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Boubaker G, Bernal A, Vigneswaran A, Imhof D, de Sousa MCF, Hänggeli KPA, Haudenschild N, Furrer J, Păunescu E, Desiatkina O, Hemphill A. In vitro and in vivo activities of a trithiolato-diRuthenium complex conjugated with sulfadoxine against the apicomplexan parasite Toxoplasma gondii. Int J Parasitol Drugs Drug Resist 2024; 25:100544. [PMID: 38703737 PMCID: PMC11087982 DOI: 10.1016/j.ijpddr.2024.100544] [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] [Received: 01/29/2024] [Revised: 04/17/2024] [Accepted: 04/24/2024] [Indexed: 05/06/2024]
Abstract
Organometallic compounds, including Ruthenium complexes, have been widely developed as anti-cancer chemotherapeutics, but have also attracted much interest as potential anti-parasitic drugs. Recently hybrid drugs composed of organometallic Ruthenium moieties that were complexed to different antimicrobial agents were synthesized. One of these compounds, a trithiolato-diRuthenium complex (RU) conjugated to sulfadoxine (SDX), inhibited proliferation of Toxoplasma gondii tachyzoites grown in human foreskin fibroblast (HFF) monolayers with an IC50 < 150 nM, while SDX and the non-modified RU complex applied either individually or as an equimolar mixture were much less potent. In addition, conjugation of SDX to RU lead to decreased HFF cytotoxicity. RU-SDX did not impair the in vitro proliferation of murine splenocytes at concentrations ranging from 0.1 to 0.5 μM but had an impact at 2 μM, and induced zebrafish embryotoxicity at 20 μM, but not at 2 or 0.2 μM. RU-SDX acted parasitostatic but not parasiticidal, and induced transient ultrastructural changes in the mitochondrial matrix of tachyzoites early during treatment. While other compounds that target the mitochondrion such as the uncouplers FCCP and CCCP and another trithiolato-Ruthenium complex conjugated to adenine affected the mitochondrial membrane potential, no such effect was detected for RU-SDX. Evaluation of the in vivo efficacy of RU-SDX in a murine T. gondii oocyst infection model comprised of non-pregnant outbred CD1 mice showed no effects on the cerebral parasite burden, but reduced parasite load in the eyes and in heart tissue.
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Affiliation(s)
- Ghalia Boubaker
- Institute of Parasitology, Department of Infectious Diseases and Pathobiology, Vetsuisse Faculty, University of Bern. Länggass-Strasse 122, 3012, Bern, Switzerland.
| | - Alice Bernal
- Institute of Parasitology, Department of Infectious Diseases and Pathobiology, Vetsuisse Faculty, University of Bern. Länggass-Strasse 122, 3012, Bern, Switzerland.
| | - Anitha Vigneswaran
- Institute of Parasitology, Department of Infectious Diseases and Pathobiology, Vetsuisse Faculty, University of Bern. Länggass-Strasse 122, 3012, Bern, Switzerland.
| | - Dennis Imhof
- Institute of Parasitology, Department of Infectious Diseases and Pathobiology, Vetsuisse Faculty, University of Bern. Länggass-Strasse 122, 3012, Bern, Switzerland.
| | - Maria Cristina Ferreira de Sousa
- Institute of Parasitology, Department of Infectious Diseases and Pathobiology, Vetsuisse Faculty, University of Bern. Länggass-Strasse 122, 3012, Bern, Switzerland; Graduate School for Cellular and Biomedical Sciences (GCB), University of Bern, Switzerland.
| | - Kai Pascal Alexander Hänggeli
- Institute of Parasitology, Department of Infectious Diseases and Pathobiology, Vetsuisse Faculty, University of Bern. Länggass-Strasse 122, 3012, Bern, Switzerland; Graduate School for Cellular and Biomedical Sciences (GCB), University of Bern, Switzerland.
| | - Noé Haudenschild
- Institute of Parasitology, Department of Infectious Diseases and Pathobiology, Vetsuisse Faculty, University of Bern. Länggass-Strasse 122, 3012, Bern, Switzerland.
| | - Julien Furrer
- Department of Chemistry, Biochemistry and Pharmaceutical Sciences, University of Bern, Freiestrasse 3, 3012, Bern, Switzerland.
| | - Emilia Păunescu
- Department of Chemistry, Biochemistry and Pharmaceutical Sciences, University of Bern, Freiestrasse 3, 3012, Bern, Switzerland.
| | - Oksana Desiatkina
- Department of Chemistry, Biochemistry and Pharmaceutical Sciences, University of Bern, Freiestrasse 3, 3012, Bern, Switzerland.
| | - Andrew Hemphill
- Institute of Parasitology, Department of Infectious Diseases and Pathobiology, Vetsuisse Faculty, University of Bern. Länggass-Strasse 122, 3012, Bern, Switzerland.
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Fang M, Li S, Mao Z, Liu X, Wang X, Lu S. A retrospective study on intracranial mixed infection with tuberculous meningitis in Shenzhen, China. Microbiol Spectr 2024; 12:e0374723. [PMID: 38767391 PMCID: PMC11218455 DOI: 10.1128/spectrum.03747-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Accepted: 04/24/2024] [Indexed: 05/22/2024] Open
Abstract
Tuberculous meningitis (TBM) is a prevalent global intracranial infection and the most lethal and disabling form of tuberculosis. TBM with mixed intracranial infections is clinically rare but has a higher mortality rate. To investigate the clinical characteristics of TBM with mixed intracranial infections, demographic and clinical data of TBM and pulmonary tuberculosis (PTB) patients admitted to Shenzhen Third People's Hospital between January 2015 and October 2022 were collected anonymously. A total of 207 cases of TBM were diagnosed, of which 16 cases (7.73%) were TBM with mixed intracranial infections. The overall mortality rate of TBM cases was 16.4%, while the mortality rate of TBM cases with mixed intracranial infections was as high as 35.7%. Compared to simple TBM cases, TBM cases with mixed intracranial infections had severer clinical symptoms. The percentage of human immune deficiency virus (HIV)-positive TBM cases with mixed intracranial infections reached up to 68.8%. HIV co-infection, CD4+/CD8+ T-cell counts less than 1, cranial nerve impairment, paralysis, cerebral infarction, PRO less than 450 mg/L, WBC less than 10 × 106 /L, and CL more than 120 mmol/L were risk factors for TBM cases with mixed intracranial infections. Compared to PTB, HIV co-infection, CD4+ T cell less than 550 /uL, and age less than 45 years were risk factors for TBM, and TBM was associated with higher mortality rates. Our study provides additional data to better understand single TBM and TBM with mixed intracranial infections. More than two-thirds of TBM cases with mixed intracranial infections were HIV-positive. Clinicians should consider the possibility of multiple infections in people with TBM/HIV co-infection. IMPORTANCE TBM can cause severe neurological damage and death, and TBM with mixed intracranial infections can exacerbate the damage and poor prognosis of the disease. TBM with mixed intracranial infections is a rare disease, which has led to an incomplete understanding of its clinical features. This study investigated the clinical features of TBM and its associated factors by comparing the characteristics of TBM with mixed intracranial infections, single TBM and pulmonary tuberculosis. This information will help to improve the understanding of TBM, diagnostic accuracy and treatment outcomes.
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Affiliation(s)
- Mutong Fang
- Department of Pulmonary Medicine, Shenzhen Third People’s Hospital, Shenzhen, Guangdong, China
| | - Sinian Li
- Department of Pulmonary Medicine, Shenzhen Third People’s Hospital, Shenzhen, Guangdong, China
| | - Zhi Mao
- Department of Pulmonary Medicine, Shenzhen Third People’s Hospital, Shenzhen, Guangdong, China
| | - Xuhui Liu
- Department of Pulmonary Medicine, Shenzhen Third People’s Hospital, Shenzhen, Guangdong, China
| | - Xiaomin Wang
- National Clinical Research Center for Infectious Diseases, Shenzhen Third People’s Hospital, Shenzhen, Guangdong, China
| | - Shuihua Lu
- Department of Pulmonary Medicine, Shenzhen Third People’s Hospital, Shenzhen, Guangdong, China
- National Clinical Research Center for Infectious Diseases, Shenzhen Third People’s Hospital, Shenzhen, Guangdong, China
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de Melo SA, Pinto SD, Ferreira EDS, Brotas R, Marinho EPM, da Silva VA, Monte RL, Feitoza PVS, Reis MF, Almeida TVR, Ferreira LCDL, Bastos MDS. Molecular diagnosis of opportunistic infections in the central nervous system of HIV-infected adults in Manaus, Amazonas. Front Med (Lausanne) 2024; 10:1298435. [PMID: 38264048 PMCID: PMC10803427 DOI: 10.3389/fmed.2023.1298435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 12/22/2023] [Indexed: 01/25/2024] Open
Abstract
Background Opportunistic infections in the central nervous system (CNS) of people with HIV/AIDS (PLWHA) remain significant contributors to morbidity and mortality, especially in resource-limited scenarios. Diagnosing these infections can be challenging, as brain imaging is non-specific and expensive. Therefore, molecular analysis of cerebrospinal fluid (CSF) may offer a more accurate and affordable method for diagnosing pathogens. Methods We conducted extensive real-time PCR testing (qPCR) on CSF to evaluate etiological agents in PLWHA with neurological manifestations. Primers targeting DNA from specific pathogens, including cytomegalovirus (CMV), herpes simplex virus (HSV), varicella-zoster virus (VZV), Epstein-Barr virus (EBV), John Cunningham virus (JCV), Toxoplasma gondii, and human T-lymphotropic virus types 1 and 2 (HTLV-1 and HTLV-2), were used. Results Cerebrospinal fluid samples revealed 90 pathogens (36.7%). Toxoplasma gondii was the most frequently detected pathogen, found in 22 samples (30.5%). Other pathogens included Cryptococcus sp. (7.7%), EBV (5.3%), CMV, VZV, and JCV (4.0% each). Conclusion Despite antiretroviral therapy and medical follow-up, opportunistic central nervous system infections remain frequent in PLWHA. Herpesviruses are commonly detected, but T. gondii is the most prevalent opportunistic pathogen in our study population. Therefore, molecular diagnosis is a crucial tool for identifying opportunistic infections, even in patients undergoing treatment.
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Affiliation(s)
| | | | | | - Reinan Brotas
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, Amazonas, Brazil
| | | | | | - Rossiclea Lins Monte
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, Amazonas, Brazil
| | | | | | - Taynná V. Rocha Almeida
- Departamento de Formação em Emergências em Saúde Pública, Ministério da Saúde, Brasília, Distrito Federal, Brazil
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Zealiyas K, Teshome S, Berhe N, Amogne W, Haile AF, Abate E, Yimer G, Weigel C, Ahmed EH, Abebe T, Baiocchi R. The Burden of Epstein-Barr Virus (EBV) and Its Determinants among Adult HIV-Positive Individuals in Ethiopia. Viruses 2023; 15:1743. [PMID: 37632085 PMCID: PMC10458830 DOI: 10.3390/v15081743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 07/28/2023] [Accepted: 08/07/2023] [Indexed: 08/27/2023] Open
Abstract
Epstein-Barr virus (EBV) is a well-known risk factor for the development of nasopharyngeal carcinoma, Hodgkin's lymphoma (HL), and Non-Hodgkin's lymphoma (NHL). People with HIV infection (PWH) are at increased risk for EBV-associated malignancies such as HL and NHL. Nevertheless, there are limited data on the burden of EBV among this population group in Ethiopia. Hence, this study aimed to determine the burden of EBV infection among adult HIV-positive individuals in Ethiopia and assess the determinants of EBV DNA positivity. We conducted a cross-sectional study at the Tikur Anbessa Specialised Hospital from March 2020 to March 2021. Two hundred and sixty individuals were enrolled in this study, including 179 HIV-positive and 81 HIV-negative individuals. A structured questionnaire was used to capture demographic and individual attributes. In addition, the clinical data of patients were also retrieved from clinical records. EBV viral capsid antigen (VCA) IgG antibody was measured by multiplex flow immunoassay, and EBV DNA levels were tested by quantitative real-time polymerase chain reaction (q-PCR) assays targeting the EBNA-1 open reading frame (ORF). Descriptive statistics were conducted to assess each study variable. A multivariable logistic regression model was applied to evaluate the determinants of EBV infection. Statistical significance was determined at a p-value < 0.05. Two hundred and fifty-three (97.7%) study participants were seropositive for the EBV VCA IgG antibody. Disaggregated by HIV status, 99.4% of HIV-positive and 93.8% of HIV-negative participants were EBV seropositive. In this study, 49.7% of HIV-positive and 24.7% of HIV-negative individuals were EBV DNA positive. PWH had a higher risk of EBV DNA positivity at 3.05 times (AOR: 3.05, 95% CI: 1.40-6.67). Moreover, among PWH, those with an HIV viral load greater than 1000 RNA copies/mL (AOR = 5.81, 95% CI = 1.40, 24.13) had a higher likelihood of EBV DNA positivity. The prevalence of EBV among PWH was significantly higher than among HIV-negative individuals. Higher HIV viral loads in PWH were associated with an increased risk of EBV DNA positivity. Since the increases in the viral load of EBV DNA among PWH could be related to the risk of developing EBV-associated cancers, it is necessary for more research on the role of EBV in EBV-associated cancer in this population group to be carried out.
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Affiliation(s)
- Kidist Zealiyas
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa 1176, Ethiopia; (K.Z.); (N.B.); (A.F.H.)
- Ethiopian Public Health Institute, Addis Ababa 1242, Ethiopia
| | - Seifegebriel Teshome
- Department of Microbiology, Immunology and Parasitology, Addis Ababa University, Addis Ababa 9086, Ethiopia; (S.T.); (T.A.)
| | - Nega Berhe
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa 1176, Ethiopia; (K.Z.); (N.B.); (A.F.H.)
| | - Wondwossen Amogne
- Department of Internal Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa 9086, Ethiopia;
| | - Aklilu Feleke Haile
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa 1176, Ethiopia; (K.Z.); (N.B.); (A.F.H.)
| | - Ebba Abate
- Global One Health Initiative, Addis Ababa 1000, Ethiopia;
| | - Getnet Yimer
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa 9086, Ethiopia;
- Center for Global Genomics and Health Equity, Department of Genetics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Christoph Weigel
- Comprehensive Cancer Center, The James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, OH 43210, USA;
- Division of Hematology, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH 43210, USA
| | - Elshafa Hassan Ahmed
- Comprehensive Cancer Center, The James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, OH 43210, USA;
| | - Tamrat Abebe
- Department of Microbiology, Immunology and Parasitology, Addis Ababa University, Addis Ababa 9086, Ethiopia; (S.T.); (T.A.)
| | - Robert Baiocchi
- Comprehensive Cancer Center, The James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, OH 43210, USA;
- Division of Hematology, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH 43210, USA
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Puplampu P, Asamoah I, Asare BO, Berko KP, Oladele O, Amankwa E, Lambert F, Afriyie AT, Ganu V. Cryptococcal meningitis among perinatally HIV-infected adolescents: Case series on presentation and management challenges. Clin Case Rep 2023; 11:e6995. [PMID: 36852119 PMCID: PMC9958000 DOI: 10.1002/ccr3.6995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 01/27/2023] [Accepted: 02/02/2023] [Indexed: 02/27/2023] Open
Abstract
Diagnosis and management of cryptococcal meningitis in HIV-infected adolescents is challenging in poor resource settings. A high index of suspicion based on clinical presentation is critical for early identification and treatment. This report sought to describe the clinical presentation and outcomes of HIV-associated cryptococcal meningitis in adolescents.
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Affiliation(s)
- Peter Puplampu
- Department of Medicine and TherapeuticsUniversity of Ghana Medical SchoolAccraGhana
- Department of Internal MedicineKorle‐Bu Teaching HospitalAccraGhana
| | - Isabella Asamoah
- Department of Medicine and TherapeuticsUniversity of Ghana Medical SchoolAccraGhana
- Department of Internal MedicineKorle‐Bu Teaching HospitalAccraGhana
| | - Bismark O. Asare
- Department of Internal MedicineKorle‐Bu Teaching HospitalAccraGhana
| | - Kofi P. Berko
- Department of Internal MedicineKorle‐Bu Teaching HospitalAccraGhana
| | | | | | - Frempong Lambert
- Department of Internal MedicineKorle‐Bu Teaching HospitalAccraGhana
| | | | - Vincent Ganu
- Department of Internal MedicineKorle‐Bu Teaching HospitalAccraGhana
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Musukuma-Chifulo K, Siddiqi OK, Chilyabanyama ON, Bates M, Chisenga CC, Simuyandi M, Sinkala E, Dang X, Koralnik IJ, Chilengi R, Munsaka S. Epstein-Barr Virus Detection in the Central Nervous System of HIV-Infected Patients. Pathogens 2022; 11:1080. [PMID: 36297137 PMCID: PMC9607430 DOI: 10.3390/pathogens11101080] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 07/19/2022] [Accepted: 09/13/2022] [Indexed: 11/01/2023] Open
Abstract
Simply detecting Epstein-Barr virus deoxyribonucleic acid (EBV-DNA) is insufficient to diagnose EBV-associated diseases. The current literature around EBV-DNA detection from cerebrospinal fluid (CSF) in human immunodeficiency virus (HIV)-positive non-lymphoma patients was systematically reviewed and a meta-analysis reporting the estimated pooled prevalence in this population when PCR methods are employed, targeting different sequence segments within the EBV genome, was conducted. Using a combination of three key concepts-Epstein-Barr virus detection, central nervous system disease, and human cerebrospinal fluid-and their MeSH terms, the PubMed database was searched. A total of 273 papers reporting the detection of EBV in CNS were screened, of which 13 met the inclusion criteria. The meta-analysis revealed a pooled prevalence of EBV-DNA in CSF of 20% (CI: 12-31%). The highest pooled prevalence was from studies conducted on the African population at 39% (CI: 27-51%). The investigation of the presence of EBV-DNA in the CSF was also very varied, with several gene targets used. While most patients from the articles included in this review and meta-analysis were symptomatic of CNS disorders, the pathogenicity of EBV in non-lymphoma HIV patients when detected in CSF has still not been determined. The presence of EBV-DNA in the CNS remains a concern, and further research is warranted to understand its significance in causing CNS disorders.
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Affiliation(s)
- Kalo Musukuma-Chifulo
- Department of Biomedical Science, School of Health Sciences, University of Zambia, Lusaka P.O. Box 50110, Zambia
- Department of Research, Centre for Infectious Disease Research in Zambia, Lusaka P.O. Box 34681, Zambia
| | - Omar Khalik Siddiqi
- Global Neurology Program, Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
- Department of Internal Medicine, Center for Virology and Vaccines Research, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
- Department of Internal Medicine, School of Medicine, University of Zambia, Lusaka P.O. Box 50110, Zambia
| | | | - Matthew Bates
- School of Life & Environmental Sciences, University of Lincoln, Lincoln LN6 7TS, UK
- HerpeZ Infection Research and Training, University Teaching Hospital, Lusaka Private Bag RW1X Ridgeway, Lusaka P.O. Box 10101, Zambia
| | | | - Michelo Simuyandi
- Department of Research, Centre for Infectious Disease Research in Zambia, Lusaka P.O. Box 34681, Zambia
| | - Edford Sinkala
- Department of Internal Medicine, School of Medicine, University of Zambia, Lusaka P.O. Box 50110, Zambia
| | - Xin Dang
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Igor Jerome Koralnik
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Roma Chilengi
- Department of Research, Centre for Infectious Disease Research in Zambia, Lusaka P.O. Box 34681, Zambia
| | - Sody Munsaka
- Department of Biomedical Science, School of Health Sciences, University of Zambia, Lusaka P.O. Box 50110, Zambia
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Ocansey BK, Otoo B, Asamoah I, Ganu V, Berko KP, Oladele O, Opoku-Asare B, Agyei M, George L, Kotey FCN, Kosmidis C, Puplampu P, Opintan JA, Denning DW. Cryptococcal and Histoplasma Antigen Screening among People With HIV in Ghana and Comparative Analysis of OIDx Histoplasma Lateral Flow Assay and IMMY Histoplasma Enzyme Immunoassay. Open Forum Infect Dis 2022; 9:ofac277. [PMID: 35854987 PMCID: PMC9291368 DOI: 10.1093/ofid/ofac277] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 05/31/2022] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Cryptococcal meningitis (CM) and disseminated histoplasmosis (DH) are common in people with HIV (PWH) and diagnosed by detecting cryptococcal antigen (CrAg) and Histoplasma antigen (Histo Ag) respectively. In Ghana, CM and DH are rarely suspected by clinicians due to limited epidemiological data.
Methods
This study was conducted among PWH in Ghana who are unwell. Sociodemographic and clinical data were collected by questionnaire. Serum and/or urine were screened for CrAg and Histo Ag, using IMMY CrAg lateral flow assay (LFA) and IMMY Histoplasma enzyme immunoassay (EIA) kits, respectively, regardless of symptoms. Samples run with IMMY Histoplasma EIA were simultaneously run with OIDx Histoplasma LFA. Laboratory investigations were conducted by the research team while diagnosis incorporating clinical assessment, screening and confirmatory testing results and treatment decisions were made by the clinical team. Treatment and outcome information on CM and DH patients were evaluated.
Results
Overall, 150 participants were recruited. There were 73% (n = 109) females, and the age range was 18–62 years. The prevalence rates of CrAg and Histo Ag were 2.7% (4/150) and 4.7% (5/107), respectively. The OIDx Histoplasma LFA showed a high concordance (98.4%) with the IMMY Histoplasma EIA. All antigen-positive cases by standard tests were diagnosed with CM and DH. Antifungal treatment was given in five patients and follow-up revealed two deaths and three recoveries.
Conclusion
Histoplasmosis among PWH may be more common than previously anticipated and may be more frequent than cryptococcosis in Ghana. The performance of the OIDx Histoplasma LFA should be further explored.
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Affiliation(s)
- Bright K. Ocansey
- University of Manchester, Manchester Academic Health Science Centre Division of Evolution, Infection and Genomics, Faculty of Biology, Medicine and Health, , Manchester, UK
| | - Benjamin Otoo
- University of Ghana Department of Bacteriology, Noguchi Memorial Institute of Medical Research, , Legon, Ghana
| | - Isabella Asamoah
- Korle-Bu Teaching Hospital Fevers Unit, Department of Medicine, , Korle-Bu, Ghana
| | - Vincent Ganu
- Korle-Bu Teaching Hospital Fevers Unit, Department of Medicine, , Korle-Bu, Ghana
| | - Kojo P. Berko
- Korle-Bu Teaching Hospital Fevers Unit, Department of Medicine, , Korle-Bu, Ghana
| | - Oluwakemi Oladele
- Korle-Bu Teaching Hospital Fevers Unit, Department of Medicine, , Korle-Bu, Ghana
| | - Bismark Opoku-Asare
- Korle-Bu Teaching Hospital Fevers Unit, Department of Medicine, , Korle-Bu, Ghana
| | - Martin Agyei
- Komfo Anokye Teaching Hospital Dermatology Unit, Department of Internal Medicine, , Kumasi, Ghana
- Kwame Nkrumah University of Science and Technology Department of Medicine, , Kumasi, Ghana
| | - Lawrence George
- Juaboso Government Hospital Laboratory Department, , Juaboso, Ghana
| | - Fleischer C. N. Kotey
- University of Ghana Medical School Department of Medical Microbiology, , Korle-Bu, Ghana
- FleRhoLife Research Consult , Teshie, Ghana
| | - Chris Kosmidis
- University of Manchester, Manchester Academic Health Science Centre Division of Evolution, Infection and Genomics, Faculty of Biology, Medicine and Health, , Manchester, UK
- National Aspergillosis Centre, Manchester University NHS Foundation Trust , Manchester, UK
| | - Peter Puplampu
- Korle-Bu Teaching Hospital Fevers Unit, Department of Medicine, , Korle-Bu, Ghana
- University of Ghana Medical School Department of Medicine and Therapeutics, , Korle-Bu, Ghana
| | | | - David W. Denning
- University of Manchester, Manchester Academic Health Science Centre Division of Evolution, Infection and Genomics, Faculty of Biology, Medicine and Health, , Manchester, UK
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de Oliveira L, Melhem MDSC, Buccheri R, Chagas OJ, Vidal JE, Diaz-Quijano FA. Early clinical and microbiological predictors of outcome in hospitalized patients with cryptococcal meningitis. BMC Infect Dis 2022; 22:138. [PMID: 35139801 PMCID: PMC8830130 DOI: 10.1186/s12879-022-07118-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 01/20/2022] [Indexed: 11/10/2022] Open
Abstract
Background Cryptococcal meningitis causes high mortality in immunocompromised and immunocompetent patients. The objective of this study was to identify early predictors of clinical outcome, available at the first days of hospitalization, in patients with cryptococcal meningitis in a tertiary center in Brazil. Methods Ninety-six cases of cryptococcal meningitis with clinical, epidemiological and laboratory data, and identification and antifungal susceptibility of the strains were analyzed. Quantitative CSF yeast counts were performed by direct microscopic exam with a Fuchs-Rosenthal cell counting chamber using an institutional protocol. Univariable and multiple analyses using logistic regression were performed to identify predictors, available at the beginning of hospitalization, of in-hospital mortality. Moreover, we performed a secondary analysis for a composite outcome defined by hospital mortality and intensive care unit transfer. Results The species and the antifungal susceptibility were not associated with the outcomes evaluated. The variables significantly associated with the mortality were age (OR = 1.08, 95% CI 1.02–1.15), the cerebrospinal fluid (CSF) yeasts count (OR = 1.65, 95% CI 1.20–2.27), systemic arterial hypertension (OR = 22.63, 95% CI 1.64–312.91) and neurological impairment identified by computed tomography (OR = 41.73, 95% CI 3.10–561.65). At the secondary analysis, CSF yeast count was also associated with the composite outcome, in addition to the culture of Cryptococcus spp. from bloodstream and cerebral toxoplasmosis. The associations were consistent with survival models evaluated. Conclusions Age and CSF yeast count were independently associated with in-hospital mortality of patients with cryptococcal meningitis but Cryptococcus species identification and antifungal susceptibility were not associated with the outcomes. Quantitative CSF yeast counts used in this study can be evaluated and implemented in other low and middle-income settings. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-022-07118-7.
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Affiliation(s)
- Lidiane de Oliveira
- Department of Epidemiology, School of Public Health, University of São Paulo, Av. Dr. Arnaldo, 715, São Paulo, SP, CEP 01246-904, Brazil.
| | - Marcia de Souza Carvalho Melhem
- Mycology Unit of Adolfo Lutz Institute, Public Health Reference Laboratory, Secretary of Health, Av. Dr.Arnaldo, 351, São Paulo, SP, CEP 05411-000, Brazil.,School of Medicine, Federal University of Mato Grosso do Sul, Bairro Universitário, Av. Costa e Silva, s/no, Campo Grande, MS, CEP 79070-900, Brazil
| | - Renata Buccheri
- Department of Neurology, Emílio Ribas Institute of Infectious Diseases, Av. Dr. Arnaldo 165, São Paulo, SP, CEP 05411-000, Brazil
| | - Oscar José Chagas
- Department of Neurology, Emílio Ribas Institute of Infectious Diseases, Av. Dr. Arnaldo 165, São Paulo, SP, CEP 05411-000, Brazil
| | - José Ernesto Vidal
- Department of Neurology, Emílio Ribas Institute of Infectious Diseases, Av. Dr. Arnaldo 165, São Paulo, SP, CEP 05411-000, Brazil.,Department of Infectious Diseases, Hospital das Clinicas, School of Medicine, University of São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 470, São Paulo, SP, CEP 01246-904, Brazil
| | - Fredi Alexander Diaz-Quijano
- Department of Epidemiology, School of Public Health, University of São Paulo, Av. Dr. Arnaldo, 715, São Paulo, SP, CEP 01246-904, Brazil
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Adjei EF, Adiku TK, Mawuli G, Bonney JHK. Molecular investigations of viral meningitis among HIV-infected adults in Accra, Ghana. BMC Res Notes 2018; 11:615. [PMID: 30153867 PMCID: PMC6114794 DOI: 10.1186/s13104-018-3720-z] [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: 06/18/2018] [Accepted: 08/20/2018] [Indexed: 11/10/2022] Open
Abstract
Objective Meningitis is one of the leading causes of death among patients living with the human immunodeficiency virus (HIV) in sub-Saharan Africa. Based on clinical presentations alone, the different types of meningitis may not be distinguished from each other, consequently accurate laboratory diagnosis is extremely essential. Viruses such as Enteroviruses (EV), Mumps virus (MuV) and Herpes Simplex Virus-1 (HSV-1) are implicated in cases of meningitis. We sought to detect and characterize viral aetiologies of meningitis among HIV-infected adults with the use of molecular tools. Results As a subset of a main research work, cerebrospinal fluid specimens were collected from a cross-section of HIV patients at the Fevers Unit of the Korle Bu Teaching Hospital with clinical features suggestive of meningitis but without laboratory confirmation. Laboratory investigations were performed with the use of the real time polymerase chain reaction for pan EV, MuV and HSV-1. None of the viruses investigated in this study was found to be positive for meningitis. However, lymphocytic pleocytosis, normal glucose and elevated protein levels were observed in some of the study participants.
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Affiliation(s)
- Emmanuel Frimpong Adjei
- Department of Medical Microbiology, School of Biomedical and Allied Health Sciences, College of Health Sciences, University of Ghana, Accra, Ghana.,Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Theophilus Korku Adiku
- Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Gifty Mawuli
- Department of Medical Microbiology, School of Biomedical and Allied Health Sciences, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Joseph Humphrey Kofi Bonney
- Department of Medical Microbiology, School of Biomedical and Allied Health Sciences, College of Health Sciences, University of Ghana, Accra, Ghana.
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