (38%). Fever (>37 °C) was found in 56% of patients. Surprisingly, the histoplasmosis was disseminated in 82% of patients with an overall case fatality rate of 14.7%. However, immunosuppressive conditions were found in 52% (16/31) of the adult patients, including lymphoid hemopathies, diabetes and immunosuppressive drugs. Conclusions: This disease, though rare and usually considered a mostly benign disease in non-HIV patients, presented a relatively high mortality rate in our cohort. Thus, histoplasmosis should be suspected, screened and investigated as a first line of defense in highly endemic areas, even in immunocompetent and non-HIV patients, especially those with fever or chronic respiratory symptoms.
Collapse
Affiliation(s)
- Houari Aissaoui
- Department of Medicine, Pneumology and Gastroenterology Units, Cayenne Hospital Center, Cayenne F-97300, French Guiana; (H.A.); (G.G.); (A.A.); (D.G.); (D.L.)
| | - Morgane Bourne-Watrin
- Unité des Maladies Infectieuses Tropicales (UMIT), Cayenne Hospital Center, Cayenne F-97300, French Guiana; (M.B.-W.); (L.E.)
| | - Benoit Lemarie
- Pneumology Department, Cochin University Hospital AP-HP, F-75014 Paris, France;
| | - Genevieve Guillot
- Department of Medicine, Pneumology and Gastroenterology Units, Cayenne Hospital Center, Cayenne F-97300, French Guiana; (H.A.); (G.G.); (A.A.); (D.G.); (D.L.)
| | - Alolia Aboikoni
- Department of Medicine, Pneumology and Gastroenterology Units, Cayenne Hospital Center, Cayenne F-97300, French Guiana; (H.A.); (G.G.); (A.A.); (D.G.); (D.L.)
| | | | - Dana Gaudard
- Department of Medicine, Pneumology and Gastroenterology Units, Cayenne Hospital Center, Cayenne F-97300, French Guiana; (H.A.); (G.G.); (A.A.); (D.G.); (D.L.)
| | - Ghazi Hadj-Amara
- Department of Pathology, Cayenne Hospital Center, Cayenne F-97300, French Guiana; (G.H.-A.); (R.M.)
| | - Ricardo Manasse
- Department of Pathology, Cayenne Hospital Center, Cayenne F-97300, French Guiana; (G.H.-A.); (R.M.)
| | - Mahamado Ouedraogo
- Laboratory of Mycology, Cayenne Hospital Center, Cayenne F-97300, French Guiana; (M.O.); (M.D.)
| | - Charles Salloum
- Department of Orthopidic Surgery and Neurosurgery, Cayenne Hospital Center, Cayenne F-97300, French Guiana;
| | - Magalie Demar
- Laboratory of Mycology, Cayenne Hospital Center, Cayenne F-97300, French Guiana; (M.O.); (M.D.)
| | - Loïc Epelboin
- Unité des Maladies Infectieuses Tropicales (UMIT), Cayenne Hospital Center, Cayenne F-97300, French Guiana; (M.B.-W.); (L.E.)
| | - Hatem Kallel
- Intensif Care Unit, Cayenne Hospital Center, Cayenne F-97300, French Guiana;
| | - Antoine Adenis
- Amazin PopHealth, Departement of Research and Innovation in Public Health (DRISP), Clinical Investigation Center (CIC Inserm 1424), Cayenne Hospital Center, Cayenne F-97300, French Guiana; (A.A.); (M.N.)
| | - Mathieu Nacher
- Amazin PopHealth, Departement of Research and Innovation in Public Health (DRISP), Clinical Investigation Center (CIC Inserm 1424), Cayenne Hospital Center, Cayenne F-97300, French Guiana; (A.A.); (M.N.)
| | - Kinan Drak Alsibai
- Department of Pathology, Cayenne Hospital Center, Cayenne F-97300, French Guiana; (G.H.-A.); (R.M.)
- Amazin PopHealth, Departement of Research and Innovation in Public Health (DRISP), Clinical Investigation Center (CIC Inserm 1424), Cayenne Hospital Center, Cayenne F-97300, French Guiana; (A.A.); (M.N.)
- Center of Biological Resources (CRB Amazonie), Cayenne Hospital Center, Cayenne F-97306, French Guiana
| | - Dominique Louvel
- Department of Medicine, Pneumology and Gastroenterology Units, Cayenne Hospital Center, Cayenne F-97300, French Guiana; (H.A.); (G.G.); (A.A.); (D.G.); (D.L.)
| |
Collapse
|
3
|
Nacher M, Lucarelli A, Van-Melle A, Basurko C, Rabier S, Chroum M, Santana T, Verin K, Bienvenu K, El Guedj M, Vaz T, Cisse H, Epelboin L, Le Turnier P, Abboud P, Djossou F, Pradinaud R, Adenis A, Couppié P. Forty Years of HIV Research in French Guiana: Comprehend to Combat. Pathogens 2024; 13:459. [PMID: 38921756 PMCID: PMC11206598 DOI: 10.3390/pathogens13060459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 05/10/2024] [Accepted: 05/17/2024] [Indexed: 06/27/2024] Open
Abstract
The drivers of the HIV epidemic, the viruses, the opportunistic infections, the attitudes and the resources allocated to the fight against HIV/AIDS, vary substantially across countries. French Guiana, at the crossroads between Amazonian South America and the Caribbean, constitutes a singular context with poor populations and rich country health funding, which has allowed researchers to gather lots of information on the particulars of our epidemic. We aimed to focus on the little known story of forty years of HIV research in French Guiana and emphasize how local research intertwined with public health action has yielded continuous progress, despite the difficult social conditions of the affected population. We searched Web of Science and associated local experts who worked through much of the epidemic in selecting the most meaningful products of local research for clinical and public health outcomes in French Guiana. Research tools and facilities included, from 1991 onwards, the HIV hospital cohort and the HIV-histoplasmosis cohort. Ad hoc studies funded by the ANRS or the European Regional Development fund shed light on vulnerable groups. The cumulative impact of prospective routine collection and focused efforts has yielded a breadth of knowledge, allowing for informed decisions and the adaptation of prevention, testing and care in French Guiana. After this overview, we emphasize that the close integration of research and public health was crucial in adapting interventions to the singular context of French Guiana.
Collapse
Affiliation(s)
- Mathieu Nacher
- Comité de Coordination Régionale de la Lutte contre le VIH et les IST, Centre Hospitalier de Cayenne, 97300 Cayenne, French Guiana; (A.L.); (S.R.); (M.C.); (T.S.); (K.V.); (K.B.); (A.A.)
- Centre d’Investigation Clinique INSERM 1424, Centre Hospitalier de Cayenne, 97300 Cayenne, French Guiana; (A.V.-M.); (C.B.)
- Département Formation Recherche en Santé, Université de Guyane, 97300 Cayenne, French Guiana;
- Institut Santé des Populations en Amazonie, Centre Hospitalier de Cayenne, 97300 Cayenne, French Guiana
| | - Aude Lucarelli
- Comité de Coordination Régionale de la Lutte contre le VIH et les IST, Centre Hospitalier de Cayenne, 97300 Cayenne, French Guiana; (A.L.); (S.R.); (M.C.); (T.S.); (K.V.); (K.B.); (A.A.)
| | - Astrid Van-Melle
- Centre d’Investigation Clinique INSERM 1424, Centre Hospitalier de Cayenne, 97300 Cayenne, French Guiana; (A.V.-M.); (C.B.)
| | - Célia Basurko
- Centre d’Investigation Clinique INSERM 1424, Centre Hospitalier de Cayenne, 97300 Cayenne, French Guiana; (A.V.-M.); (C.B.)
| | - Sébastien Rabier
- Comité de Coordination Régionale de la Lutte contre le VIH et les IST, Centre Hospitalier de Cayenne, 97300 Cayenne, French Guiana; (A.L.); (S.R.); (M.C.); (T.S.); (K.V.); (K.B.); (A.A.)
| | - Malorie Chroum
- Comité de Coordination Régionale de la Lutte contre le VIH et les IST, Centre Hospitalier de Cayenne, 97300 Cayenne, French Guiana; (A.L.); (S.R.); (M.C.); (T.S.); (K.V.); (K.B.); (A.A.)
| | - Thiago Santana
- Comité de Coordination Régionale de la Lutte contre le VIH et les IST, Centre Hospitalier de Cayenne, 97300 Cayenne, French Guiana; (A.L.); (S.R.); (M.C.); (T.S.); (K.V.); (K.B.); (A.A.)
| | - Karine Verin
- Comité de Coordination Régionale de la Lutte contre le VIH et les IST, Centre Hospitalier de Cayenne, 97300 Cayenne, French Guiana; (A.L.); (S.R.); (M.C.); (T.S.); (K.V.); (K.B.); (A.A.)
| | - Ketty Bienvenu
- Comité de Coordination Régionale de la Lutte contre le VIH et les IST, Centre Hospitalier de Cayenne, 97300 Cayenne, French Guiana; (A.L.); (S.R.); (M.C.); (T.S.); (K.V.); (K.B.); (A.A.)
| | - Myriam El Guedj
- Hôpital de Jour Adultes, Centre Hospitalier de Cayenne, 97300 Cayenne, French Guiana
| | - Tania Vaz
- Hôpital de Jour Adultes, Centre Hospitalier de Cayenne, 97300 Cayenne, French Guiana
| | - Hawa Cisse
- Hôpital de Jour Adultes, Centre Hospitalier de Cayenne, 97300 Cayenne, French Guiana
| | - Loïc Epelboin
- Service des Maladies Infectieuses et Tropicales, Centre Hospitalier de Cayenne, 97300 Cayenne, French Guiana; (L.E.); (P.L.T.); (P.A.); (F.D.)
| | - Paul Le Turnier
- Service des Maladies Infectieuses et Tropicales, Centre Hospitalier de Cayenne, 97300 Cayenne, French Guiana; (L.E.); (P.L.T.); (P.A.); (F.D.)
| | - Philippe Abboud
- Service des Maladies Infectieuses et Tropicales, Centre Hospitalier de Cayenne, 97300 Cayenne, French Guiana; (L.E.); (P.L.T.); (P.A.); (F.D.)
| | - Félix Djossou
- Service des Maladies Infectieuses et Tropicales, Centre Hospitalier de Cayenne, 97300 Cayenne, French Guiana; (L.E.); (P.L.T.); (P.A.); (F.D.)
| | - Roger Pradinaud
- Service de Dermatologie Vénéréologie, Centre Hospitalier de Cayenne, 97300 Cayenne, French Guiana;
| | - Antoine Adenis
- Comité de Coordination Régionale de la Lutte contre le VIH et les IST, Centre Hospitalier de Cayenne, 97300 Cayenne, French Guiana; (A.L.); (S.R.); (M.C.); (T.S.); (K.V.); (K.B.); (A.A.)
- Centre d’Investigation Clinique INSERM 1424, Centre Hospitalier de Cayenne, 97300 Cayenne, French Guiana; (A.V.-M.); (C.B.)
- Département Formation Recherche en Santé, Université de Guyane, 97300 Cayenne, French Guiana;
- Institut Santé des Populations en Amazonie, Centre Hospitalier de Cayenne, 97300 Cayenne, French Guiana
| | - Pierre Couppié
- Département Formation Recherche en Santé, Université de Guyane, 97300 Cayenne, French Guiana;
- Institut Santé des Populations en Amazonie, Centre Hospitalier de Cayenne, 97300 Cayenne, French Guiana
- Service de Dermatologie Vénéréologie, Centre Hospitalier de Cayenne, 97300 Cayenne, French Guiana;
| |
Collapse
|
4
|
Been Sayeed SJ, Rahman MM, Moniruzzaman M, Kabir AH, Mallik MU, Hasan MR, Golam-Ur-Rahman M, Mondal BC, Hossain MA, Rahman M. Clinical, Laboratory Characteristics, and Treatment Outcomes of Histoplasmosis Among Patients Admitted to a Referral Tertiary Care Hospital in Bangladesh. Cureus 2023; 15:e50813. [PMID: 38249268 PMCID: PMC10797216 DOI: 10.7759/cureus.50813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2023] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND Histoplasmosis is a systemic mycosis caused by Histoplasma capsulatum (H. capsulatum). Systemic involvement of histoplasmosis usually occurs in immune-compromised patients, patients with AIDS, or those taking immunosuppressive therapy. The present study aims to describe the clinical and laboratory characteristics and treatment outcome of histoplasmosis as the diagnosis is challenging and management protocol differs. METHOD This retrospective study was done using a data registry at the medicine department of Dhaka Medical College Hospital. Here, patients received the standard treatment of histoplasmosis. Here, patients received the standard treatment of histoplasmosis, and clinical outcome was assessed at 3 months following starting standard treatment. RESULT A total of nine patients were enrolled, six (66.7%) had systemic histoplasmosis. Three were poultry workers, and the most common comorbidity was diabetes 3 (33.3%). Fever 7 (77.7%), weight loss 6 (66.7%), hyperpigmentation 5 (55.5%), cough 4 (44.4%), oral ulceration 4 (44.4%), lymphadenopathy 4 (44.4%), and hypotension 3 (33.3%) were the most common clinical presentations. Seven (77.7%) out of nine patients were cured of histoplasmosis; however, one died before initiating antifungal medications and another one died due to a hypersensitivity reaction to liposomal amphotericin B. Conclusion: For local histoplasmosis, oral itraconazole is an effective antifungal medication. However, in disseminated Histoplasmosis, liposomal amphotericin B followed by oral itraconazole is still one of the preferable and effective treatment options. Clinicians should be aware of hypersensitivity reactions of liposomal amphotericin B and its management before giving an infusion.
Collapse
Affiliation(s)
| | | | - Md Moniruzzaman
- Medicine and Rheumatology, National Institute of Neurosciences & Hospital, Dhaka, BGD
| | | | | | - Md Rockyb Hasan
- Internal Medicine, Texas Tech University Health Sciences Center, Amarillo, USA
| | | | - Bikash Chandra Mondal
- Respiratory Medicine, National Institute of Diseases of the Chest and Hospital, Dhaka, BGD
| | | | - Mehrin Rahman
- Medicine, Dhaka Medical College Hospital, Dhaka, BGD
| |
Collapse
|
5
|
Cáceres DH, Gómez BL, Tobón ÁM, Restrepo Á, Chiller T, Lindsley MD, Meis JF, Verweij PE. Tackling Histoplasmosis Infection in People Living with HIV from Latin America: From Diagnostic Strategy to Public Health Solutions. J Fungi (Basel) 2023; 9:jof9050558. [PMID: 37233269 DOI: 10.3390/jof9050558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 05/04/2023] [Accepted: 05/05/2023] [Indexed: 05/27/2023] Open
Abstract
Histoplasmosis, caused by the thermally dimorphic fungus Histoplasma spp., is a disease with a broad clinical spectrum, presenting from asymptomatic/flu-like symptoms to progressive disseminated disease in people with immunosuppression. In recent years, the concept of histoplasmosis as a disease restricted to the American continent has changed, as now histoplasmosis is reported in many regions around the world. In Latin America, histoplasmosis represents a threat, especially in people with advanced HIV disease (AHD). Diagnosis of histoplasmosis in people living with HIV (PLHIV) is challenging due to the low index of suspicion of the disease, non-specificity of signs and symptoms, and limited access to specific laboratory testing, while the diagnostic delay is significantly associated with mortality. In the last decade, novel diagnostic tests have been developed for the rapid detection of histoplasmosis, such as commercial kits for antigen detection. Furthermore, advocacy groups were created that presented histoplasmosis as a public health problem, with emphasis on patients at risk of progressive disseminated disease. This review aims to discuss the impact of histoplasmosis associated with AHD in Latin America and the strategies employed to tackle histoplasmosis, from the implementation of laboratory testing to disease advocacy and public health interventions.
Collapse
Affiliation(s)
- Diego H Cáceres
- Center of Expertise in Mycology Radboudumc/Canisius Wilhelmina Hospital, 6532 SZ Nijmegen, The Netherlands
- Studies in Translational Microbiology and Emerging Diseases (MICROS) Research Group, School of Medicine and Health Sciences, Universidad del Rosario, Bogota 111221, Colombia
- IMMY, Norman, OK 73069, USA
| | - Beatriz L Gómez
- Studies in Translational Microbiology and Emerging Diseases (MICROS) Research Group, School of Medicine and Health Sciences, Universidad del Rosario, Bogota 111221, Colombia
| | - Ángela M Tobón
- Instituto Colombiano de Medicina Tropical, Universidad CES, Medellín 055450, Colombia
| | - Ángela Restrepo
- COLCIENCIAS Emeritus Researcher, Ministerio de Ciencias, Tecnología e Innovación, Bogota 111321, Colombia
| | - Tom Chiller
- Mycotic Diseases Branch, Centers for Disease Control and Prevention (CDC), Atlanta, GA 30329, USA
| | - Mark D Lindsley
- Mycotic Diseases Branch, Centers for Disease Control and Prevention (CDC), Atlanta, GA 30329, USA
| | - Jacques F Meis
- Center of Expertise in Mycology Radboudumc/Canisius Wilhelmina Hospital, 6532 SZ Nijmegen, The Netherlands
- Department I of Internal Medicine, Excellence Center for Medical Mycology, University Hospital Cologne, 50931 Cologne, Germany
| | - Paul E Verweij
- Center of Expertise in Mycology Radboudumc/Canisius Wilhelmina Hospital, 6532 SZ Nijmegen, The Netherlands
| |
Collapse
|
6
|
Camous L, Surel A, Kallel H, Nicolas M, Martino F, Valette M, Demoule A, Pommier JD. Factors related to mortality in critically ill histoplasmosis: a multicenter retrospective study in Guadeloupe and French Guyana. Ann Intensive Care 2023; 13:30. [PMID: 37085583 PMCID: PMC10121956 DOI: 10.1186/s13613-023-01128-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 04/13/2023] [Indexed: 04/23/2023] Open
Abstract
PURPOSE To describe clinical and biological features and the outcomes of patients admitted for histoplasmosis in two intensive care units (ICU) in French Guyana and in the French West Indies (Guadeloupe). METHODS All patients admitted to these two ICUs for culture-proven histoplasmosis between January 2014 to August 2022 were included in the study. Using univariate and multivariate analysis, we assessed risk factors at ICU admission that were associated with death. RESULTS Forty patients were included (65% men). Median age was 56 years and simplified acute physiologic score (SAPS) II was 65. HIV was found in 58%, another immunodeficiency was identified in 28%, and no underlying immunodeficiency could be identified in 14% of patients. Within the first 24 h of ICU admission, 85% of patients had acute respiratory failure, 78% had shock, 30% had coma, and 48% had hemophagocytic lymphohistiocytosis. Mechanical ventilation was instituted in 78% of patients and renal replacement therapy in 55%. The 30-day mortality was 53%. By multivariate analysis, factors independently associated with 30-day mortality were SOFA score (odds ratio [OR] 1.5, 95% confidence interval [CI] [1.1-2.1]), time between symptom onset and treatment per day (OR 1.1, 95% CI 1.0-1.1), and hemophagocytic lymphohistiocytosis (OR 6.4, 95% CI 1.1-47.5). CONCLUSION Histoplasmosis requiring ICU admission is a protean disease with multiple and severe organ involvement. Immunodeficiency is found in most patients. The prognosis remains severe despite appropriate treatment and is worsened by late treatment initiation.
Collapse
Affiliation(s)
- Laurent Camous
- Intensive Care Unit, Guadeloupe Teaching Hospital, Antilles-Guyane University, Chemin de Chauvel, Les Abymes, France.
- Réanimation médicale et chirurgicale-CHU de Guadeloupe, 97139, Les Abyme, France.
| | - Arthur Surel
- Intensive Care Unit, Guadeloupe Teaching Hospital, Antilles-Guyane University, Chemin de Chauvel, Les Abymes, France
| | - Hatem Kallel
- Intensive Care Unit, Cayenne Hospital, French Guyana, France
| | - Muriel Nicolas
- Mycology Department, Guadeloupe Teaching Hospital, Antilles-Guyane University, Chemin de Chauvel, Les Abymes, France
| | - Frederic Martino
- Intensive Care Unit, Guadeloupe Teaching Hospital, Antilles-Guyane University, Chemin de Chauvel, Les Abymes, France
- Université de Paris and Université des Antilles, INSERM, BIGR, 75015, Paris, France
| | - Marc Valette
- Intensive Care Unit, Guadeloupe Teaching Hospital, Antilles-Guyane University, Chemin de Chauvel, Les Abymes, France
| | - Alexandre Demoule
- UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Université, INSERM, 75005, Paris, France
- Service de Médecine Intensive et Réanimation (Département R3S), AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, Site Pitié-Salpêtrière, 75013, Paris, France
| | - Jean-David Pommier
- Intensive Care Unit, Guadeloupe Teaching Hospital, Antilles-Guyane University, Chemin de Chauvel, Les Abymes, France
- Institut Pasteur de Guadeloupe, Morne Jolivière, 97139, Les Abymes, France
| |
Collapse
|
7
|
Behera RK, Gupta PC, Khurana S, Sehgal S, Sharma S, Ram J. A rare presentation of ocular histoplasmosis in a patient with systemic nocardiosis. Indian J Ophthalmol 2022; 70:2689-2691. [PMID: 35791207 PMCID: PMC9426055 DOI: 10.4103/ijo.ijo_2633_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Ranjan K Behera
- Department of Ophthalmology, Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Parul C Gupta
- Department of Ophthalmology, Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Surbhi Khurana
- Department of Ophthalmology, Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Shobha Sehgal
- Department of Immunopathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Suryaprakash Sharma
- Department of Ophthalmology, Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Jagat Ram
- Department of Ophthalmology, Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| |
Collapse
|
8
|
Freire M, Carvalho V, Spener R, da Silva CR, da Silva Neto JR, Carlos Ferreira L, Nogueira PA. Hemophagocytic Syndrome in a Patient with HIV and Histoplasmosis: A not so Rare Correlation. Clin Med Insights Pathol 2022; 15:2632010X221118059. [PMID: 36051652 PMCID: PMC9425888 DOI: 10.1177/2632010x221118059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 07/15/2022] [Indexed: 11/18/2022] Open
Abstract
Hemophagocytic lymphohistiocytosis (HLH) is a disorder that occurs due to unsuitable monocyte activation in a variety of infections. In human immunodeficiency virus (HIV) infections, patients with advanced immunossupression associated with opportunistic infections are at increased risk of developing HLH. We describe a clinical case of a 33-year-old male student diagnosed with HIV who was hospitalized for investigation of asthenia and dyspnea, accompanied by adynamia, decreased motor force in the left leg, dysphagia, and dysfluency. His general condition was regular, he was pale, feverish, and had normal cardiac and pulmonary auscultation. Physical examination revealed ulcerated lesions in the perianal region and hepatosplenomegaly without palpable lymph node enlargement. Laboratory parameters showed pancytopenia, a slight increase in liver function accompanied by high lactate dehydrogenase, and hiperferritinemia. The initial diagnosis was disseminated histoplasmosis, thus amphotericin B deoxycholate was empirically prescribed while waiting on myeloculture and blood cultures for fungi and mycobacteria. Other clinical procedures were blood transfusion, resumption of antiretroviral therapy (ART) and secondary prophylaxis. Myeloculture blood cultures of fungi and mycobacteria were negative. Patient evolved well in relation to the initial complaints and showed partial clinical and laboratory improvement. However, 23 days after hospitalization, he developed a febrile episode accompanied by chills and a convulsive crisis. The patient was transferred to the intensive unit care and developed septic shock and respiratory failure. He died 25 days after the onset of the condition. After the postmortem examination, histopathology revealed countless rounded fungal structures compatible with Histoplasma sp., which were observed in the peripancreatic lymph node, liver, and spleen, in addition to hemophagocytosis in the splenic parenchyma. We thus conclude that when the patient met criteria for HLH, such as fever, hepatosplenomegaly, hiperferritinemia, and pancytopenia, the evolution was fast due to the aggressive and rapidly fatal nature of HLH, despite anti-fungal and corticoid treatment. Therefore, this case report reinforces the need to consider hemophagocytic syndrome in patients with HIV and disseminated histoplasmosis, especially where histoplasmosis is highly endemic, in order for the treatment be started early when there is high clinical suspicion.
Collapse
Affiliation(s)
- Monique Freire
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil.,Programa de Pós-graduação em Ciências da Saúde, Universidade Federal do Amazonas, Manaus, Brazil
| | - Viviane Carvalho
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | - Renata Spener
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | - Christiane Rodrigues da Silva
- Programa de Pós-graduação em Biologia da Realação Patogeno Hospedeiro, Instituto Leônidas e Maria Deane, Manaus, Brazil
| | | | - Luiz Carlos Ferreira
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil.,Programa de Pós-graduação em Ciências da Saúde, Universidade Federal do Amazonas, Manaus, Brazil
| | - Paulo Afonso Nogueira
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil.,Programa de Pós-graduação em Biologia da Realação Patogeno Hospedeiro, Instituto Leônidas e Maria Deane, Manaus, Brazil
| |
Collapse
|
9
|
Joseph CT, Feely M, Iovine N. Disseminated genitourinary histoplasmosis in a patient with AIDS with negative urine antigen testing. BMJ Case Rep 2021; 14:e243375. [PMID: 34772673 PMCID: PMC8593604 DOI: 10.1136/bcr-2021-243375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2021] [Indexed: 11/03/2022] Open
Abstract
Disseminated histoplasmosis is a life-threatening condition in immunocompromised patients. The majority of healthy persons have benign disease not requiring treatment. However, in persons living with HIV, mortality is high and accurate diagnosis is paramount. We present a case of a 48-year-old HIV-positive woman who presented with haematuria and flank pain. She had a history of recurrent urinary tract infection and nephrolithiasis with obstructive hydronephrosis. During cystoscopy, a bladder lesion was found. Pathological evaluation demonstrated abundant intracellular organisms with apparent budding. Subsequent urine histoplasma antigen was negative. Given the high index of suspicion for histoplasmosis based on the surgical pathology findings and epidemiological history, the patient was started immediately on antifungal therapy. One week later, PCR results of the bladder lesion confirmed the presence of Histoplasma capsulatum This case highlights a rare presentation of genitourinary histoplasmosis and the utility of surgical pathology evaluation and PCR for diagnosis.
Collapse
Affiliation(s)
| | - Michael Feely
- Pathology, Immunology and Laboratory Medicine, University of Florida, Gainesville, Florida, USA
| | - Nicole Iovine
- Infectious Disease and Global Medicine, University of Florida, Gainesville, Florida, USA
| |
Collapse
|
10
|
Progressive disseminated histoplasmosis in children living with HIV: a case series study. Eur J Pediatr 2021; 180:1923-1931. [PMID: 33555424 DOI: 10.1007/s00431-021-03969-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Revised: 01/17/2021] [Accepted: 01/26/2021] [Indexed: 10/22/2022]
Abstract
Progressive disseminated histoplasmosis (PDH) is thought to be on the top of the list of AIDS-defining illnesses in South America. Reported experience in children is very scarce. The aim of this study was to describe the clinical characteristics, management, and outcomes of children living with HIV presenting with PDH in Ecuador. We did a retrospective study using collected data on medical records of children living with HIV attended in Francisco Icaza Bustamante Children's Hospital (Guayaquil) between 1997 and 2019. The inclusion criteria consisted of patients under 18 years of age at admission with documented HIV infection and laboratory-confirmed diagnosis of PDH. Twenty-four children living with HIV were attended due to laboratory-confirmed PDH. Median CD4 cell count was 39 cells/mm³ (p25-p75 21-155) between 1 and 5 years and 22 cells/mm³ (p25-p75 10-57) for those aged 6 years and over. Fever (96%) was the most common clinical manifestation, followed by hepatomegaly (75%), cough (67%), weight loss (63%), diarrhea (63%), and abdominal distension (58%). Most significant laboratory findings were hypoalbuminemia (90%), hypertransaminasemia (78%), and pancytopenia (46%). Intravenous treatment with amphotericin B deoxycholate was started in all but one case in which diagnosis was postmortem. All these 23 patients were discharged after being hospitalized for a median of 68 days (p25-p75 48-90). Two children showed relapse during follow-up, one of whom died during the hospitalization of this second episode of PDH.Conclusion: Clinical manifestations and laboratory findings of PDH in children living with HIV seem similar to those seen in adults, and low CD4 cell count appears to be the most important risk factor. What is Known: • Since 1987, progressive disseminated histoplasmosis has been considered an AIDS-defining illness and, although underdiagnosis is frequent, is thought to be on the top of the list of AIDS-defining illnesses in South America. • Reported experience in children is very scarce. What is New: • Clinical manifestations and laboratory findings of progressive disseminated histoplasmosis in children living with HIV seem similar to those seen in adults. • Low CD4 cell count to be the most important risk factor.
Collapse
|
11
|
Cherabie J, Mazi P, Rauseo AM, Ayres C, Larson L, Rutjanawech S, O’Halloran J, Presti R, Powderly WG, Spec A. Long-Term Mortality after Histoplasma Infection in People with HIV. J Fungi (Basel) 2021; 7:jof7050369. [PMID: 34066845 PMCID: PMC8150352 DOI: 10.3390/jof7050369] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 05/04/2021] [Accepted: 05/06/2021] [Indexed: 11/20/2022] Open
Abstract
Histoplasmosis is a common opportunistic infection in people with HIV (PWH); however, no study has looked at factors associated with the long-term mortality of histoplasmosis in PWH. We conducted a single-center retrospective study on the long-term mortality of PWH diagnosed with histoplasmosis between 2002 and 2017. Patients were categorized into three groups based on length of survival after diagnosis: early mortality (death < 90 days), late mortality (death ≥ 90 days), and long-term survivors. Patients diagnosed during or after 2008 were considered part of the modern antiretroviral therapy (ART) era. Insurance type (private vs. public) was a surrogate indicator of socioeconomic status. Out of 54 PWH infected with histoplasmosis, overall mortality was 37%; 14.8% early mortality and 22.2% late mortality. There was no statistically significant difference in survival based on the availability of modern ART (p = 0.60). Insurance status reached statistical significance with 38% of survivors having private insurance versus only 8% having private insurance in the late mortality group (p = 0.05). High mortality persists despite the advent of modern ART, implicating a contribution from social determinants of health, such as private insurance. Larger studies are needed to elucidate the role of these factors in the mortality of PWH.
Collapse
|
12
|
Klus J, Ly VT, Chan C, Le T. Prognosis and treatment effects of HIV-associated talaromycosis in a real-world patient cohort. Med Mycol 2021; 59:392-399. [PMID: 33644813 PMCID: PMC8023982 DOI: 10.1093/mmy/myab005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 01/11/2021] [Accepted: 01/19/2021] [Indexed: 01/07/2023] Open
Abstract
Talaromycosis is a leading cause of AIDS-associated opportunistic infections and death in Southeast Asia. We have recently shown in the Itraconazole versus Amphotericin for Talaromycosis (IVAP) trial that induction therapy with amphotericin B reduced mortality over 24 weeks, but not during the first 2 weeks. Antifungal treatment effects in real-world settings have not been rigorously evaluated. Using data obtained from patient records at the Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam from 2004 to 2009, we first developed a prognostic model using Bayesian logistic regression to identify predictors of death. Second, we developed a causal model using propensity score matching to assess the treatment effects of amphotericin B and itraconazole. Our prognostic model identified intravenous drug use (odds ratio [OR] = 2.01), higher respiratory rate (OR = 1.12), higher absolute lymphocyte count (OR = 1.62), a concurrent respiratory infection (OR = 1.67) or central nervous system infection (OR = 2.66) as independent predictors of death. Fever (OR = 0.56) was a protective factor. Our prognostic model exhibits good in-sample performance and out-of-sample validation, with a discrimination power of 0.85 and 0.91, respectively. Our causal model showed no significant difference in treatment outcomes between amphotericin B and itraconazole over the first 2 weeks (95% credible interval: 0.62, 2.50). Our prognostic model provides a simple tool based on routinely collected clinical data to predict individual patient outcome. Our causal model shows similar results to the IVAP trial at 2 weeks, demonstrating an agreement between real-world data and clinical trial data.
Collapse
Affiliation(s)
- Jonathan Klus
- Department of Statistical Science, Duke University, Durham, NC 27708, USA
| | - Vo Trieu Ly
- Department of Infectious Diseases, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
- Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Cliburn Chan
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC 27710, USA
| | - Thuy Le
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
- Division of Infectious Diseases and International Health, Duke University School of Medicine, Durham, NC 27710, USA
| |
Collapse
|
13
|
Hanna KF, Havens JP, Bares SH. Successful application of pharmacogenomic testing in the evaluation and management of a patient with human immunodeficiency virus and disseminated histoplasmosis. J Am Pharm Assoc (2003) 2021; 61:e152-e155. [PMID: 33583749 DOI: 10.1016/j.japh.2021.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 12/21/2020] [Accepted: 01/12/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To demonstrate the successful use of pharmacogenomic testing to specifically tailor antifungal treatment to the phenotype of a patient with human immunodeficiency virus (HIV) and disseminated histoplasmosis who had clinical progression while on itraconazole and subsequently had insufficient therapeutic drug levels of voriconazole. CASE SUMMARY We present the case of a patient with HIV and disseminated histoplasmosis with a persistently elevated serum Histoplasma capsulatum antigen and subtherapeutic levels of voriconazole. Pharmacogenomic testing revealed he was a CYP2C19 rapid metabolizer, thus explaining his persistent, subtherapeutic levels of voriconazole and prompting a change in therapy. PRACTICE IMPLICATIONS Our case illustrates the importance of pharmacogenomic testing as a tool to evaluate subtherapeutic itraconazole or voriconazole levels, especially in patients with failed clinical or Histoplasmosis Ag response despite reporting full adherence to prescribed therapy.
Collapse
|
14
|
Nacher M, Alsibai KD, Adenis A, Blaizot R, Abboud P, Demar M, Djossou F, Epelboin L, Misslin C, Ntab B, Valdes A, Couppié P. Reduced Severity in Patients With HIV-Associated Disseminated Histoplasmosis With Deep Lymphadenopathies: A Trench War Remains Within the Lymph Nodes? Front Cell Infect Microbiol 2021; 10:598701. [PMID: 33628743 PMCID: PMC7897652 DOI: 10.3389/fcimb.2020.598701] [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: 08/25/2020] [Accepted: 12/09/2020] [Indexed: 11/13/2022] Open
Abstract
Background Disseminated histoplasmosis is a major killer of patients with advanced HIV. It is proteiform and often hard to diagnose in the absence of diagnostic tests. We aimed to describe disseminated histoplasmosis with lymphadenopathies in French Guiana and to compare survival and severity of those patients to patients without lymphadenopathies. Methods A retrospective cohort study was performed on data records collected between January 1, 1981 and October 1, 2014. Results Among 349 cases of disseminated histoplasmosis 168 (48.3%) had superficial lymphadenopathies and 133(38.1%) had deep lymphadenopathies. The median LDH concentration, ferritin concentration, TGO concentration, and WHO performance status were lower among patients with deep lymphadenopathies than those without deep lymphadenopathies. There was a significant decrease in the risk of early death (<1 month) among those with deep lymphadenopathies relative to those without (OR=0.26 (95%CI=0.10-0.60), P=0.0006) and in the overall risk of death (OR=0.33 (95%CI=0.20-0.55), P<0.0001). These associations remained strongly significant after adjusting for time period, CD4 counts, age, delay between beginning of symptoms and hospital admission, antifungal and antiretroviral treatment. Conclusions The present data show that in patients with advanced HIV and disseminated histoplasmosis, the presence of deep lymphadenopathies is associated with fewer markers of severity and a lower risk of death. To our knowledge it is the first study to show this. The presence of deep lymphadenopathies is hypothesized to reflect the patient's partially effective defense against H. capsulatum.
Collapse
Affiliation(s)
- Mathieu Nacher
- CIC INSERM 1424, Centre hospitalier Andree Rosemon Cayenne, Cayenne, French Guiana.,DFR Santé, Université de Guyane, Cayenne, French Guiana
| | - Kinan Drak Alsibai
- Department of Pathology, Centre hospitalier Andrée Rosemon, Cayenne, French Guiana
| | - Antoine Adenis
- CIC INSERM 1424, Centre hospitalier Andree Rosemon Cayenne, Cayenne, French Guiana.,DFR Santé, Université de Guyane, Cayenne, French Guiana
| | - Romain Blaizot
- DFR Santé, Université de Guyane, Cayenne, French Guiana.,Department of Dermatology, Centre hospitalier Andrée Rosemon, Cayenne, French Guiana
| | - Philippe Abboud
- Service des Maladies Infectieuses et Tropicales, Centre hospitalier Andrée Rosemon Cayenne, Cayenne, French Guiana
| | - Magalie Demar
- Laboratory, Centre hospitalier Andrée Rosemon Cayenne, Cayenne, French Guiana.,UMR Tropical Biome and Immunopathology, Université de Guyane, Cayenne, French Guiana
| | - Félix Djossou
- Service des Maladies Infectieuses et Tropicales, Centre hospitalier Andrée Rosemon Cayenne, Cayenne, French Guiana
| | - Loïc Epelboin
- Service des Maladies Infectieuses et Tropicales, Centre hospitalier Andrée Rosemon Cayenne, Cayenne, French Guiana
| | - Caroline Misslin
- Service de Médecine, Centre hospitalier de l'Ouest Guyanais, Saint Laurent du Maroni, French Guiana
| | - Balthazar Ntab
- Département d'Information Médicale, Centre hospitalier de l'Ouest Guyanais, Saint Laurent du Maroni, French Guiana
| | - Audrey Valdes
- Equipe Opérationnelle d'hygiène hospitalière, Centre hospitalier Andrée Rosemon Cayenne, Cayenne, French Guiana
| | - Pierre Couppié
- DFR Santé, Université de Guyane, Cayenne, French Guiana.,Department of Dermatology, Centre hospitalier Andrée Rosemon, Cayenne, French Guiana
| |
Collapse
|
15
|
Franklin AD, Larson L, Rauseo AM, Rutjanawech S, Hendrix MJ, Powderly WG, Spec A. A comparison of presentations and outcomes of histoplasmosis across patients with varying immune status. Med Mycol 2021; 59:myaa112. [PMID: 33443574 DOI: 10.1093/mmy/myaa112] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 12/11/2020] [Accepted: 12/16/2020] [Indexed: 12/13/2022] Open
Abstract
Few large cohorts have examined histoplasmosis in both immunocompromised and immunocompetent patients. We describe the differences in presentations and outcomes of histoplasmosis by immune and dissemination status. We assembled a retrospective cohort of adult patients diagnosed with histoplasmosis from 2002 to 2017. Patients were grouped by immune status: people living with HIV (PLWH), patients who were HIV negative but had other-immunocompromise (OIC), and immunocompetent patients. Patients were further classified into asymptomatic lung nodule (ALN), localized and disseminated disease groups, and outcomes were compared across patients by these immune status categories We identified 261 patients with histoplasmosis: 54 (21%) PLWH, 98 (38%) OIC, and 109 (42%) immunocompetent. Disseminated disease was more common among PLWH than among other groups (P < .001). In localized disease, median time from symptom onset to diagnosis was longer in immunocompetent patients than in other groups (P = .012), and was not significant in disseminated disease. The 90-day mortality was higher in PLWH (25%) and OIC (26%) with localized disease compared to the immunocompetent group (4%) (P = .009), but this difference was not seen in disseminated disease. Patients with localized disease had lower 90-day mortality (14%) compared to those with disseminated disease (21%) (P = .034). We conclude that immunocompetent individuals present with fewer typical symptoms, laboratory findings, and radiographic features of Histoplasma infection, leading to potential delays in diagnosis in this group. Despite this, immunocompetent patients have lower 90-day mortality in localized disease, and do not experience increased 90-day mortality in disseminated disease. LAY SUMMARY This article examines how the signs and symptoms of histoplasmosis vary by immune status and dissemination status. Immunocompetent patients with localized disease present with fewer typical signs and symptoms, are diagnosed later, but despite this have lower 90-day mortality.
Collapse
Affiliation(s)
- Alexander D Franklin
- Department of Medicine, Washington University School of Medicine, St Louis, MO, USA
| | - Lindsey Larson
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St Louis, MO, USA
| | - Adriana M Rauseo
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St Louis, MO, USA
| | - Sasinuch Rutjanawech
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St Louis, MO, USA
| | - Michael Joshua Hendrix
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St Louis, MO, USA
| | - William G Powderly
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St Louis, MO, USA
| | - Andrej Spec
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St Louis, MO, USA
| |
Collapse
|
16
|
Nacher M, Drak Alsibai K, Valdes A, Blaizot R, Abboud P, Demar M, Djossou F, Epelboin L, Misslin C, Ntab B, Adenis A, Couppié P. Risk Factors for Mortality among HIV-Infected Patients with Disseminated Histoplasmosis. J Fungi (Basel) 2020; 6:jof6040326. [PMID: 33266199 PMCID: PMC7712551 DOI: 10.3390/jof6040326] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 11/25/2020] [Accepted: 11/29/2020] [Indexed: 11/16/2022] Open
Abstract
Identifying prognostic factors is important in order to guide the choice of first-line therapy for disseminated histoplasmosis. Our objective was to identify factors associated with death among a cohort of 330 patients compiled over 34 years of clinical practice in French Guiana. Survival analysis was performed with death as the failure event and date of symptom onset as the origin event. Incidence rates were and Cox proportional hazards models were computed. Overall, 330 HIV-infected patients with disseminated histoplasmosis were included in the analysis, with 126 deaths occurring. One-quarter of all patients died within 6 months of the first symptoms. Patients with dyspnea, renal failure, arterial blood pressure < 90 mmHG, and a WHO performance score > 2 had a greater incidence of death. Bivariate analyses showed that patients with increased LDH, low hemoglobin, low serum protein, low CD4 counts, and low platelets tended to have a greater incidence of death. After adjusting for potential confounders, patients with dyspnea, a WHO performance score > 2, serum protein < 60 g/L, and hemoglobin < 8.9 g/dL had an increased risk of dying. The interaction terms showed that patients treated with liposomal amphotericin B had a marked reduction in death among patients with renal failure; among renal failure patients, the elevation of LDH was associated with a significant risk of death.
Collapse
Affiliation(s)
- Mathieu Nacher
- CIC INSERM 1424, Centre Hospitalier AndreeRosemon Cayenne, 97300 Cayenne, France;
- DFR Santé, Université de Guyane, 97300 Cayenne, France; (R.B.); (P.C.)
- Correspondence: ; Tel.: +594-594-395-024
| | - Kinan Drak Alsibai
- Department of Pathology, Centre Hospitalier AndreeRosemon Cayenne, 97300 Cayenne, France
| | - Audrey Valdes
- Equipe Opérationnelle d’hygiène hospitalière, Centre Hospitalier AndreeRosemon Cayenne, 97300 Cayenne, France;
| | - Romain Blaizot
- DFR Santé, Université de Guyane, 97300 Cayenne, France; (R.B.); (P.C.)
- Department of Dermatology, Centre Hospitalier Andree Rosemon Cayenne, 97300 Cayenne, France
| | - Philippe Abboud
- Service des Maladies Infectieuses et Tropicales, Centre Hospitalier AndreeRosemon Cayenne, 97300 Cayenne, France; (P.A.); (F.D.); (L.E.)
| | - Magalie Demar
- Laboratory, Centre Hospitalier AndreeRosemon Cayenne, 97300 Cayenne, France;
- UMR Tropical Biome and Immunopathology, Université de Guyane, 97300 Cayenne, France
| | - Félix Djossou
- Service des Maladies Infectieuses et Tropicales, Centre Hospitalier AndreeRosemon Cayenne, 97300 Cayenne, France; (P.A.); (F.D.); (L.E.)
| | - Loïc Epelboin
- Service des Maladies Infectieuses et Tropicales, Centre Hospitalier AndreeRosemon Cayenne, 97300 Cayenne, France; (P.A.); (F.D.); (L.E.)
| | - Caroline Misslin
- Service de Médecine, Centre Hospitalier de l’Ouest Guyanais, 97320 Saint Laurent du Maroni, France;
| | - Balthazar Ntab
- Département d’Information Médicale, Centre Hospitalier de l’Ouest Guyanais, 97320 Saint Laurent du Maroni, France;
| | - Antoine Adenis
- CIC INSERM 1424, Centre Hospitalier AndreeRosemon Cayenne, 97300 Cayenne, France;
- DFR Santé, Université de Guyane, 97300 Cayenne, France; (R.B.); (P.C.)
| | - Pierre Couppié
- DFR Santé, Université de Guyane, 97300 Cayenne, France; (R.B.); (P.C.)
- Department of Dermatology, Centre Hospitalier Andree Rosemon Cayenne, 97300 Cayenne, France
| |
Collapse
|
17
|
Abstract
BACKGROUND Progressive disseminated histoplasmosis (PDH) is a serious fungal infection that affects people living with HIV. The best way to treat the condition is unclear. OBJECTIVES We assessed evidence in three areas of equipoise. 1. Induction. To compare efficacy and safety of initial therapy with liposomal amphotericin B versus initial therapy with alternative antifungals. 2. Maintenance. To compare efficacy and safety of maintenance therapy with 12 months of oral antifungal treatment with shorter durations of maintenance therapy. 3. Antiretroviral therapy (ART). To compare the outcomes of early initiation versus delayed initiation of ART. SEARCH METHODS We searched the Cochrane Infectious Diseases Group Specialized Register; Cochrane CENTRAL; MEDLINE (PubMed); Embase (Ovid); Science Citation Index Expanded, Conference Proceedings Citation Index-Science, and BIOSIS Previews (all three in the Web of Science); the WHO International Clinical Trials Registry Platform, ClinicalTrials.gov, and the ISRCTN registry, all up to 20 March 2020. SELECTION CRITERIA We evaluated studies assessing the use of liposomal amphotericin B and alternative antifungals for induction therapy; studies assessing the duration of antifungals for maintenance therapy; and studies assessing the timing of ART. We included randomized controlled trials (RCT), single-arm trials, prospective cohort studies, and single-arm cohort studies. DATA COLLECTION AND ANALYSIS Two review authors assessed eligibility and risk of bias, extracted data, and assessed certainty of evidence. We used the Cochrane 'Risk of bias' tool to assess risk of bias in randomized studies, and ROBINS-I tool to assess risk of bias in non-randomized studies. We summarized dichotomous outcomes using risk ratios (RRs), with 95% confidence intervals (CI). MAIN RESULTS We identified 17 individual studies. We judged eight studies to be at critical risk of bias, and removed these from the analysis. 1. Induction We found one RCT which compared liposomal amphotericin B to deoxycholate amphotericin B. Compared to deoxycholate amphotericin B, liposomal amphotericin B may have higher clinical success rates (RR 1.46, 95% CI 1.01 to 2.11; 1 study, 80 participants; low-certainty evidence). Compared to deoxycholate amphotericin B, liposomal amphotericin B has lower rates of nephrotoxicity (RR 0.25, 95% CI 0.09 to 0.67; 1 study, 77 participants; high-certainty evidence). We found very low-certainty evidence to inform comparisons between amphotericin B formulations and azoles for induction therapy. 2. Maintenance We found no eligible study that compared less than 12 months of oral antifungal treatment to 12 months or greater for maintenance therapy. For both induction and maintenance, fluconazole performed poorly in comparison to other azoles. 3. ART We found one study, in which one out of seven participants in the 'early' arm and none of the three participants in the 'late' arm died. AUTHORS' CONCLUSIONS Liposomal amphotericin B appears to be a better choice compared to deoxycholate amphotericin B for treating PDH in people with HIV; and fluconazole performed poorly compared to other azoles. Other treatment choices for induction, maintenance, and when to start ART have no evidence, or very low certainty evidence. PDH needs prospective comparative trials to help inform clinical decisions.
Collapse
Affiliation(s)
- Marylou Murray
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Paul Hine
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| |
Collapse
|
18
|
Damasceno-Escoura AH, Mora DJ, Cardeal AC, Berto-Nascimento JC, Etchebehere RM, de Meneses ACO, Adad SJ, Micheletti AMR, Silva-Vergara ML. Histoplasmosis in HIV-Infected Patients: Epidemiological, Clinical and Necropsy Data from a Brazilian Teaching Hospital. Mycopathologia 2020; 185:339-346. [PMID: 32078723 DOI: 10.1007/s11046-020-00435-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 02/11/2020] [Indexed: 11/26/2022]
Abstract
Histoplasmosis occurs in 5-10% of HIV-infected patients in endemic areas and evolves to severe and disseminated infection with mortality rates over 50% in some regions. This report presents epidemiological, clinical and outcome data from HIV-infected patients with histoplasmosis confirmed by culture and/or at necropsy who were admitted to a Brazilian teaching hospital. Data from 65 patients were obtained from their respective medical and necropsy records. From 2005 to 2018, 36 HIV-infected patients were diagnosed with histoplasmosis confirmed by culture. At admission, most of these patients presented disseminated fungal infection, whereas 15 (41.7%) were simultaneously diagnosed with both HIV infection and histoplasmosis. Fever, weight loss, hepatosplenomegaly, respiratory and digestive symptoms were present in 86.2%, 50%, 44.4% and 41.7% of the patients, respectively. At admission, 24 patients had low CD4 T-cell count and high viral load values. Among the 30 patients who received antifungals, 16 (53.3%) were cured, 13 (43.3%) died, and one was lost to follow-up. Six patients died prior to therapy. From 1990 to 2018, 63 necropsies of patients with Histoplasma capsulatum infection were performed. Of these patients, 29 (46.0%) were HIV-infected individuals, including 21 (72.4%) who presented disseminated histoplasmosis and 21 (72.4%) who were diagnosed with histoplasmosis at necropsy. The epidemiological, clinical and outcome profiles presented herein are similar to those described elsewhere and reinforce the difficulties that are still present in limited-resource settings where advanced immunodeficiency, combined with severe fungal infection and late patient admissions, is related to poor outcomes.
Collapse
Affiliation(s)
| | - Delio José Mora
- Infectious Diseases Unit, Internal Medicine Department, Triângulo Mineiro Federal University, Mailbox 118, Uberaba, Minas Gerais, 38001-170, Brazil
| | - Anderson Clayton Cardeal
- Infectious Diseases Unit, Internal Medicine Department, Triângulo Mineiro Federal University, Mailbox 118, Uberaba, Minas Gerais, 38001-170, Brazil
| | - Júlio Cesar Berto-Nascimento
- Infectious Diseases Unit, Internal Medicine Department, Triângulo Mineiro Federal University, Mailbox 118, Uberaba, Minas Gerais, 38001-170, Brazil
| | | | | | - Sheila Jorge Adad
- Special Pathology Unit, Triângulo Mineiro Federal University, Uberaba, Minas Gerais, Brazil
| | | | - Mario León Silva-Vergara
- Infectious Diseases Unit, Internal Medicine Department, Triângulo Mineiro Federal University, Mailbox 118, Uberaba, Minas Gerais, 38001-170, Brazil.
| |
Collapse
|
19
|
Sinha S, Agrawal D, Sardana K, Malhotra P. Cutaneous Histoplasmosis: An Unusual Presentation with Nasal Obstruction. Indian Dermatol Online J 2020; 11:612-615. [PMID: 32832454 PMCID: PMC7413458 DOI: 10.4103/idoj.idoj_422_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 10/29/2019] [Accepted: 11/26/2019] [Indexed: 01/19/2023] Open
Abstract
Histoplasmosis is a systemic fungal disease that may be presented with a variety of clinical manifestations, usually as an opportunistic infection in immunocompromised individuals. We present an HIV seropositive patient with a large fleshy growth causing left-sided nasal obstruction, as an unusual presentation. The lesions shrunk dramatically and almost completely on intravenous amphotericin-B lipid complex (ABLC) given for 2 weeks followed by long-term oral itraconazole.
Collapse
Affiliation(s)
- Surabhi Sinha
- Department of Dermatology, Venereology and Leprology, Dr. RML Hospital and PGIMER, New Delhi, India
| | - Diksha Agrawal
- Department of Dermatology, Venereology and Leprology, Dr. RML Hospital and PGIMER, New Delhi, India
| | - Kabir Sardana
- Department of Dermatology, Venereology and Leprology, Dr. RML Hospital and PGIMER, New Delhi, India
| | - Purnima Malhotra
- Department of Pathology, Dr. RML Hospital and PGIMER, New Delhi, India
| |
Collapse
|
20
|
Couppié P, Herceg K, Bourne-Watrin M, Thomas V, Blanchet D, Alsibai KD, Louvel D, Djossou F, Demar M, Blaizot R, Adenis A. The Broad Clinical Spectrum of Disseminated Histoplasmosis in HIV-Infected Patients: A 30 Years' Experience in French Guiana. J Fungi (Basel) 2019; 5:jof5040115. [PMID: 31847076 PMCID: PMC6958354 DOI: 10.3390/jof5040115] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 09/12/2019] [Accepted: 09/17/2019] [Indexed: 12/22/2022] Open
Abstract
Histoplasmosis is a common but neglected AIDS-defining condition in endemic areas for Histoplasma capsulatum. At the advanced stage of HIV infection, the broad spectrum of clinical features may mimic other frequent opportunistic infections such as tuberculosis and makes it difficult for clinicians to diagnose histoplasmosis in a timely manner. Diagnosis of histoplasmosis is difficult and relies on a high index of clinical suspicion along with access to medical mycology facilities with the capacity to implement conventional diagnostic methods (direct examination and culture) in a biosafety level 3 laboratory as well as indirect diagnostic methods (molecular biology, antibody, and antigen detection tools in tissue and body fluids). Time to initiation of effective antifungals has an impact on the patient's prognosis. The initiation of empirical antifungal treatment should be considered in endemic areas for Histoplasma capsulatum and HIV. Here, we report on 30 years of experience in managing HIV-associated histoplasmosis based on a synthesis of clinical findings in French Guiana with considerations regarding the difficulties in determining its differential diagnosis with other opportunistic infections.
Collapse
Affiliation(s)
- Pierre Couppié
- Service de Dermatologie-Vénérologie, Centre Hospitalier de Cayenne, Avenue des Flamboyants, BP 6006, 97300 Cayenne, France; (M.B.-W.); (R.B.)
- Equipe EA3593, Ecosystèmes Amazoniens et Pathologie Tropicale, Université de Guyane, 97300 Cayenne, France; (K.H.); (D.B.); (F.D.); (M.D.); (A.A.)
- Correspondence: ; Tel.: +594-594-395325; Fax: +594-594-395041
| | - Katarina Herceg
- Equipe EA3593, Ecosystèmes Amazoniens et Pathologie Tropicale, Université de Guyane, 97300 Cayenne, France; (K.H.); (D.B.); (F.D.); (M.D.); (A.A.)
| | - Morgane Bourne-Watrin
- Service de Dermatologie-Vénérologie, Centre Hospitalier de Cayenne, Avenue des Flamboyants, BP 6006, 97300 Cayenne, France; (M.B.-W.); (R.B.)
| | - Vincent Thomas
- Service de Médecine B, Centre Hospitalier de Cayenne, 97300 Cayenne, France; (V.T.); (D.L.)
| | - Denis Blanchet
- Equipe EA3593, Ecosystèmes Amazoniens et Pathologie Tropicale, Université de Guyane, 97300 Cayenne, France; (K.H.); (D.B.); (F.D.); (M.D.); (A.A.)
- Laboratoire de Parasitologie-Mycologie, Centre Hospitalier de Cayenne, 97300 Cayenne, France
| | - Kinan Drak Alsibai
- Laboratoire d’Anatomie et Cytologie Pathologique, Centre Hospitalier de Cayenne, 97300 Cayenne, France;
| | - Dominique Louvel
- Service de Médecine B, Centre Hospitalier de Cayenne, 97300 Cayenne, France; (V.T.); (D.L.)
| | - Felix Djossou
- Equipe EA3593, Ecosystèmes Amazoniens et Pathologie Tropicale, Université de Guyane, 97300 Cayenne, France; (K.H.); (D.B.); (F.D.); (M.D.); (A.A.)
- Unité de Maladies Infectieuses et Tropicales, Centre Hospitalier de Cayenne, 97300 Cayenne, France
| | - Magalie Demar
- Equipe EA3593, Ecosystèmes Amazoniens et Pathologie Tropicale, Université de Guyane, 97300 Cayenne, France; (K.H.); (D.B.); (F.D.); (M.D.); (A.A.)
- Laboratoire de Parasitologie-Mycologie, Centre Hospitalier de Cayenne, 97300 Cayenne, France
| | - Romain Blaizot
- Service de Dermatologie-Vénérologie, Centre Hospitalier de Cayenne, Avenue des Flamboyants, BP 6006, 97300 Cayenne, France; (M.B.-W.); (R.B.)
- Equipe EA3593, Ecosystèmes Amazoniens et Pathologie Tropicale, Université de Guyane, 97300 Cayenne, France; (K.H.); (D.B.); (F.D.); (M.D.); (A.A.)
| | - Antoine Adenis
- Equipe EA3593, Ecosystèmes Amazoniens et Pathologie Tropicale, Université de Guyane, 97300 Cayenne, France; (K.H.); (D.B.); (F.D.); (M.D.); (A.A.)
- Centre d’Investigation Clinique Antilles Guyane, Inserm CIC 1424, Centre Hospitalier de Cayenne, 97300 Cayenne, France
| |
Collapse
|
21
|
Linder KA, Kauffman CA. Histoplasmosis: Epidemiology, Diagnosis, and Clinical Manifestations. CURRENT FUNGAL INFECTION REPORTS 2019. [DOI: 10.1007/s12281-019-00341-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
22
|
Almeida MA, Damasceno LS, Pizzini CV, Muniz MDM, Almeida-Paes R, Zancopé-Oliveira RM. Role of western blot assay for the diagnosis of histoplasmosis in AIDS patients from a National Institute of Infectious Diseases in Rio de Janeiro, Brazil. Mycoses 2019; 62:261-267. [PMID: 30561870 DOI: 10.1111/myc.12877] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 12/07/2018] [Accepted: 12/10/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND Histoplasmosis is a frequent fungal infection in HIV/AIDS patients, with high morbimortality rates when diagnosis and treatment are delayed. Antibody detection, which is faster than the gold standard culture test, hastens the laboratory investigation. OBJECTIVES To evaluate the role of WB for antibody detection in the diagnosis of histoplasmosis among HIV/AIDS patients. PATIENTS AND METHODS Fifty patients with proven or probable histoplasmosis were included. Clinical, epidemiological and laboratory data were described in the same population after a review of their medical records. WB was performed using deglycosylated histoplasmin. RESULTS About 82% of patients were adult males and the mean age was 39.3 years. CD4+ T lymphocyte count less than 150 cells/mm3 was observed in 62% patients. Antibodies against Histoplasma capsulatum M antigen were detected in 62% of patients, and against both M and H antigens in 28% of individuals. Sera from 10% of patients were nonreactive. Histoplasmosis was the first opportunistic infection in 38% of the cases. Disseminated and pulmonary histoplasmosis occurred in 84% and 16% of patients, respectively. The overall mortality was 16%. CONCLUSION WB could be useful for the histoplasmosis diagnosis in HIV/AIDS patients because of its easefulness and good sensitivity in a population where antibody production is hampered.
Collapse
Affiliation(s)
- Marcos Abreu Almeida
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil
| | | | - Cláudia Vera Pizzini
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil
| | - Mauro de Medeiros Muniz
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil
| | - Rodrigo Almeida-Paes
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil
| | | |
Collapse
|
23
|
Wilson AG, KuKanich KS, Hanzlicek AS, Payton ME. Clinical signs, treatment, and prognostic factors for dogs with histoplasmosis. J Am Vet Med Assoc 2018; 252:201-209. [PMID: 29319442 DOI: 10.2460/javma.252.2.201] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine the clinical manifestations of histoplasmosis in a large sample of dogs, compare outcomes achieved with fluconazole versus itraconazole, and identify variables available at the time of diagnosis with prognostic value. DESIGN Retrospective case series with nested cohort study. ANIMALS 79 dogs with confirmed histoplasmosis evaluated at 2 veterinary teaching hospitals from 1999 through 2015. PROCEDURES Medical records were reviewed and data extracted regarding clinical signs at evaluation, physical examination findings, clinical laboratory values, other diagnostic test results, treatments, and outcomes. Data were compared between antifungal agents used (fluconazole or itraconazole) and between other variables. RESULTS Various breeds were represented. Working and herding breeds had mostly disseminated histoplasmosis, and toy breeds had mostly the gastrointestinal form. The diagnosis was often achieved with noninvasive techniques, such as cytologic evaluation of rectal scrape samples (n = 24) or blood films (15). Clinical remission was achieved in 16 of 25 (64%) dogs receiving fluconazole and 17 of 24 (71%) dogs receiving itraconazole. No differences were identified between antifungal agents in survival, clinical remission, or disease relapse rates. Identified negative prognostic factors included Great Pyrenees breed, dyspnea, need for oxygen supplementation, icterus, palpable abdominal organomegaly, anemia, thrombocytopenia, hypercalcemia, high serum alkaline phosphatase activity, and hyperbilirubinemia, whereas diarrhea was a positive prognostic factor. CONCLUSIONS AND CLINICAL RELEVANCE Findings suggested that histoplasmosis should be considered in a sick dog of any breed in an endemic area. Clinical signs may be nonspecific. Diagnosis may often be possible with noninvasive and inexpensive tests. Either fluconazole or itraconazole may be an effective treatment option.
Collapse
|
24
|
McGill JE, Hanzlicek AS, Kukanich KS, Norsworthy GD, Cook AK. Pretreatment Histoplasma capsulatum urine enzymatic immunoassay concentrations do not correlate with outcome but may be influenced by renal function in cats with histoplasmosis. J Feline Med Surg 2018; 20:1177-1179. [PMID: 29513156 PMCID: PMC11104216 DOI: 10.1177/1098612x18761440] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES The objective of this study was to determine if urine Histoplasma antigen (HAg) enzyme immunoassay (EIA) concentrations at the time of diagnosis and prior to the administration of antifungal agents are predictive of outcome for cats infected with Histoplasma capsulatum and to determine if compromised renal function affects urine HAg EIA measurements. METHODS Medical records at four institutions were searched to identify cats diagnosed with histoplasmosis between April 2012 and December 2015. Pretreatment urine Histoplasma EIA values were recorded, along with patient signalment, serum creatinine concentration, urine specific gravity, site(s) of infection and survival data. RESULTS Pretreatment urine HAg EIA measurements were available for 50 cats, and ranged from 0-19.1 ng/ml (median 6.3 ng/ml). Thirty-five cats were alive at day 180, 12 had died or were euthanized (median survival time 24 days; range 2-124 days) and three were lost to follow-up. The median urine HAg EIA at the time of diagnosis for cats alive at 6 months was 5 ng/ml (range 0-19.1); this was similar to findings for the non-survivors (median 7.29 ng/ml; range 0.78-19.1; P = 0.54). Surviving cats were significantly younger (mean age 6.9 years) than non-survivors (mean age 9.9 years; P = 0.03) but median body weights (3.8 kg vs 3.6 kg) and rates of pulmonary involvement (22/35 vs 9/12) were similar for the two groups. Median urine HAg EIA concentration was lower in cats with evidence of renal compromise than cats with acceptable renal function (0.54 ng/ml vs 7.2 ng/ml; P <0.013). CONCLUSIONS AND RELEVANCE Urine HAg EIA concentrations at the time of diagnosis are not predictive of outcome in cats with histoplasmosis and should not be used as a prognostic indicator in this species. Renal function may influence urine HAg EIA concentrations in cats; further investigation is needed to see if concurrent kidney disease impacts test sensitivity.
Collapse
Affiliation(s)
- Jennifer E McGill
- Department of Veterinary Clinical Sciences, Louisiana State University, Baton Rouge, LA, USA
| | - Andrew S Hanzlicek
- Center for Veterinary Health Sciences, Oklahoma State University, Stillwater, OK, USA
| | - Kate S Kukanich
- Department of Clinical Sciences, Kansas State University, Manhattan, KS, USA
| | | | - Audrey K Cook
- Department of Small Animal Clinical Sciences, Texas A&M University, College Station, TX, USA
| |
Collapse
|
25
|
Silva Junior GBD, Parente Filho SLA, Soares DDS, Alencar RDND, Peixoto TTT, Nogueira IS, Oliveira Filho AMPD, Menezes FH, Cavalcante MG, Pires Neto RDJ, Daher EDF. Acute kidney injury and other factors associated with mortality in hiv-infected patients. ACTA ACUST UNITED AC 2018; 64:509-517. [PMID: 30304308 DOI: 10.1590/1806-9282.64.06.509] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 11/02/2017] [Indexed: 11/21/2022]
Abstract
OBJECTIVE HIV-related mortality is still high, especially in developed countries. The aim of this study is to investigate factors associated to death in HIV-infected patients. METHODS This is a cross-sectional study with all HIV adult patients admitted to a tertiary infectious diseases hospital in Fortaleza, Northeast Brazil, from January 2013 to December 2014. Patients were divided into two groups: survivors and non-survivors. Demo-graphical, clinical and laboratory data were compared and a logistic regression was performed in order to investigate risk factors for death. P values ≤0.05 were considered statistically significant. RESULTS A total of 200 patients with mean age of 39 years were including in the study, 69.5% males. Fifteen patients (7.5%) died. Non-survivors presented a higher percentage of males (93.3 vs. 67.3%, p = 0.037). Non-survivors presented AKI (73.3 vs. 10.3%, p < 0.001), liver dysfunction (33.3 vs. 11.5, p = 0.031), dyspnea (73.3 vs. 33.0%, p = 0.002) and disorientation (33.3 vs. 12.4%, p = 0.025) more frequently. Non-survivors also had higher levels of urea (73.8 ± 52.7vs. 36.1 ± 29.1 mg/dL, p < 0.001), creatinine (1.98 ± 1.65 vs. 1.05 ± 1.07 mg/dL, p < 0.001), aspartate aminotransferase (130.8 vs. 84.8 U/L, p = 0.03), alanine aminotransferase (115.6 vs. 85.4 U/L, p = 0.045) and lactate dehydrogenase (LDH) (1208 vs. 608 U/L, p = 0.012), as well as lower levels of bicarbonate (18.0 ± 4.7 vs. 21.6 ± 4.6 mEq/L, p = 0.016) and PCO2 (27.8 ± 7.7 vs. 33.0 ± 9.3 mmHg, p = 0.05). In multivariate analysis, disorientation (p = 0.035, OR = 5.523, 95%CI = 1.130 - 26.998), dyspnoea (p = 0.046, OR = 4.064, 95%CI = 1.028 - 16.073), AKI (p < 0.001, OR = 18.045, 95%CI = 4.308 - 75.596) and disseminated histoplasmosis (p = 0.016, OR = 12.696, 95%CI = 1.618 - 99.646) and LDH > 1000 U/L (p = 0.038, OR = 4.854, 95%CI = 1.093 - 21.739) were risk factors for death.]CONCLUSION: AKI and disseminated histoplasmosis (DH) were the main risk factors for death in the studied population. Neurologic and respiratory impairment as well as higher levels of LDH also increased mortality in HIV-infected patients.
Collapse
Affiliation(s)
- Geraldo Bezerra da Silva Junior
- School of Medicine, Public Health and Medical Sciences Post-Graduation Programs, Health Sciences Center, University of Fortaleza. Fortaleza, Ceará, Brasil
| | | | - Douglas de Sousa Soares
- Department of Internal Medicine, School of Medicine, Federal University of Ceará.Fortaleza, Ceará, Brasil
| | | | - Tiago Tomaz Teles Peixoto
- Department of Internal Medicine, School of Medicine, Federal University of Ceará.Fortaleza, Ceará, Brasil
| | - Isadora Sales Nogueira
- Department of Internal Medicine, School of Medicine, Federal University of Ceará.Fortaleza, Ceará, Brasil
| | | | - Fernanda Holanda Menezes
- Department of Internal Medicine, School of Medicine, Federal University of Ceará.Fortaleza, Ceará, Brasil
| | - Malena Gadelha Cavalcante
- School of Medicine, Medical Sciences and PharmacologyPost-Graduation Programs, Federal University of Ceará. Fortaleza, Ceará, Brasil
| | - Roberto da Justa Pires Neto
- Department of Community Health, Public Health Post-Graduation Program, School of Medicine, Federal University of Ceará. Fortaleza, Ceará, Brasil
| | - Elizabeth de Francesco Daher
- Department of Internal Medicine, School of Medicine, Federal University of Ceará.Fortaleza, Ceará, Brasil.,School of Medicine, Medical Sciences and PharmacologyPost-Graduation Programs, Federal University of Ceará. Fortaleza, Ceará, Brasil
| |
Collapse
|
26
|
Ludwig HC, Hanzlicek AS, KuKanich KS, Payton ME. Candidate prognostic indicators in cats with histoplasmosis treated with antifungal therapy. J Feline Med Surg 2018; 20:985-996. [PMID: 29256743 PMCID: PMC11129244 DOI: 10.1177/1098612x17746523] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/23/2017] [Indexed: 06/15/2024]
Abstract
Objectives The aim of this study was to retrospectively identify candidate prognostic indicators in cats with histoplasmosis treated with antifungal therapy. Methods Medical records of cats diagnosed with histoplasmosis were reviewed. Candidate prognostic indicators were assessed for an association with survival to hospital discharge and survival to 1 and 6 months after diagnosis. Potential indicators included easily obtained data at the time of the initial hospital visit derived from cat signalment, historical information, physical examination, laboratory data, form of disease and initial treatment. Results Approximately 88% of cats survived to discharge, with 77% and 67% surviving to 1 and 6 months, respectively. Clinical variables significantly associated with death at more than one outcome time point included the presence of dyspnea, adventitial lung sounds, fungemia, neurologic disease, neutropenia, lymphopenia, multiple cytopenias (anemia, neutropenia, thrombocytopenia), hyperbilirubinemia and increased creatinine kinase activity. Cats that did not survive were more likely to have received corticosteroids, oxygen supplementation and required hospitalization. In addition, cats that did not survive required significantly longer hospitalization. There was no significant difference between initial antifungal drug and survival. Conclusions and relevance Potential prognostic indicators were associated with more severe respiratory, hepatic, hematologic or neurologic disease. Prospective investigation concerning clinical indicators of disease severity of these body systems is indicated.
Collapse
Affiliation(s)
- Hilary C Ludwig
- Department of Veterinary Clinical Sciences, Oklahoma State University, Stillwater, OK, USA
| | - Andrew S Hanzlicek
- Department of Veterinary Clinical Sciences, Oklahoma State University, Stillwater, OK, USA
| | - Kate S KuKanich
- Department of Clinical Sciences, Kansas State University, Manhattan, KS, USA
| | - Mark E Payton
- Department of Statistics, Oklahoma State University, Stillwater, OK, USA
| |
Collapse
|
27
|
Boigues BCS, Paniago AMM, Lima GME, Nunes MDO, Uehara SNDO. Clinical outcomes and risk factors for death from disseminated histoplasmosis in patients with AIDS who visited a high-complexity hospital in Campo Grande, MS, Brazil. Rev Soc Bras Med Trop 2018; 51:155-161. [PMID: 29768547 DOI: 10.1590/0037-8682-0369-2017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 03/20/2018] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Disseminated histoplasmosis (DH) is a systemic mycosis caused by Histoplasma capsulatum (H. capsulatum) and is characterized by progressive and fatal evolution in immunocompromised patients. Moreover, it is considered an AIDS-defining disease. METHODS We performed an observational, analytical, retrospective study to identify the clinical outcomes and risk factors for death from DH in patients with AIDS at an infectious diseases service facility in Brazil between September 2011 and July 2016. Patients with a positive serology for HIV and DH were diagnosed via direct examination and/or positive cultures for H. capsulatum. RESULTS Twenty-three patients were included in this study. Approximately, 82.6% were men, with a mean age of 41.0±11.5 years, and 52.2% had a concomitant diagnosis of AIDS and DH. The median CD4+ T cell count was 19 cells/mm3, and 56.5% of the patients died. The most frequently observed symptoms were fever, dyspnea, and skin lesions. On the basis of a comparative analysis of those who died and survived, the absence of splenomegaly and hepatomegaly and the presence of H. capsulatum in the peripheral blood were considered as risk factors for death. Those who died had a higher leukocyte count; CRP, urea, and lactate dehydrogenase levels; AST index; and international normalized ratio prothrombin time. The serum total protein and albumin levels of the patients were lower. CONCLUSIONS The mortality rate for DH is high among severely immunocompromised patients with AIDS. The risk factors for death were those traditionally associated with blood dyscrasia, inflammatory activity, as well as increased renal and nutritional impairment.
Collapse
Affiliation(s)
| | | | | | - Maina de Oliveira Nunes
- Laboratório de Micologia Médica, Universidade Federal de Mato Grosso do Sul, Campo Grande, MS, Brasil
| | | |
Collapse
|
28
|
Samayoa B, Roy M, Cleveland AA, Medina N, Lau-Bonilla D, Scheel CM, Gomez BL, Chiller T, Arathoon E. High Mortality and Coinfection in a Prospective Cohort of Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome Patients with Histoplasmosis in Guatemala. Am J Trop Med Hyg 2017; 97:42-48. [PMID: 28719316 DOI: 10.4269/ajtmh.16-0009] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Histoplasmosis is one of the most common and deadly opportunistic infections among persons living with human immunodeficiency virus (HIV)/acquired immune deficiency syndrome in Latin America, but due to limited diagnostic capacity in this region, few data on the burden and clinical characteristics of this disease exist. Between 2005 and 2009, we enrolled patients ≥ 18 years of age with suspected histoplasmosis at a hospital-based HIV clinic in Guatemala City. A case of suspected histoplasmosis was defined as a person presenting with at least three of five clinical or radiologic criteria. A confirmed case of histoplasmosis was defined as a person with a positive culture or urine antigen test for Histoplasma capsulatum. Demographic and clinical data were also collected and analyzed. Of 263 enrolled as suspected cases of histoplasmosis, 101 (38.4%) were confirmed cases. Median time to diagnosis was 15 days after presentation (interquartile range [IQR] = 5-23). Crude overall mortality was 43.6%; median survival time was 19 days (IQR = 4-69). Mycobacterial infection was diagnosed in 70 (26.6%) cases; 26 (25.7%) histoplasmosis cases were coinfected with mycobacteria. High mortality and short survival time after initial symptoms were observed in patients with histoplasmosis. Mycobacterial coinfection diagnoses were frequent, highlighting the importance of pursuing diagnoses for both diseases.
Collapse
Affiliation(s)
- Blanca Samayoa
- Facultad de Ciencias Químicas y Farmacia, Universidad de San Carlos de Guatemala, Guatemala, Guatemala.,Clinica Familiar "Luis Ángel García," Hospital General San Juan de Dios/Asociación de Salud Integral, Guatemala, Guatemala
| | - Monika Roy
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Narda Medina
- Clinica Familiar "Luis Ángel García," Hospital General San Juan de Dios/Asociación de Salud Integral, Guatemala, Guatemala
| | - Dalia Lau-Bonilla
- Clinica Familiar "Luis Ángel García," Hospital General San Juan de Dios/Asociación de Salud Integral, Guatemala, Guatemala
| | | | - Beatriz L Gomez
- Corporación para Investigaciones Biológicas, Medellín, Colombia.,School of Medicine, Universidad del Rosario, Bogota, Colombia
| | - Tom Chiller
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Eduardo Arathoon
- Clinica Familiar "Luis Ángel García," Hospital General San Juan de Dios/Asociación de Salud Integral, Guatemala, Guatemala
| |
Collapse
|
29
|
Caceres DH, Tobón AM, Cleveland AA, Scheel CM, Berbesi DY, Ochoa J, Restrepo A, Brandt ME, Chiller T, Gómez BL. Clinical and Laboratory Profile of Persons Living with Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome and Histoplasmosis from a Colombian Hospital. Am J Trop Med Hyg 2016; 95:918-924. [PMID: 27481056 PMCID: PMC5062801 DOI: 10.4269/ajtmh.15-0837] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Accepted: 05/12/2016] [Indexed: 11/07/2022] Open
Abstract
Histoplasmosis is common among persons living with human immunodeficiency virus/acquired immune deficiency syndrome (PLWHA) in Latin America, but its diagnosis is difficult and often nonspecific. We conducted prospective screening for histoplasmosis among PLWHA with signs or symptoms suggesting progressive disseminated histoplasmosis (PDH) and hospitalized in Hospital La María in Medellín, Colombia. The study's aim was to obtain a clinical and laboratory profile of PLWHA with PDH. During 3 years (May 2008 to August 2011), we identified 89 PLWHA hospitalized with symptoms suggestive of PDH, of whom 45 (51%) had histoplasmosis. We observed tuberculosis (TB) coinfection in a large proportion of patients with PDH (35%), so all analyses were performed adjusting for this coinfection and, alternatively, excluding histoplasmosis patients with TB. Results showed that the patients with PDH were more likely to have Karnofsky score ≤ 30 (prevalence ratio [PR] = 1.98, 95% confidence interval [CI] = 0.97-4.06), liver compromised with hepatomegaly and/or splenomegaly (PR = 1.77, CI = 1.03-3.06) and elevation in serum of alanine aminotransferase and aspartate aminotransferase to values > 40 mU/mL (PR = 2.06, CI = 1.09-3.88 and PR = 1.53, CI = 0.99-2.35, respectively). Using multiple correspondence analyses, we identified in patients with PDH a profile characterized by the presence of constitutional symptoms, namely weight loss and Karnofsky classification ≤ 30, gastrointestinal manifestations with alteration of liver enzymes and hepatosplenomegaly and/or splenomegaly, skin lesions, and hematological alterations. Study of the profiles is no substitute for laboratory diagnostics, but identifying clinical and laboratory indicators of PLWHA with PDH should allow development of strategies for reducing the time to diagnosis and thus mortality caused by Histoplasma capsulatum.
Collapse
Affiliation(s)
- Diego H Caceres
- Medical and Experimental Mycology Group, Corporación para Investigaciones Biológicas (CIB), Medellín, Colombia. School of Medicine, Universidad CES, Medellín, Colombia
| | - Angela M Tobón
- Medical and Experimental Mycology Group, Corporación para Investigaciones Biológicas (CIB), Medellín, Colombia. Hospital La María, Medellín, Colombia
| | | | - Christina M Scheel
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Jesús Ochoa
- Facultad Nacional de Salud Pública, Universidad de Antioquia, Medellín, Colombia
| | - Angela Restrepo
- Medical and Experimental Mycology Group, Corporación para Investigaciones Biológicas (CIB), Medellín, Colombia
| | - Mary E Brandt
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Tom Chiller
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Beatriz L Gómez
- Medical and Experimental Mycology Group, Corporación para Investigaciones Biológicas (CIB), Medellín, Colombia. School of Medicine and Health Sciences, Universidad del Rosario, Bogota, Colombia.
| |
Collapse
|
30
|
Silva TC, Treméa CM, Zara ALSA, Mendonça AF, Godoy CSM, Costa CR, Souza LKH, Silva MRR. Prevalence and lethality among patients with histoplasmosis and AIDS in the Midwest Region of Brazil. Mycoses 2016; 60:59-65. [PMID: 27625302 DOI: 10.1111/myc.12551] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 05/30/2016] [Accepted: 07/19/2016] [Indexed: 11/29/2022]
Abstract
Histoplasmosis is a systemic mycosis that is considered an important public health problem. In this work, we performed a descriptive, observational, cross-sectional and retrospective study with a secondary data analysis of medical records from 2000 to 2012 at a tertiary hospital. The study sample consisted of 275 patients with laboratory-confirmed Disseminated Histoplasmosis (DH)/AIDS. The results showed that the prevalence of DH associated with AIDS was 4.4%. The majority of patients were young adult men with fever in 84.2%, cough in 63.4%, weight loss in 63.1%, diarrhoea in 44.8% and skin manifestations in 27.6% of patients. In the overall cohort, the CD4 counts were low, but not significantly different in survivors and non-survivors. Higher levels of urea and lower levels of haemoglobin and platelets were observed in non-survivor patients (<.05). The global lethality was 71.3% (196/275). The results with high prevalence and lethality highlight the need to adopt measures to facilitate early diagnosis, proper treatment and improved prognosis.
Collapse
Affiliation(s)
- Thaísa C Silva
- Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiania, Goiás, Brazil
| | - Carolina M Treméa
- Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiania, Goiás, Brazil
| | - Ana Laura S A Zara
- Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiania, Goiás, Brazil
| | | | - Cássia S M Godoy
- Hospital of Tropical Diseases "Dr. Anuar Auad", Goiania, Goiás, Brazil
| | - Carolina R Costa
- Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiania, Goiás, Brazil
| | - Lúcia K H Souza
- Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiania, Goiás, Brazil
| | - Maria R R Silva
- Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiania, Goiás, Brazil
| |
Collapse
|
31
|
Chitin recognition via chitotriosidase promotes pathologic type-2 helper T cell responses to cryptococcal infection. PLoS Pathog 2015; 11:e1004701. [PMID: 25764512 PMCID: PMC4357429 DOI: 10.1371/journal.ppat.1004701] [Citation(s) in RCA: 133] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Accepted: 01/23/2015] [Indexed: 12/13/2022] Open
Abstract
Pulmonary mycoses are often associated with type-2 helper T (Th2) cell responses. However, mechanisms of Th2 cell accumulation are multifactorial and incompletely known. To investigate Th2 cell responses to pulmonary fungal infection, we developed a peptide-MHCII tetramer to track antigen-specific CD4+ T cells produced in response to infection with the fungal pathogen Cryptococcus neoformans. We noted massive accruement of pathologic cryptococcal antigen-specific Th2 cells in the lungs following infection that was coordinated by lung-resident CD11b+ IRF4-dependent conventional dendritic cells. Other researchers have demonstrated that this dendritic cell subset is also capable of priming protective Th17 cell responses to another pulmonary fungal infection, Aspergillus fumigatus. Thus, higher order detection of specific features of fungal infection by these dendritic cells must direct Th2 cell lineage commitment. Since chitin-containing parasites commonly elicit Th2 responses, we hypothesized that recognition of fungal chitin is an important determinant of Th2 cell-mediated mycosis. Using C. neoformans mutants or purified chitin, we found that chitin abundance impacted Th2 cell accumulation and disease. Importantly, we determined Th2 cell induction depended on cleavage of chitin via the mammalian chitinase, chitotriosidase, an enzyme that was also prevalent in humans experiencing overt cryptococcosis. The data presented herein offers a new perspective on fungal disease susceptibility, whereby chitin recognition via chitotriosidase leads to the initiation of harmful Th2 cell differentiation by CD11b+ conventional dendritic cells in response to pulmonary fungal infection. Humans often inhale potentially pathogenic fungi in the environment. While CD4+ helper T (Th) cells are required for protection against invasive disease, a subset of Th cells, called Th2 cells, are associated with increased mortality and allergy/asthma morbidity. Our study aimed to unravel the cellular and molecular basis of pulmonary Th2 cell induction in response to lethal infection with Cryptococcus neoformans. Antigen-presenting cells coordinate naïve Th cell priming and differentiation, but the precise leukocyte responsible for Th2 cell expansion to pulmonary cryptococcal infection has not been determined. Using an experimental mouse model of pulmonary cryptococcosis, we show that a subset of lung-resident dendritic cells is uniquely required for Th2 cell induction. We additionally sought to identify the molecular signal received by the host that allows dendritic cells to selectively induce Th2 cells. Since parasites and fungi elicit Th2 cell responses and both produce chitin, a molecule not found in vertebrates, we hypothesized that recognition of fungal chitin is a determinant of fungal disease. Here, we demonstrate that C. neoformans chitin and the host-derived chitinase, chitotriosidase, promote Th2 cell accumulation and disease. These findings highlight a promising target of next generation therapies aimed at limiting immunopathology caused by pulmonary fungal infection.
Collapse
|
32
|
Putot A, Perrin S, Jolivet A, Vantilcke V. HIV-associated disseminated histoplasmosis in western French Guiana, 2002-2012. Mycoses 2015; 58:160-6. [DOI: 10.1111/myc.12293] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Revised: 11/30/2014] [Accepted: 12/16/2014] [Indexed: 11/28/2022]
Affiliation(s)
- A. Putot
- Department of Medicine; Centre Hospitalier de l'Ouest Guyanais; Saint Laurent du Maroni French Guiana
| | - S. Perrin
- Department of Medicine; Centre Hospitalier de l'Ouest Guyanais; Saint Laurent du Maroni French Guiana
| | - A. Jolivet
- Department of Public Health; Centre Hospitalier de l'Ouest Guyanais; Saint Laurent du Maroni French Guiana
| | - V. Vantilcke
- Department of Medicine; Centre Hospitalier de l'Ouest Guyanais; Saint Laurent du Maroni French Guiana
| |
Collapse
|
33
|
Nacher M, Adenis A, Sambourg E, Huber F, Abboud P, Epelboin L, Mosnier E, Vantilcke V, Dufour J, Djossou F, Demar M, Couppié P. Histoplasmosis or tuberculosis in HIV-infected patients in the amazon: what should be treated first? PLoS Negl Trop Dis 2014; 8:e3290. [PMID: 25474641 PMCID: PMC4256267 DOI: 10.1371/journal.pntd.0003290] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
- Mathieu Nacher
- Centre d′Investigation Clinique Antilles Guyane, Inserm CIC1424, Centre Hospitalier de Cayenne, Cayenne, French Guiana, France
- Equipe EA3593, Ecosystèmes amazoniens et Pathologie Tropicale, Université de la Guyane, Cayenne, French Guiana, France
- * E-mail:
| | - Antoine Adenis
- Centre d′Investigation Clinique Antilles Guyane, Inserm CIC1424, Centre Hospitalier de Cayenne, Cayenne, French Guiana, France
- Equipe EA3593, Ecosystèmes amazoniens et Pathologie Tropicale, Université de la Guyane, Cayenne, French Guiana, France
| | - Emilie Sambourg
- Equipe EA3593, Ecosystèmes amazoniens et Pathologie Tropicale, Université de la Guyane, Cayenne, French Guiana, France
- Service de Dermatologie Vénérologie, Centre Hospitalier de Cayenne, Cayenne, French Guiana, France
| | - Florence Huber
- Hôpital de Jour Adultes, Consultations Spécialisées, Centre Hospitalier de Cayenne, Cayenne, French Guiana, France
| | - Philippe Abboud
- Equipe EA3593, Ecosystèmes amazoniens et Pathologie Tropicale, Université de la Guyane, Cayenne, French Guiana, France
- Unité des Maladies Infectieuses et Tropicales, Centre Hospitalier de Cayenne, Cayenne, French Guiana, France
| | - Loïc Epelboin
- Equipe EA3593, Ecosystèmes amazoniens et Pathologie Tropicale, Université de la Guyane, Cayenne, French Guiana, France
- Unité des Maladies Infectieuses et Tropicales, Centre Hospitalier de Cayenne, Cayenne, French Guiana, France
| | - Emilie Mosnier
- Unité des Maladies Infectieuses et Tropicales, Centre Hospitalier de Cayenne, Cayenne, French Guiana, France
- Département des centres délocalisés de prévention et de soins, Centre Hospitalier de Cayenne, Cayenne, French Guiana, France
| | - Vincent Vantilcke
- Service de Médecine Interne, Centre Hospitalier de l′Ouest Guyanais, Saint Laurent du Maroni, French Guiana, France
| | - Julie Dufour
- Equipe EA3593, Ecosystèmes amazoniens et Pathologie Tropicale, Université de la Guyane, Cayenne, French Guiana, France
- Service de Dermatologie Vénérologie, Centre Hospitalier de Cayenne, Cayenne, French Guiana, France
| | - Félix Djossou
- Equipe EA3593, Ecosystèmes amazoniens et Pathologie Tropicale, Université de la Guyane, Cayenne, French Guiana, France
- Unité des Maladies Infectieuses et Tropicales, Centre Hospitalier de Cayenne, Cayenne, French Guiana, France
| | - Magalie Demar
- Equipe EA3593, Ecosystèmes amazoniens et Pathologie Tropicale, Université de la Guyane, Cayenne, French Guiana, France
- Laboratoire Hospitalo-Universitaire de Parasitologie-Mycologie, Centre Hospitalier de Cayenne, Cayenne, French Guiana, France
| | - Pierre Couppié
- Equipe EA3593, Ecosystèmes amazoniens et Pathologie Tropicale, Université de la Guyane, Cayenne, French Guiana, France
- Service de Dermatologie Vénérologie, Centre Hospitalier de Cayenne, Cayenne, French Guiana, France
| |
Collapse
|
34
|
[Fever and dyspnea in a Panamanian woman with a bleeding ulcer]. Presse Med 2014; 43:1302-6. [PMID: 25263075 DOI: 10.1016/j.lpm.2014.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Revised: 03/16/2014] [Accepted: 05/15/2014] [Indexed: 11/23/2022] Open
|
35
|
Richaud C, Chandesris MO, Lanternier F, Benzaquen-Forner H, Garcia-Hermoso D, Picard C, Catherinot E, Bougnoux ME, Lortholary O. Imported African histoplasmosis in an immunocompetent patient 40 years after staying in a disease-endemic area. Am J Trop Med Hyg 2014; 91:1011-4. [PMID: 25246691 DOI: 10.4269/ajtmh.13-0731] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Histoplasmosis caused by Histoplasma capsulatum var. duboisii is a rare disease outside central and western Africa. In Europe, all cases are imported. We report a case of an African histoplasmosis with isolated pulmonary involvement in a non-immunocompromised patient that occurred 40 years after his stay in a disease-endemic area. The patient was given itraconazole. (18)F-fluoro-2-deoxy-d-glucose positron emission tomography-computed tomography was used to assess evolution during treatment. The outcome for the patient was favorable.
Collapse
Affiliation(s)
- Clémence Richaud
- Université Paris Descartes, Sorbonne Paris Cité, France; Service des Maladies Infectieuses et Tropicales et Centre d'Infectiologie Necker Pasteur, Service d'Hématologie Adultes, Centre d'Etude des Déficits Immunitaires, et Service de Microbiologie, Hôpital Necker-Enfants-Malades, Assistance Publique-Hôpitaux de Paris, Paris, France; Service de Pneumologie, Hôpital Simone Veil, Eaubonne, France; Institut Pasteur, Unité de Mycologie Moléculaire, Centre National de Référence Mycoses Invasives et Antifongiques, Centre National de la Recherche Scientifique, Unité Recherche Associée 3012, Paris, France; Laboratoire de Génétique Humaine des Maladies Infectieuses, Institut National de la Santé et de la Recherche Médicale Unité 980, Faculté Necker, Fondation IMAGINE, Université Paris Descartes, Paris, France
| | - Marie-Olivia Chandesris
- Université Paris Descartes, Sorbonne Paris Cité, France; Service des Maladies Infectieuses et Tropicales et Centre d'Infectiologie Necker Pasteur, Service d'Hématologie Adultes, Centre d'Etude des Déficits Immunitaires, et Service de Microbiologie, Hôpital Necker-Enfants-Malades, Assistance Publique-Hôpitaux de Paris, Paris, France; Service de Pneumologie, Hôpital Simone Veil, Eaubonne, France; Institut Pasteur, Unité de Mycologie Moléculaire, Centre National de Référence Mycoses Invasives et Antifongiques, Centre National de la Recherche Scientifique, Unité Recherche Associée 3012, Paris, France; Laboratoire de Génétique Humaine des Maladies Infectieuses, Institut National de la Santé et de la Recherche Médicale Unité 980, Faculté Necker, Fondation IMAGINE, Université Paris Descartes, Paris, France
| | - Fanny Lanternier
- Université Paris Descartes, Sorbonne Paris Cité, France; Service des Maladies Infectieuses et Tropicales et Centre d'Infectiologie Necker Pasteur, Service d'Hématologie Adultes, Centre d'Etude des Déficits Immunitaires, et Service de Microbiologie, Hôpital Necker-Enfants-Malades, Assistance Publique-Hôpitaux de Paris, Paris, France; Service de Pneumologie, Hôpital Simone Veil, Eaubonne, France; Institut Pasteur, Unité de Mycologie Moléculaire, Centre National de Référence Mycoses Invasives et Antifongiques, Centre National de la Recherche Scientifique, Unité Recherche Associée 3012, Paris, France; Laboratoire de Génétique Humaine des Maladies Infectieuses, Institut National de la Santé et de la Recherche Médicale Unité 980, Faculté Necker, Fondation IMAGINE, Université Paris Descartes, Paris, France
| | - Hélène Benzaquen-Forner
- Université Paris Descartes, Sorbonne Paris Cité, France; Service des Maladies Infectieuses et Tropicales et Centre d'Infectiologie Necker Pasteur, Service d'Hématologie Adultes, Centre d'Etude des Déficits Immunitaires, et Service de Microbiologie, Hôpital Necker-Enfants-Malades, Assistance Publique-Hôpitaux de Paris, Paris, France; Service de Pneumologie, Hôpital Simone Veil, Eaubonne, France; Institut Pasteur, Unité de Mycologie Moléculaire, Centre National de Référence Mycoses Invasives et Antifongiques, Centre National de la Recherche Scientifique, Unité Recherche Associée 3012, Paris, France; Laboratoire de Génétique Humaine des Maladies Infectieuses, Institut National de la Santé et de la Recherche Médicale Unité 980, Faculté Necker, Fondation IMAGINE, Université Paris Descartes, Paris, France
| | - Dea Garcia-Hermoso
- Université Paris Descartes, Sorbonne Paris Cité, France; Service des Maladies Infectieuses et Tropicales et Centre d'Infectiologie Necker Pasteur, Service d'Hématologie Adultes, Centre d'Etude des Déficits Immunitaires, et Service de Microbiologie, Hôpital Necker-Enfants-Malades, Assistance Publique-Hôpitaux de Paris, Paris, France; Service de Pneumologie, Hôpital Simone Veil, Eaubonne, France; Institut Pasteur, Unité de Mycologie Moléculaire, Centre National de Référence Mycoses Invasives et Antifongiques, Centre National de la Recherche Scientifique, Unité Recherche Associée 3012, Paris, France; Laboratoire de Génétique Humaine des Maladies Infectieuses, Institut National de la Santé et de la Recherche Médicale Unité 980, Faculté Necker, Fondation IMAGINE, Université Paris Descartes, Paris, France
| | - Capucine Picard
- Université Paris Descartes, Sorbonne Paris Cité, France; Service des Maladies Infectieuses et Tropicales et Centre d'Infectiologie Necker Pasteur, Service d'Hématologie Adultes, Centre d'Etude des Déficits Immunitaires, et Service de Microbiologie, Hôpital Necker-Enfants-Malades, Assistance Publique-Hôpitaux de Paris, Paris, France; Service de Pneumologie, Hôpital Simone Veil, Eaubonne, France; Institut Pasteur, Unité de Mycologie Moléculaire, Centre National de Référence Mycoses Invasives et Antifongiques, Centre National de la Recherche Scientifique, Unité Recherche Associée 3012, Paris, France; Laboratoire de Génétique Humaine des Maladies Infectieuses, Institut National de la Santé et de la Recherche Médicale Unité 980, Faculté Necker, Fondation IMAGINE, Université Paris Descartes, Paris, France
| | - Emilie Catherinot
- Université Paris Descartes, Sorbonne Paris Cité, France; Service des Maladies Infectieuses et Tropicales et Centre d'Infectiologie Necker Pasteur, Service d'Hématologie Adultes, Centre d'Etude des Déficits Immunitaires, et Service de Microbiologie, Hôpital Necker-Enfants-Malades, Assistance Publique-Hôpitaux de Paris, Paris, France; Service de Pneumologie, Hôpital Simone Veil, Eaubonne, France; Institut Pasteur, Unité de Mycologie Moléculaire, Centre National de Référence Mycoses Invasives et Antifongiques, Centre National de la Recherche Scientifique, Unité Recherche Associée 3012, Paris, France; Laboratoire de Génétique Humaine des Maladies Infectieuses, Institut National de la Santé et de la Recherche Médicale Unité 980, Faculté Necker, Fondation IMAGINE, Université Paris Descartes, Paris, France
| | - Marie-Elisabeth Bougnoux
- Université Paris Descartes, Sorbonne Paris Cité, France; Service des Maladies Infectieuses et Tropicales et Centre d'Infectiologie Necker Pasteur, Service d'Hématologie Adultes, Centre d'Etude des Déficits Immunitaires, et Service de Microbiologie, Hôpital Necker-Enfants-Malades, Assistance Publique-Hôpitaux de Paris, Paris, France; Service de Pneumologie, Hôpital Simone Veil, Eaubonne, France; Institut Pasteur, Unité de Mycologie Moléculaire, Centre National de Référence Mycoses Invasives et Antifongiques, Centre National de la Recherche Scientifique, Unité Recherche Associée 3012, Paris, France; Laboratoire de Génétique Humaine des Maladies Infectieuses, Institut National de la Santé et de la Recherche Médicale Unité 980, Faculté Necker, Fondation IMAGINE, Université Paris Descartes, Paris, France
| | - Olivier Lortholary
- Université Paris Descartes, Sorbonne Paris Cité, France; Service des Maladies Infectieuses et Tropicales et Centre d'Infectiologie Necker Pasteur, Service d'Hématologie Adultes, Centre d'Etude des Déficits Immunitaires, et Service de Microbiologie, Hôpital Necker-Enfants-Malades, Assistance Publique-Hôpitaux de Paris, Paris, France; Service de Pneumologie, Hôpital Simone Veil, Eaubonne, France; Institut Pasteur, Unité de Mycologie Moléculaire, Centre National de Référence Mycoses Invasives et Antifongiques, Centre National de la Recherche Scientifique, Unité Recherche Associée 3012, Paris, France; Laboratoire de Génétique Humaine des Maladies Infectieuses, Institut National de la Santé et de la Recherche Médicale Unité 980, Faculté Necker, Fondation IMAGINE, Université Paris Descartes, Paris, France
| |
Collapse
|
36
|
Iriart X, Blanchet D, Menard S, Lavergne RA, Chauvin P, Adenis A, Cassaing S, Fillaux J, Magnaval JF, Demar M, Carme B, Bessieres MH, Couppie P, Nacher M, Berry A, Aznar C. A complementary tool for management of disseminated Histoplasma capsulatum var. capsulatum infections in AIDS patients. Int J Med Microbiol 2014; 304:1062-5. [PMID: 25201327 DOI: 10.1016/j.ijmm.2014.07.016] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Revised: 07/21/2014] [Accepted: 07/28/2014] [Indexed: 11/19/2022] Open
Abstract
In South America, disseminated histoplasmosis due to Histoplasma capsulatum var. capsulatum (H. capsulatum), is a severe and frequent opportunistic infection in AIDS patients. In areas outside the USA where specific-Histoplasma antigen detection is not available, the diagnosis is difficult. With the galactomannan antigen (GM) detection, a test commonly used for invasive aspergillosis diagnosis, there is a cross-reactivity with H. capsulatum that can be helpful for the diagnosis of histoplasmosis. The aim of this study was to evaluate the GM detection for the diagnosis of disseminated histoplasmosis in AIDS patients. The performance of the GM detection was evaluated with serum collected in French Guiana where H. capsulatum is highly endemic. Sera from AIDS patients with disseminated histoplasmosis occurring from 2002 to 2009 and from control HIV-positive patients without histoplasmosis were tested with the GM detection and Histoplasma-specific antibody detection (IEP). In 39 AIDS patients with proven disseminated histoplasmosis, the sensitivity of the Histoplasma IEP was only 35.9% and was linked to the TCD4+ lymphocyte level. For the GM detection, the sensitivity (Se) was 76.9% and specificity (Sp) was 100% with the recommended threshold for aspergillosis diagnosis (0.5). The test was more efficient with a threshold of 0.4 (Se: 0.82 [95% CI: 0.66-0.92], Sp: 1.00 [95% CI: 0.86-1.00], LR+: >10, LR-: 0.18). This study confirms that the GM detection can be a surrogate marker for the diagnosis of disseminated histoplasmosis in AIDS patients in endemic areas where Histoplasma EIA is not available.
Collapse
Affiliation(s)
- Xavier Iriart
- Service de Parasitologie-Mycologie, Centre Hospitalier Universitaire de Toulouse, Toulouse, France; INSERM UMR1043/CNRS UMR5282/Université de Toulouse UPS, Centre de Physiopathologie de Toulouse Purpan (CPTP), Toulouse F-31300, France.
| | - Denis Blanchet
- Laboratoire Hospitalier et Universitaire Parasitologie Mycologie, Centre Hospitalier de Cayenne, BP 6006, 97300 Cayenne, French Guiana
| | - Sandie Menard
- INSERM UMR1043/CNRS UMR5282/Université de Toulouse UPS, Centre de Physiopathologie de Toulouse Purpan (CPTP), Toulouse F-31300, France
| | - Rose-Anne Lavergne
- Service de Parasitologie-Mycologie, Centre Hospitalier Universitaire de Toulouse, Toulouse, France; INSERM UMR1043/CNRS UMR5282/Université de Toulouse UPS, Centre de Physiopathologie de Toulouse Purpan (CPTP), Toulouse F-31300, France
| | - Pamela Chauvin
- Service de Parasitologie-Mycologie, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Antoine Adenis
- CIC-EC Antilles-Guyane, CIE 802 Inserm, Centre Hospitalier de Cayenne, BP 6006, 97300 Cayenne, French Guiana
| | - Sophie Cassaing
- Service de Parasitologie-Mycologie, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Judith Fillaux
- Service de Parasitologie-Mycologie, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Jean-François Magnaval
- Service de Parasitologie-Mycologie, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Magalie Demar
- Laboratoire Hospitalier et Universitaire Parasitologie Mycologie, Centre Hospitalier de Cayenne, BP 6006, 97300 Cayenne, French Guiana; Equipe EA 3593 Épidémiologie des Parasitoses et Mycoses Tropicales, Université Antilles Guyane, Campus Saint Denis, Cayenne, French Guiana
| | - Bernard Carme
- Laboratoire Hospitalier et Universitaire Parasitologie Mycologie, Centre Hospitalier de Cayenne, BP 6006, 97300 Cayenne, French Guiana; Equipe EA 3593 Épidémiologie des Parasitoses et Mycoses Tropicales, Université Antilles Guyane, Campus Saint Denis, Cayenne, French Guiana
| | - Marie-Hélène Bessieres
- Service de Parasitologie-Mycologie, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Pierre Couppie
- Service de dermatologie, Centre Hospitalier de Cayenne, BP 6006, 97300 Cayenne, French Guiana; Equipe EA 3593 Épidémiologie des Parasitoses et Mycoses Tropicales, Université Antilles Guyane, Campus Saint Denis, Cayenne, French Guiana
| | - Mathieu Nacher
- CIC-EC Antilles-Guyane, CIE 802 Inserm, Centre Hospitalier de Cayenne, BP 6006, 97300 Cayenne, French Guiana; Equipe EA 3593 Épidémiologie des Parasitoses et Mycoses Tropicales, Université Antilles Guyane, Campus Saint Denis, Cayenne, French Guiana
| | - Antoine Berry
- Service de Parasitologie-Mycologie, Centre Hospitalier Universitaire de Toulouse, Toulouse, France; INSERM UMR1043/CNRS UMR5282/Université de Toulouse UPS, Centre de Physiopathologie de Toulouse Purpan (CPTP), Toulouse F-31300, France
| | - Christine Aznar
- Laboratoire Hospitalier et Universitaire Parasitologie Mycologie, Centre Hospitalier de Cayenne, BP 6006, 97300 Cayenne, French Guiana; Equipe EA 3593 Épidémiologie des Parasitoses et Mycoses Tropicales, Université Antilles Guyane, Campus Saint Denis, Cayenne, French Guiana.
| |
Collapse
|
37
|
|
38
|
Progressive disseminated histoplasmosis in the HIV population in Europe in the HAART era. Case report and literature review. Infection 2014; 42:611-20. [PMID: 24627267 DOI: 10.1007/s15010-014-0611-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2013] [Accepted: 02/28/2014] [Indexed: 12/16/2022]
Abstract
INTRODUCTION In highly endemic areas, up to 20 % of human immunodeficiency virus (HIV)-infected persons will develop progressive disseminated histoplasmosis (PDH). Europe is not endemic to histoplasmosis, and the disease is mainly found in immigrants often co-infected with HIV. METHODS We present a case of a patient with HIV and PDH highlighting the possible diagnostic difficulties that may arise in a non-endemic area and review the literature of histoplasmosis in the context of HIV infection with special focus on Europe. DISCUSSION When cellular immunity wanes (usually at CD4 T-lymphocyte counts <150 cells/μL) histoplasma infection, acquired earlier, can reactivate and disseminate. PDH is an acquired immune deficiency syndrome(AIDS)-defining disease and a life-threatening infection, with a clinical spectrum ranging from an acute, fatal course with lung infiltrates and respiratory failure, shock, coagulopathy and multi-organ failure, to a more subacute disease with focal organ involvement, pancytopenia and hepatosplenomegaly. Mortality rates remain high for untreated patients, but early diagnosis, proper antifungal treatment and early initiation of antiretroviral therapy have improved the prognosis. CONCLUSION European infectious diseases physicians, microbiologists and pathologists must be aware of histoplasmosis, particularly when facing HIV-infected immigrants from endemic areas. This is increasingly important due to migration and travel activities from these areas.
Collapse
|
39
|
Vantilcke V, Boukhari R, Jolivet A, Vautrin C, Misslin C, Adenis A, Nacher M. Fever in hospitalized HIV-infected patients in Western French Guiana: first think histoplasmosis. Int J STD AIDS 2014; 25:656-61. [DOI: 10.1177/0956462413516299] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Accepted: 10/20/2013] [Indexed: 11/16/2022]
Abstract
Summary In Western French Guiana, there was a dramatic increase in HIV prevalence between 1990 and 2000. The present study describes the causes of fever among HIV patients hospitalized in the medical ward of the only hospital in the western part of French Guiana. A retrospective descriptive study was conducted between 1 January 2008 and 30 June 2010 in the department of medicine of Saint Laurent du Maroni Hospital. The main characteristics of 67 patients having presented with fever in the first 48 hours of hospitalization were described. Among patients with CD4 <200/mm3 the main febrile opportunistic infection was disseminated histoplasmosis (41.1%). Among patients with CD4 counts <50/mm3 and fever without focal points 85.7% had disseminated histoplasmosis. Three patients died and all had disseminated histoplasmosis. Disseminated histoplasmosis is the most common febrile opportunistic infection in western French Guiana. Primary prophylaxis with itraconazole among immunocompromised patients seems warranted.
Collapse
Affiliation(s)
- Vincent Vantilcke
- Centre hospitalier de l'ouest Guyanais, service de médecine, Saint Laurent du Maroni, French Guiana
| | - Rachida Boukhari
- Centre hospitalier de l'ouest Guyanais, Laboratoire Polyvalent, Saint Laurent du Maroni, French Guiana
| | - Anne Jolivet
- Centre hospitalier de l'ouest Guyanais, service de médecine, Saint Laurent du Maroni, French Guiana
| | - Cyrille Vautrin
- Centre hospitalier de l'ouest Guyanais, service de médecine, Saint Laurent du Maroni, French Guiana
| | - Caroline Misslin
- Centre hospitalier de l'ouest Guyanais, service de médecine, Saint Laurent du Maroni, French Guiana
| | - Antoine Adenis
- Centre d'investigation clinique épidémiologie clinique Antilles Guyane, INSERM CIC 1424, Centre hospitalier de Cayenne, French Guiana
- Epidemiologie des parasitoses et mycoses tropicales, EA 3593, Université des Antilles et de la Guyane, French Guiana
| | - Mathieu Nacher
- Centre d'investigation clinique épidémiologie clinique Antilles Guyane, INSERM CIC 1424, Centre hospitalier de Cayenne, French Guiana
- Epidemiologie des parasitoses et mycoses tropicales, EA 3593, Université des Antilles et de la Guyane, French Guiana
| |
Collapse
|
40
|
Nacher M, Adenis A, Blanchet D, Vantilcke V, Demar M, Basurko C, Gaubert-Maréchal E, Dufour J, Aznar C, Carme B, Couppié P. Risk factors for disseminated histoplasmosis in a cohort of HIV-infected patients in French Guiana. PLoS Negl Trop Dis 2014; 8:e2638. [PMID: 24498446 PMCID: PMC3907336 DOI: 10.1371/journal.pntd.0002638] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Accepted: 11/27/2013] [Indexed: 11/29/2022] Open
Abstract
Disseminated histoplasmosis is the first AIDS-defining infection in French Guiana. A retrospective cohort study studied predictive factors of disseminated histoplasmosis in HIV-infected patients between 1996 and 2008. Cox proportional hazards models were used. The variables studied were age, sex, last CD4/CD8 count, CD4 nadir, herpes or pneumocystosis, cotrimoxazole and fluconazole use, antiretroviral treatment and the notion of recent initiation of HAART. A total of 1404 patients were followed for 6833 person-years. The variables independently associated with increased incidence of disseminated histoplasmosis were CD4 count<50 per mm3, CD4 count between 50 and 200 per mm3, a CD4 nadir <50 per mm3, CD8 count in the lowest quartile, herpes infection, and recent antiretroviral treatment initiation (less than 6 months). The variables associated with decreased incidence of histoplasmosis were antiretroviral treatment for more than 6 months, fluconazole treatment, and pneumocystosis. There were 13.5% of deaths at 1 month, 17.5% at 3 months, and 22.5% at 6 months after the date of diagnosis of histoplasmosis. The most important predictive factors for death within 6 months of diagnosis were CD4 counts and antiretroviral treatment. The present study did not study environmental/occupational factors but provides predictive factors for disseminated histoplasmosis and its outcome in HIV patients in an Amazonian environment during the HAART era. Disseminated histoplasmosis is the first AIDS-related disease in French Guiana, and probably in the Amazonian area. In order to determine the factors that are associated with histoplasmosis, a retrospective looked at a cohort of HIV-infected patients between 1996 and 2008. Multiple models were used to study the relation of age, sex, last CD4/CD8 count, CD4 nadir, herpes or pneumocystosis, cotrimoxazole and fluconazole use, antiretroviral treatment and the notion of recent initiation of antiretroviral treatment with the occurrence of disseminated histoplasmosis. A total of 1404 patients were followed for 6833 person-years. The variables independently associated with the incidence of disseminated histoplasmosis were low CD4 counts, the lowest CD4 counts were most at risk; Patients with the lowest CD8 counts were also at increased risk; Antiretroviral treatment was generally associated with lower histoplasmosis incidence, but for the first 6 months following antiretroviral treatment initiation there was a transient period of increased risk of diagnosing histoplasmosis; Herpes was also associated with more histoplasmosis; Pneumocystosis and Fluconazole treatment were negatively associated with histoplasmosis. Of 156 patients with histoplasmosis, there were 13.5% of deaths at 1 month, 17.5% at 3 months, and 22.5% at 6 months after the date of diagnosis of histoplasmosis. The most important predictive factors for death within 6 months of diagnosis were low CD4 counts and no antiretroviral treatment. The present study did not study environmental/occupational factors but provides predictive factors for disseminated histoplasmosis and its outcome in HIV patients in an Amazonian environment during the HAART era. These results are useful to guide clinicians working in an area where this diagnosis is often overlooked.
Collapse
Affiliation(s)
- Mathieu Nacher
- Centre d'Investigation Clinique, Epidémiologie Clinique Antilles Guyane (CIC EC CIE802), Centre Hospitalier de Cayenne, Cayenne, French Guiana
- COREVIH Guyane, CH de Cayenne, Cayenne, French Guiana
- Equipe EA 3593 Epidemiologie des Parasitoses et Mycoses Tropicales, Université Antilles Guyane, Campus Saint Denis, Cayenne, French Guiana
- * E-mail:
| | - Antoine Adenis
- Centre d'Investigation Clinique, Epidémiologie Clinique Antilles Guyane (CIC EC CIE802), Centre Hospitalier de Cayenne, Cayenne, French Guiana
| | - Denis Blanchet
- Equipe EA 3593 Epidemiologie des Parasitoses et Mycoses Tropicales, Université Antilles Guyane, Campus Saint Denis, Cayenne, French Guiana
- Laboratoire Hospitalo Universitaire de Parasitologie Mycologie, CH de Cayenne, Cayenne, French Guiana
| | - Vincent Vantilcke
- Service de Médecine, Centre Hospitalier de l'Ouest Guyanais, Saint Laurent du Maroni, French Guiana
| | - Magalie Demar
- Equipe EA 3593 Epidemiologie des Parasitoses et Mycoses Tropicales, Université Antilles Guyane, Campus Saint Denis, Cayenne, French Guiana
- Unité des Maladies Infectieuses et Tropicales, Centre Hospitalier de Cayenne, Cayenne, French Guiana
| | - Célia Basurko
- Centre d'Investigation Clinique, Epidémiologie Clinique Antilles Guyane (CIC EC CIE802), Centre Hospitalier de Cayenne, Cayenne, French Guiana
| | | | - Julie Dufour
- Service Dermatologie, CH de Cayenne, Cayenne, French Guiana
| | - Christine Aznar
- Equipe EA 3593 Epidemiologie des Parasitoses et Mycoses Tropicales, Université Antilles Guyane, Campus Saint Denis, Cayenne, French Guiana
- Laboratoire Hospitalo Universitaire de Parasitologie Mycologie, CH de Cayenne, Cayenne, French Guiana
| | - Bernard Carme
- Equipe EA 3593 Epidemiologie des Parasitoses et Mycoses Tropicales, Université Antilles Guyane, Campus Saint Denis, Cayenne, French Guiana
- Laboratoire Hospitalo Universitaire de Parasitologie Mycologie, CH de Cayenne, Cayenne, French Guiana
| | - Pierre Couppié
- Equipe EA 3593 Epidemiologie des Parasitoses et Mycoses Tropicales, Université Antilles Guyane, Campus Saint Denis, Cayenne, French Guiana
- Service Dermatologie, CH de Cayenne, Cayenne, French Guiana
| |
Collapse
|
41
|
Adenis A, Nacher M, Hanf M, Basurko C, Dufour J, Huber F, Aznar C, Carme B, Couppie P. Tuberculosis and histoplasmosis among human immunodeficiency virus-infected patients: a comparative study. Am J Trop Med Hyg 2014; 90:216-23. [PMID: 24394475 DOI: 10.4269/ajtmh.13-0084] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
In disease-endemic areas, histoplasmosis is the main differential diagnosis for tuberculosis among human immunodeficiency virus (HIV)-infected patients. However, no study has compared the two diseases. Thus, the objective of this study was to compare tuberculosis and histoplasmosis in HIV-infected patients. A population of 205 HIV-infected patients (99 with tuberculosis and 106 with histoplasmosis) hospitalized in Cayenne, French Guiana during January 1, 1997-December 31, 2008 were selected retrospectively from the French Hospital Database on HIV. Multivariate analysis showed that tuberculosis was associated with cough (adjusted odds ratio [AOR] = 0.20, 95% confidence interval [CI] = 0.05-0.73) and a C-reactive protein level > 70 mg/L (AOR = 0.98, 95% CI = 0.97-0.99). Variables associated with disseminated histoplasmosis were a γ-glutamyl transferase level > 72 IU/L (AOR = 4.99, 95% CI = 1.31-18.99), origin from French Guiana (AOR = 5.20, 95% CI = 1.30-20.73), disseminated localization (AOR = 6.40, 95% CI = 1.44-28.45), a concomitant opportunistic infection (AOR = 6.71, 95% CI = 1.50-29.96), a neutrophil count < 2,750 cells/mm(3) (AOR = 10.54, 95% CI = 2.83-39.24), a CD4 cell count < 60 cells/mm(3) (AOR = 11.62, 95% CI = 2.30-58.63), and a platelet count < 150,000/mm(3) (AOR = 19.20, 95% CI = 3.35-110.14). Tuberculosis and histoplasmosis have similarities, but some factors show a greater association with one of these diseases. Thus, adapted therapeutic choices can be made by using simple clinical and paraclinical criteria.
Collapse
Affiliation(s)
- Antoine Adenis
- Centre d'Investigation Clinique Epidémiologie Clinique Antilles-Guyane, Service de Dermatologie Vénérologie, et Laboratoire Hospitalo-Universitaire de Parasitologie-Mycologie, Inserm CIE 802, Centre Hospitalier de Cayenne, Cayenne, French Guiana; Equipe EA3593, Epidémiologie des Parasitoses et des Mycoses Tropicales, Université des Antilles et de la Guyane, Cayenne, French Guiana
| | | | | | | | | | | | | | | | | |
Collapse
|
42
|
Nacher M, Adenis A, Aznar C, Blanchet D, Vantilcke V, Demar M, Carme B, Couppié P. How many have died from undiagnosed human immunodeficiency virus-associated histoplasmosis, a treatable disease? Time to act. Am J Trop Med Hyg 2013; 90:193-4. [PMID: 24277783 DOI: 10.4269/ajtmh.13-0226] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Human immunodeficiency virus (HIV)-associated disseminated Histoplasma capsulatum capsulatum infection often mimics tuberculosis. This disease is well know in the United States but is dramatically underdiagnosed in Central and South America. In the Amazon region, given the available incidence data and the regional HIV prevalence, it is expected that, every year, 1,500 cases of histoplasmosis affect HIV patients in that region alone. Given the mortality in undiagnosed patients, at least 600 patients would be expected to die from an undiagnosed but treatable disease. The lack of a simple diagnostic tool and the lack of awareness by clinicians spiral in a vicious cycle and made a major problem invisible for 30 years. The HIV/acquired immunodeficiency syndrome community should tackle this problem now to prevent numerous avoidable deaths from HIV-associated histoplasmosis in the region and elsewhere.
Collapse
Affiliation(s)
- Mathieu Nacher
- Centre d'Investigation Clinique Epidémiologie Clinique Antilles Guyane CIC-EC CIE 802, Cayenne General Hospital, Cayenne, French Guiana; Coordination Regionale de la Lutte Contre le VIH de Guyane, Laboratoire Hospitalo-Universitaire de Parasitologie Mycologie, Unité des Maladies Infectieuses et Tropicale, et Service de Dermatologie Vénéréologie, Centre Hospitalier de Cayenne, Cayenne, French Guiana; Equipe EPaT EA3593 Epidemiologie des Parasitoses et Mycoses Tropicales, Université Antilles Guyane, Cayenne, French Guiana
| | | | | | | | | | | | | | | |
Collapse
|
43
|
Tomazini B, Bandeira R, Aragão T, Borges JCA, Sasdelli R, Salgado VP, de Campos FPF, de Lima PP. Co-infection of disseminated histoplasmosis and tuberculosis in an AIDS patient. AUTOPSY AND CASE REPORTS 2013; 3:49-58. [PMID: 31528618 PMCID: PMC6671895 DOI: 10.4322/acr.2013.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2013] [Accepted: 09/14/2013] [Indexed: 11/23/2022] Open
Abstract
Histoplasmosis is a fungal disease caused by the dimorphic fungus Histoplasma capsulatum, recognized as an AIDS-defining illness since the Center for Disease Control's revision criteria in 1985. This infection is reported to be present in 5-20% of AIDS patients, and in 95% of the cases it is manifested in its disseminated form. Serum antibodies and/or antigen research can make diagnosis, but the demonstration of the agent by culture or histopathological examination remains the gold standard methods. Co-infections in patients with AIDS are well known; however, reports on disseminated tuberculosis and histoplasmosis are scarce. The authors report the case of a female patient who presented a short-course history of weight loss, fever, and mild respiratory symptoms, with hepatosplenomegaly and lymphadenopathy. Laboratory workup called attention to anemia, altered liver, canalicular enzymes, liver function tests, high titer of lactate dehydrogenase (LDH), and pulmonary nodules on thoracic computed tomography. Incidental finding of yeast forms within the leukocytes during a routine blood cell count highlighted the diagnosis of histoplasmosis. The patient started receiving amphotericin B but succumbed soon after. The authors emphasize the possibility of this co-infection, the diagnosis of severe infection through the finding of yeast forms within peripheral leukocytes, and for the high titer of LDH in aiding the differential diagnosis.
Collapse
Affiliation(s)
- Bruno Tomazini
- Department of Internal Medicine, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo/SP - Brazil
| | - Raquel Bandeira
- Infectious Diseases Institute, Hospital Emílio Ribas, São Paulo/SP - Brazil
| | - Thiago Aragão
- Department of Internal Medicine, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo/SP - Brazil
| | - Julio Cesar Andreotti Borges
- Department of Internal Medicine, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo/SP - Brazil
| | - Rafael Sasdelli
- Department of Internal Medicine, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo/SP - Brazil
| | - Valéria Pereira Salgado
- Clinical Laboratory Service, Hospital Universitário, Universidade de São Paulo, São Paulo/SP - Brazil
| | | | | |
Collapse
|
44
|
Dasmasceno LS, Novaes Jr AR, Alencar CHM, Lima DT, Sidrim JJC, Gonçalves MVF, de Mesquita JRL, Leitão TDMJS. Disseminated histoplasmosis and aids: relapse and late mortality in endemic area in north-eastern Brazil. Mycoses 2013; 56:520-6. [DOI: 10.1111/myc.12067] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2012] [Revised: 02/03/2013] [Accepted: 02/07/2013] [Indexed: 11/27/2022]
Affiliation(s)
| | - Alberto Ramos Novaes Jr
- Department of Community Health; School of Medicine; Federal University of Ceará; Fortaleza; CE; Brazil
| | | | - Daniel Teixeira Lima
- Specialized Medical Mycology Center; Federal University of Ceará; Fortaleza; CE; Brazil
| | | | | | | | | |
Collapse
|
45
|
DAI ZHICHU, ZHAO HAIJIN, CAI SHAOXI, LV YANHUA, TONG WANCHENG. Invasive pulmonary aspergillosis in non-neutropenic patients with and without underlying disease: A single-centre retrospective analysis of 52 subjects. Respirology 2013; 18:323-31. [DOI: 10.1111/j.1440-1843.2012.02283.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
46
|
Histoplasmosis y sida: factores de riesgo clínicos y de laboratorio asociados al pronóstico de la enfermedad. INFECTIO 2012. [DOI: 10.1016/s0123-9392(12)70026-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
47
|
Brilhante RSN, Fechine MAB, Mesquita JRL, Cordeiro RA, Rocha MFG, Monteiro AJ, Lima RAC, Caetano ÉP, Pereira JF, Castelo-Branco DSCM, Camargo ZP, Sidrim JJC. Histoplasmosis in HIV-positive patients in Ceará, Brazil: clinical-laboratory aspects and in vitro antifungal susceptibility of Histoplasma capsulatum isolates. Trans R Soc Trop Med Hyg 2012; 106:484-8. [PMID: 22703696 DOI: 10.1016/j.trstmh.2012.05.003] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2011] [Revised: 05/15/2012] [Accepted: 05/15/2012] [Indexed: 11/28/2022] Open
Abstract
This study contains a descriptive analysis of histoplasmosis in AIDS patients between 2006 and 2010 in the state of Ceará, Brazil. Additionally, the in vitro susceptibility of Histoplasma capsulatum isolates obtained during this period was assessed. We report 208 cases of patients with histoplasmosis and AIDS, describing the epidemiological, clinical, laboratory and therapeutic aspects. The in vitro antifungal susceptibility test was carried out by the microdilution method, according to Clinical and Laboratory Standards Institute, with H. capsulatum in the filamentous and yeast phases, against the antifungals amphotericin B, fluconazole, itraconazole, voriconazole and caspofungin. In 38.9% of the cases, histoplasmosis was the first indicator of AIDS and in 85.8% of the patients the CD4 cell count was lower than 100 cells/mm(3). The lactate dehydrogenase levels were high in all the patients evaluated, with impairment of hepatic and renal function and evolution to death in 42.3% of the cases. The in vitro susceptibility profile demonstrated there was no antifungal resistance among the isolates evaluated. There was a significant increase in the number of histoplasmosis cases in HIV-positive patients during the period surveyed in the state of Ceará, northeastern Brazil, but no antifungal resistance among the recovered isolates of H. capsulatum.
Collapse
Affiliation(s)
- Raimunda S N Brilhante
- Specialized Medical Mycology Center, Federal University of Ceará, Fortaleza, Ceará, Brazil.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
48
|
Peigne V, Dromer F, Elie C, Lidove O, Lortholary O. Imported acquired immunodeficiency syndrome-related histoplasmosis in metropolitan France: a comparison of pre-highly active anti-retroviral therapy and highly active anti-retroviral therapy eras. Am J Trop Med Hyg 2011; 85:934-41. [PMID: 22049053 DOI: 10.4269/ajtmh.2011.11-0224] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Histoplasma capsulatum var. capsulatum infection is rare outside disease-endemic areas. Clinical presentation and outcome of acquired immunodeficiency syndrome-related histoplasmosis are unknown in non-endemic areas with wide access to highly active anti-retroviral therapy (HAART). Retrospective analysis of cases recorded at the French National Reference Center for Mycoses and Antifungals during two decades: pre-HAART (1985-1994) and HAART (1997-2006). Clinical features and outcome of all adults with proven acquired immunodeficiency syndrome-related histoplasmosis were compared between the two periods. One hundred four patients were included (40 during the pre-HAART era and 64 during the HAART era). Diagnosis was established a mean of 62 days after onset of symptoms. One-year overall mortality rates decreased from 53% (pre-HAART era) to 22% (HAART era). Diagnosis during the pre-HAART era and an older age were the only independent factors associated with death. Histoplasmosis is a rare invasive fungal infection outside disease-endemic areas. Its prognosis improved significantly during the HAART era.
Collapse
Affiliation(s)
- Vincent Peigne
- Institut Pasteur, Unité de Mycologie Moléculaire, Centre National de Référence Mycologie et Antifongiques, Paris, France.
| | | | | | | | | | | |
Collapse
|
49
|
|
50
|
Abstract
In order to determine whether HIV-associated disseminated histoplasmosis was a recent infection or a reactivation, time series of first episodes of disseminated histoplasmosis were analyzed. Climatic variables were associated with histoplasmosis incidence. This suggested an important proportion of cases were due to recent exposure, and therefore primary prophylaxis may be warranted in French Guiana.
Collapse
|