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de Menezes MLP, Cruz KS, Ogusku MM, da Silva BKNI, Alves MJ, Grisolia ME, Gonçalves MJF, de Souza JVB, Jackisch-Matsuura AB. Histoplasmosis in HIV/AIDS patients in Amazonas, Northern Brazil. Braz J Microbiol 2024; 55:1331-1337. [PMID: 38368282 PMCID: PMC11153426 DOI: 10.1007/s42770-024-01277-2] [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: 09/05/2023] [Accepted: 02/07/2024] [Indexed: 02/19/2024] Open
Abstract
Histoplasmosis is commonly observed in AIDS patients as a neglected opportunistic disease that has an important relationship with environmental factors. The present study described the clinical characteristics of HIV/AIDS patients diagnosed with disseminated histoplasmosis in a tertiary healthcare facility in Manaus, Amazonas, Brazil, and evaluated the patients' homes and urban environmental samples as a source of exposure to Histoplasma capsulatum. A review of medical records from 2017 to 2019 of patients with HIV/AIDS associated with histoplasmosis was carried out, as well as the collection of environmental samples in the homes of these patients. These samples were subjected to DNA extraction and then subjected to qPCR. A total of 62 patients diagnosed with HIV/AIDS and histoplasmosis were identified, which corresponds to 4.5% (n = 62/1372) of the HIV/AIDS cases detected in the period. Of these, 68% (n = 42/62) were male, with a mean age of 36 years and low education. In 47% (n = 29/62) of the cases, the diagnosis of HIV/AIDS and histoplasmosis occurred simultaneously. Mortality was 45% (n = 28/62), and 68% (n = 42/62) of these patients did not regularly use highly active antiretroviral therapy. The main symptoms found were respiratory, gastrointestinal, and weight loss, and in 81% (n = 50/62), the place of residence was in an urban area. A total of 57 environmental samples were analyzed, and the presence of Histoplasma capsulatum was not detected in any of the analyzed samples. There was a high mortality rate in the studied group of patients with AIDS and histoplasmosis. Most patients reported residing in urban areas of Manaus, with no history of travel to other areas previously known as being high risk for histoplasmosis.
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Affiliation(s)
- Marcia Larissa Pereira de Menezes
- Laboratório de Diversidade Microbiana da Amazônia Com Importância Para a Saúde, Instituto Leônidas e Maria Deane - FIOCRUZ, Manaus, Amazonas, Brazil
- Programa de Pós-Graduação Em Condições de Vida E Situações de Saúde Na Amazônia (PPGVIDA) - ILMD/FIOCRUZ, Manaus, Amazonas, Brazil
| | - Katia Santana Cruz
- Laboratório de Micologia Médica, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Amazonas, Brazil
| | - Mauricio Morishi Ogusku
- Laboratório de Micobacteriologia, Instituto Nacional de Pesquisas da Amazônia (INPA), Manaus, Amazonas, Brazil
| | | | - Marla Jalene Alves
- Laboratório de Diversidade Microbiana da Amazônia Com Importância Para a Saúde, Instituto Leônidas e Maria Deane - FIOCRUZ, Manaus, Amazonas, Brazil
| | - Maria Eduarda Grisolia
- Laboratório de Diversidade Microbiana da Amazônia Com Importância Para a Saúde, Instituto Leônidas e Maria Deane - FIOCRUZ, Manaus, Amazonas, Brazil
| | | | | | - Ani Beatriz Jackisch-Matsuura
- Laboratório de Diversidade Microbiana da Amazônia Com Importância Para a Saúde, Instituto Leônidas e Maria Deane - FIOCRUZ, Manaus, Amazonas, Brazil.
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Precit MR, Enriquez C, Neely M, Smit M, Bender JM, Bard JD, Anand V, Mohandas S. VP Shunt With Recurrent Malfunction in Two Pediatric Patients: Is the Hydrocephalus Truly Idiopathic? Pediatr Infect Dis J 2022; 41:358-359. [PMID: 34260486 DOI: 10.1097/inf.0000000000003207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Mimi R Precit
- From the Department of Pathology and Laboratory Medicine
| | | | - Michael Neely
- Department of Infectious Diseases, Children's Hospital Los Angeles
- Keck School of Medicine, University of Southern California, California
| | - Michael Smit
- Department of Infectious Diseases, Children's Hospital Los Angeles
- Keck School of Medicine, University of Southern California, California
| | - Jeffrey M Bender
- Department of Infectious Diseases, Children's Hospital Los Angeles
- Keck School of Medicine, University of Southern California, California
| | - Jennifer Dien Bard
- From the Department of Pathology and Laboratory Medicine
- Keck School of Medicine, University of Southern California, California
| | - Vikram Anand
- Department of Infectious Diseases, Children's Hospital Los Angeles
- Keck School of Medicine, University of Southern California, California
| | - Sindhu Mohandas
- Department of Infectious Diseases, Children's Hospital Los Angeles
- Keck School of Medicine, University of Southern California, California
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Nacher M, Valdes A, Adenis A, Blaizot R, Ugo F, Abboud P, Demar M, Djossou F, Epelboin L, Misslin C, Blanchet D, Couppié P, Alsibai KD. Review of diagnostic methods and results for HIV-associated disseminated histoplasmosis: Pathologists are not sufficiently involved. Trop Med Int Health 2021; 26:1462-1469. [PMID: 34310800 DOI: 10.1111/tmi.13663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Disseminated histoplasmosis is a major killer of HIV-infected persons in Latin America. Antigen detection, fungal culture and Polymerase Chain Reaction are often not available, but cytology and histology are present in most hospitals and may offer a diagnostic alternative. In this study, we review 34 years of clinical experience to describe the roles of cytology and histology in diagnosing disseminated histoplasmosis. METHODS Retrospective multicentric study of 349 patients between 1 January 1981 and 1 October 2014 with confirmed disseminated histoplasmosis. RESULTS Around 32/214 (14.9%) of samples were screened using cytopathology, as were 10/101 (9.9%) bronchoalveolar lavage samples and 5/61 (8.2%) of spinal fluid samples. The samples most commonly sent to pathology were liver biopsies, lower digestive tract and lymphnode biopsies; the greatest proportion of positive results were found in lower digestive tract (43/59 (72.9%) positives), lymph node (39/63 (66.1%)), and liver (38/75 (50.7%)) samples. Overall, 97.2% of bone marrow and 97% of bronchoalveolar lavage samples were directly examined by a mycologist. Positive direct examination was independently associated with death (aHR = 1.5 (95%CI = 1-2.2)). CONCLUSIONS Opportunities for a rapid diagnosis were regularly missed, notably for bone marrow samples, which could have been examined using staining methods complementary to those of the mycologist.
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Affiliation(s)
- Mathieu Nacher
- CIC INSERM 1424, Centre Hospitalier Andree Rosemon Cayenne, Cayenne, French Guiana.,DFR Santé, Université de Guyane, Cayenne, French Guiana
| | - Audrey Valdes
- Equipe Opérationnelle d'hygiène hospitalière, Centre hospitalier Andree Rosemon Cayenne, 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 Andree Rosemon Cayenne, Cayenne, French Guiana
| | - Françoise Ugo
- Service des Maladies Infectieuses et Tropicales, Centre Hospitalier Andree Rosemon Cayenne, Cayenne, French Guiana
| | - Philippe Abboud
- Service des Maladies Infectieuses et Tropicales, Centre Hospitalier Andree Rosemon Cayenne, Cayenne, French Guiana
| | - Magalie Demar
- Laboratory, Centre Hospitalier Andree 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 Andree Rosemon Cayenne, Cayenne, French Guiana
| | - Loïc Epelboin
- Service des Maladies Infectieuses et Tropicales, Centre Hospitalier Andree Rosemon Cayenne, Cayenne, French Guiana
| | - Caroline Misslin
- Service de Médecine, Centre Hospitalier de l'Ouest Guyanais, Saint Laurent du Maroni, French Guiana
| | - Denis Blanchet
- Laboratory, Centre Hospitalier Andree Rosemon Cayenne, Cayenne, French Guiana.,UMR Tropical Biome and Immunopathology, Université de Guyane, Cayenne, French Guiana
| | - Pierre Couppié
- DFR Santé, Université de Guyane, Cayenne, French Guiana.,Department of Dermatology, Centre Hospitalier Andree Rosemon Cayenne, Cayenne, French Guiana
| | - Kinan Drak Alsibai
- Department of Pathology, Centre Hospitalier Andrée Rosemon Cayenne, Cayenne, French Guiana
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Cytological Spectrum of Pulmonary Histoplasmosis Diagnosed by Bronchoalveolar Lavage: 12 Years of Experience in French Guiana. J Fungi (Basel) 2021; 7:jof7070576. [PMID: 34356955 PMCID: PMC8304076 DOI: 10.3390/jof7070576] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 07/10/2021] [Accepted: 07/10/2021] [Indexed: 12/02/2022] Open
Abstract
Disseminated histoplasmosis is a major cause of mortality in HIV-infected patients. Rapid and efficient diagnosis of Histoplasma capsulatum is crucial. Cytopathology is available in most hospitals and represents a rapid diagnostic alternative. In this study, we reviewed 12 years of experience to describe the cytology of histoplasmosis diagnosed by bronchoalveolar lavage (BAL) in relation to patient characteristics. BAL-diagnosed pulmonary histoplasmosis concerned 17 patients (14 HIV+). BAL cellularity ranged from 76,000 to 125,000 cells/mL in HIV patients, and 117,000 to 160,000 cells/mL in non-HIV patients. Macrophages predominated in all HIV patients (from 60% to 88%), lymphocytic infiltrates ranged from 5% to 15%, and neutrophils were very heterogeneous (from 2% to 32%). The number of H. capsulatum at hot spots seemed greater in HIV-infected than in immunocompetent patients (9 to 375 vs. 4 to 10) and were inversely proportional to the CD4 counts. Yeasts were both intracellular and extracellular in 85.7% of the HIV patients. This is the most comprehensive series detailing the cytological aspects of BAL in the diagnosis of H. capsulatum, focusing on the number of yeasts and their clustering pattern. The cytological examination of the Gomori-Grocott-stained BAL allows a reliable diagnosis of histoplasmosis.
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Histoplasmosis in Children; HIV/AIDS Not a Major Driver. J Fungi (Basel) 2021; 7:jof7070530. [PMID: 34209280 PMCID: PMC8305925 DOI: 10.3390/jof7070530] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 06/24/2021] [Accepted: 06/25/2021] [Indexed: 12/31/2022] Open
Abstract
The classification of histoplasmosis as an AIDS-defining illness has largely attributed its occurrence in people to the presence of HIV/AIDS especially in Africa. Prior to the advent of the HIV/AIDS epidemic, several cases of histoplasmosis were documented both in the pediatric and adult populations. Our review revealed 1461 reported cases of pediatric histoplasmosis globally in the last eight decades (1939-2021). North America (n = 1231) had the highest number of cases, followed by South America (n = 135), Africa (n = 65), Asia (n = 26) and Europe (n = 4). Histoplasmosis was much more common in the non-HIV pediatric population (n = 1418, 97.1%) compared to the HIV population. The non-HIV factors implicated were, childhood malignancies (n = 207), such as leukemias and lymphomas as well as their treatment, lung diseases (n = 7), environmental exposures and toxins (n = 224), autoimmune diseases (n = 12), organ transplants (n = 12), long-term steroid therapy (n = 3), the use of immunosuppressive drugs such as TNF-alpha inhibitors (n = 7) malnutrition (n = 12), histiocytosis (n = 3), Hyper immunoglobulin M and E syndromes (n = 15, 1.2%), pancytopenia (n = 26), diabetes mellitus (n = 1) and T-cell deficiency (n = 21). Paediatricians should always consider or rule out a diagnosis of histoplasmosis in children presenting with symptoms suggestive of the above clinical conditions.
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Drak Alsibai K, Couppié P, Blanchet D, Adenis A, Epelboin L, Blaizot R, Louvel D, Djossou F, Demar M, Nacher M. Cytological and Histopathological Spectrum of Histoplasmosis: 15 Years of Experience in French Guiana. Front Cell Infect Microbiol 2020; 10:591974. [PMID: 33194840 PMCID: PMC7658294 DOI: 10.3389/fcimb.2020.591974] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 10/07/2020] [Indexed: 12/29/2022] Open
Abstract
Background Disseminated histoplasmosis remains a major killer of immunocompromised patients in Latin America. Cytological and histological methods are usually present in most hospitals and may represent a precious diagnostic method. We report 15 years of experience of the department of pathology of the Centre Hospitalier de Cayenne Andrée Rosemon in French Guiana. Methods Specimens from live patients from January 2005 to June 2020 with the presence of H. capsulatum on cytological and/or histological analysis were analyzed. All specimens were examined by an experienced pathologist. The analysis was descriptive. Results Two hundred two cytological and histological samples were diagnosed with histoplasmosis between January 2005 and June 2020. The 202 samples included 153 (75.7%) histopathological formalin-fixed and paraffin-embedded tissues (biopsy or surgical specimens) and 49 (24.3%) cytological analysis from all organs. One hundred thirty-four patients (82.7%) were HIV-positive, 15 patients (9.3%) had immunosuppressant treatment, and 13 patients (8%) were immunocompetent. Seventy-eight of 202 (38.5%) were samples from the digestive tract, mostly the colon (53/78 cases, 70%) and small intestine (14/78 cases, 18%). Microorganisms were more numerous in digestive samples (notably the colon) than in other organs. Lymphocyte and histiocyte inflammation of moderate to marked intensity were observed in all positive specimens. Tuberculoid epithelioid granuloma were present in 16/78 (20,5%) specimens including 14 colon and 2 small intestine specimens. There were 11/202 cases of liver histoplasmosis, 26/202 (12,8%) cases of pulmonary histoplasmosis. Bone marrow involvement was diagnosed in 14 (2%) specimens (8 aspiration and 6 biopsies). Lymph nodes were positive in 42 specimens (31 histology and 11 cytology). Histopathological analysis of the 31 lymph nodes showed a variable histological appearance. Tuberculoid forms were most frequent (24/31, 77,4%). Conclusions From the pathologist perspective, this is the largest series to date showing that digestive involvement was the most frequent, usually with a tuberculoid form and a greater load of Histoplasma. With awareness and expertise, cytology and pathology are widely available methods that can give life-saving results in a short time to help orient clinicians facing a potentially fatal infection requiring prompt treatment.
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Affiliation(s)
- Kinan Drak Alsibai
- Department of Pathology, Centre Hospitalier de Cayenne Andrée Rosemon, Cayenne, French Guiana
- Centre of Biological Resource (CRB Amazonie), Centre Hospitalier de Cayenne Andrée Rosemon, Cayenne, French Guiana
| | - Pierre Couppié
- Department of Dermatology, Centre Hospitalier de Cayenne Andrée Rosemon, Cayenne, French Guiana
- DFR Santé, Université de Guyane, Cayenne, French Guiana
| | - Denis Blanchet
- Laboratory, Centre Hospitalier de Cayenne Andrée Rosemon, Cayenne, French Guiana
| | - Antoine Adenis
- CIC INSERM 1424, Centre Hospitalier de Cayenne Andrée Rosemon, Cayenne, French Guiana
| | - Loïc Epelboin
- 1 Service des Maladies Infectieuses et Tropicales, Centre Hospitalier de Cayenne Andrée Rosemon, Cayenne, French Guiana
| | - Romain Blaizot
- Department of Dermatology, Centre Hospitalier de Cayenne Andrée Rosemon, Cayenne, French Guiana
| | - Dominique Louvel
- Service de Médecine B, Centre Hospitalier de Cayenne Andrée Rosemon, Cayenne, French Guiana
| | - Félix Djossou
- 1 Service des Maladies Infectieuses et Tropicales, Centre Hospitalier de Cayenne Andrée Rosemon, Cayenne, French Guiana
| | - Magalie Demar
- Laboratory, Centre Hospitalier de Cayenne Andrée Rosemon, Cayenne, French Guiana
- UMR Tropical Biome and Immunopathology, Université de Guyane, Cayenne, French Guiana
| | - Mathieu Nacher
- DFR Santé, Université de Guyane, Cayenne, French Guiana
- CIC INSERM 1424, Centre Hospitalier de Cayenne Andrée Rosemon, Cayenne, French Guiana
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Alvarado P, Pérez-Rojas Y, Zambrano EA, Gonzatti MI, Roschman-González A. Improved serodiagnosis of histoplasmosis by use of deglycosylated extracellular released antigens of Histoplasma capsulatum. J Microbiol Methods 2020; 175:105981. [PMID: 32534998 DOI: 10.1016/j.mimet.2020.105981] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 06/07/2020] [Accepted: 06/07/2020] [Indexed: 11/15/2022]
Abstract
The diagnosis of histoplasmosis depends on various approaches: direct clinical examination, fungus isolation from cultures of clinical samples, histopathological evaluation, and serological testing. In serodiagnostic assays, the Histoplasma capsulatum H and M antigenic glycoproteins have been extensively used. However, both antigens showed limitations attributed mainly to their cross-reactivity with glycoproteins from other pathogenic fungi, which compromises specificity, and generates false positives, misdiagnosis, and therapeutic failure. In this work, we deglycosylated extracellular released antigens from the Venezuelan 7090 H. capsulatum clinical isolate, using chemical and enzymatic methods and evaluated their effectiveness by indirect enzyme-linked immunosorbent assay (ELISA) with sera from patients with either histoplasmosis or PCM. Prior to deglycosylation, the extracellular released antigen showed 62% of sensitivity 66% of specificity and 68% of cross-reactivity with paracoccidioidomicosis sera. The chemically deglycosylated extracellular released antigen, for 8 or 18 h showed 72 and 52% sensitivity with 98% and 92% specificity, respectively. Moreover, cross-reactivity with Paracoccidioides decreased to 4 and 16%, following deglycosylation for 8 or 18 h, respectively. The enzymatically treated antigen showed 52% of sensitivity, 92% of specificity and 8% cross-reactivity against Paracoccidioides. Deglycosylation of the H. capsulatum antigen improves its specificity and decreases its cross-reactivity against Paracoccidioides when using indirect ELISA for serodiagnosis. Therefore, it is recommended to deglycosylate the fungal extracellular released antigen for clinical serodiagnosis, and to monitor humoral immune responses during therapy of patients with the different clinical forms of histoplasmosis.
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Affiliation(s)
- Primavera Alvarado
- Laboratorio de Micología, Instituto de Biomedicina "Dr. Jacinto Convit", Caracas, Venezuela.
| | - Yenis Pérez-Rojas
- Grupo de Bioquímica e Inmunología de Hemoparásitos, Universidad Simón Bolívar, Venezuela
| | - Edgar Armando Zambrano
- Laboratorio de Bioquímica de Parásitos, Instituto de Biomedicina. "Dr. Jacinto Convit", Caracas, Venezuela
| | - Mary I Gonzatti
- Grupo de Bioquímica e Inmunología de Hemoparásitos, Universidad Simón Bolívar, Venezuela
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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.
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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
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Granulomatous mastitis due to coinfection with Histoplasma sp. and Paracoccidioides sp.: A case report. Med Mycol Case Rep 2020; 27:52-54. [PMID: 31993319 PMCID: PMC6976907 DOI: 10.1016/j.mmcr.2020.01.006] [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: 08/05/2019] [Revised: 12/26/2019] [Accepted: 01/13/2020] [Indexed: 01/18/2023] Open
Abstract
A 51 years old female patient with granulomatous mastitis diagnosis, was referred to the Medical Mycology Department “Dr. Dante Borelli” at the Instituto de Medicina Tropical, Universidad Central de Venezuela (IMT-UCV). Mycological diagnosis demonstrated the presence of intracellular yeast structures suggesting Histoplasma sp. and also multi-budding structures compatible with Paracoccidioides sp. To the best of our knowledge, this is the first case report of a granulomatous mastitits due to coinfection of both fungi. 2012 Elsevier Ltd. All rights reserved.
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Pineda J, Merino-Alado R, Mata-Essayag S, Landaeta ME, Garrido L, Rosas MDM. Nasal Septum Perforation Associated to Histoplasmosis: A Retrospective Study. PESQUISA BRASILEIRA EM ODONTOPEDIATRIA E CLÍNICA INTEGRADA 2020. [DOI: 10.1590/pboci.2020.090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Bonifaz A, Estrada-Caraveo Y, Tirado-Sánchez A. Epidemiology of Endemic Mycosis in Children. CURRENT FUNGAL INFECTION REPORTS 2019. [DOI: 10.1007/s12281-019-00358-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Caceres DH, Valdes A. Histoplasmosis and Tuberculosis Co-Occurrence in People with Advanced HIV. J Fungi (Basel) 2019; 5:jof5030073. [PMID: 31404979 PMCID: PMC6787747 DOI: 10.3390/jof5030073] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 08/05/2019] [Accepted: 08/07/2019] [Indexed: 12/11/2022] Open
Abstract
Distinguishing between histoplasmosis, tuberculosis (TB), and co-occurrence of disease is a frequent dilemma for clinical staff treating people with advanced Human Immunodeficiency Virus (HIV) infection. This problem is most frequently observed in clinical settings in countries where both diseases are endemic. It is also a challenge outside these endemic countries in HIV clinics that take care of patients coming from countries with endemic histoplasmosis and TB. The gold standard for diagnosis of both of these diseases is based on conventional laboratory tests (culture, histopathology and special stains). These tests have several limitations, such as lack of laboratory infrastructure for handling isolates (biosafety level 3), shortage of laboratory staff who have appropriate training and experience, variable analytical performance of tests and long turn-around time. Recently, novel rapid assays for the diagnosis of histoplasmosis and TB became available. However, this technology is not yet widely used. Mortality in immunocompromised patients, such as people with advanced HIV, is directly linked with the ability to rapidly diagnose opportunistic diseases. The aim of this review is to synthesize the main aspects of epidemiology, clinical characteristics, diagnosis and treatment of histoplasmosis/TB co-occurrence in people with advanced HIV.
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Affiliation(s)
- Diego H Caceres
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
- Studies in Translational Microbiology and Emerging Diseases (MICROS) Research Group, School of Medicine and Health Sciences, Universidad del Rosario, 11011 Bogota, Colombia.
| | - Audrey Valdes
- Service de Maladies Infectieuses et Tropicales, Centre Hospitalier de Cayenne, 97306 Cayenne, French Guiana.
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Wheat J, Myint T, Guo Y, Kemmer P, Hage C, Terry C, Azar MM, Riddell J, Ender P, Chen S, Shehab K, Cleveland K, Esguerra E, Johnson J, Wright P, Douglas V, Vergidis P, Ooi W, Baddley J, Bamberger D, Khairy R, Vikram H, Jenny-Avital E, Sivasubramanian G, Bowlware K, Pahud B, Sarria J, Tsai T, Assi M, Mocherla S, Prakash V, Allen D, Passaretti C, Huprikar S, Anderson A. Central nervous system histoplasmosis: Multicenter retrospective study on clinical features, diagnostic approach and outcome of treatment. Medicine (Baltimore) 2018; 97:e0245. [PMID: 29595679 PMCID: PMC5895412 DOI: 10.1097/md.0000000000010245] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Central nervous system (CNS) involvement occurs in 5 to 10% of individuals with disseminated histoplasmosis. Most experience has been derived from small single center case series, or case report literature reviews. Therefore, a larger study of central nervous system (CNS) histoplasmosis is needed in order to guide the approach to diagnosis, and treatment.A convenience sample of 77 patients with histoplasmosis infection of the CNS was evaluated. Data was collected that focused on recognition of infection, diagnostic techniques, and outcomes of treatment.Twenty nine percent of patients were not immunosuppressed. Histoplasma antigen, or anti-Histoplasma antibodies were detected in the cerebrospinal fluid (CSF) in 75% of patients. One year survival was 75% among patients treated initially with amphotericin B, and was highest with liposomal, or deoxycholate formulations. Mortality was higher in immunocompromised patients, and patients 54 years of age, or older. Six percent of patients relapsed, all of whom had the acquired immunodeficiency syndrome (AIDS), and were poorly adherent with treatment.While CNS histoplasmosis occurred most often in immunocompromised individuals, a significant proportion of patients were previously, healthy. The diagnosis can be established by antigen, and antibody testing of the CSF, and serum, and antigen testing of the urine in most patients. Treatment with liposomal amphotericin B (AMB-L) for at least 1 month; followed by itraconazole for at least 1 year, results in survival among the majority of individuals. Patients should be followed for relapse for at least 1 year, after stopping therapy.
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Affiliation(s)
| | - Thein Myint
- University of Kentucky School of Medicine, Lexington, Kentucky
| | - Ying Guo
- Emory University Rollins School of Public Health
| | - Phebe Kemmer
- Emory University Rollins School of Public Health
| | | | - Colin Terry
- Indiana University Health, Indianapolis, Indiana
| | - Marwan M. Azar
- Yale University School of Medicine, New Haven, Connecticut
| | - James Riddell
- University of Michigan Health System, Ann Arbor, Michigan
| | - Peter Ender
- St. Luke's University Hospital and Health Network, Bethlehem
| | - Sharon Chen
- Stanford University School of Medicine, Stanford
| | | | | | | | - James Johnson
- Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Patty Wright
- University of California at San Francisco School of Medicine, San Francisco
| | - Vanja Douglas
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | | | - Winnie Ooi
- Lahey Hospital and Medical Center, Burlington, Massachusetts
| | - John Baddley
- University of Alabama- Birmingham, Birmingham, Alabama
| | | | - Raed Khairy
- Sparks Center for Infectious Diseases, Fort Smith, Arkansas
| | | | | | | | - Karen Bowlware
- University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | | | - Juan Sarria
- University of Texas Medical Branch, Galveston
| | | | - Maha Assi
- Infectious Disease Consultants, Wichita, Kansas
| | | | - Vidhya Prakash
- Southern Illinois University School of Medicine, Springfield, Illinois
| | - David Allen
- Courage Fund, National University of Singapore, Singapore
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Chen S, Sun KY, Feng XW, Ran X, Lama J, Ran YP. Efficacy and safety of itraconazole use in infants. World J Pediatr 2016; 12:399-407. [PMID: 27286691 DOI: 10.1007/s12519-016-0034-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Accepted: 03/18/2015] [Indexed: 02/05/2023]
Abstract
BACKGROUND Itraconazole has been used to treat fungal infections, in particular invasive fungal infections in infants or neonates in many countries. DATA SOURCES Literature search was conducted through Ovid EMBASE, PubMed, ISI Web of Science, CNKI and Google scholarship using the following key words: "pediatric" or "infant" or "neonate" and "fungal infection" in combination with "itraconazole". Based on the literature and our clinical experience, we outline the administration of itraconazole in infants in order to develop evidence-based pharmacotherapy. RESULTS Of 45 articles on the use of itraconazole in infancy, 13 are related to superficial fungal infections including tinea capitis, sporotrichosis, mucosal fungal infections and opportunistic infections. The other 32 articles are related to systemic fungal infections including candidiasis, aspergillosis, histoplasmosis, zygomycosis, trichosporonosis and opportunistic infections as caused by Myceliophthora thermophila. CONCLUSION Itraconazole is safe and effective at a dose of 5 mg/kg per day in a short duration of therapy for superficial fungal infections and 10 mg/kg per day for systemic fungal infections in infants. With a good compliance, it is cost-effective in treating infantile fungal infections. The profiles of adverse events induced by itraconazole in infants are similar to those in adults and children.
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Affiliation(s)
- Shuang Chen
- Department of Dermatovenereology, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Kai-Yi Sun
- Department of Dermatovenereology, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Xiao-Wei Feng
- Department of Dermatovenereology, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Xin Ran
- Department of Dermatovenereology, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Jebina Lama
- Department of Dermatovenereology, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Yu-Ping Ran
- Department of Dermatovenereology, West China Hospital, Sichuan University, Chengdu, 610041, China.
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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.
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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
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Histoplasmosis infections worldwide: thinking outside of the Ohio River valley. CURRENT TROPICAL MEDICINE REPORTS 2015; 2:70-80. [PMID: 26279969 DOI: 10.1007/s40475-015-0044-0] [Citation(s) in RCA: 139] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
In the United States, histoplasmosis is generally thought to occur mainly in the Ohio and Mississippi River Valleys, and the classic map of histoplasmosis distribution reflecting this is second nature to many U.S. physicians. With the advent of the HIV pandemic reports of patients with progressive disseminated histoplasmosis and AIDS came from regions of known endemicity, as well as from regions not thought to be endemic for histoplasmosis throughout the world. In addition, our expanding armamentarium of immunosuppressive medications and biologics has increased the diagnosis of histoplasmosis worldwide. While our knowledge of areas in which histoplasmosis is endemic has improved, it is still incomplete. Our contention is that physicians should consider histoplasmosis with the right constellations of symptoms in any febrile patient with immune suppression, regardless of geographic location or travel history.
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Verhagen LM, Maes M, Villalba JA, d'Alessandro A, Rodriguez LP, España MF, Hermans PWM, de Waard JH. Agreement between QuantiFERON®-TB Gold In-Tube and the tuberculin skin test and predictors of positive test results in Warao Amerindian pediatric tuberculosis contacts. BMC Infect Dis 2014; 14:383. [PMID: 25012075 PMCID: PMC4227090 DOI: 10.1186/1471-2334-14-383] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Accepted: 06/30/2014] [Indexed: 01/14/2023] Open
Abstract
Background Interferon-gamma release assays have emerged as a more specific alternative to the tuberculin skin test (TST) for detection of tuberculosis (TB) infection, especially in Bacille Calmette-Guérin (BCG) vaccinated people. We determined the prevalence of Mycobacterium tuberculosis infection by TST and QuantiFERON®-TB Gold In-Tube (QFT-GIT) and assessed agreement between the two test methods and factors associated with positivity in either test in Warao Amerindian children in Venezuela. Furthermore, progression to active TB disease was evaluated for up to 12 months. Methods 163 HIV-negative childhood household contacts under 16 years of age were enrolled for TST, QFT-GIT and chest X-ray (CXR). Follow-up was performed at six and 12 months. Factors associated with TST and QFT-GIT positivity were studied using generalized estimation equations logistic regression models. Results At baseline, the proportion of TST positive children was similar to the proportion of children with a positive QFT-GIT (47% vs. 42%, p = 0.12). Overall concordance between QFT-GIT and TST was substantial (kappa 0.76, 95% CI 0.46-1.06). Previous BCG vaccination was not associated with significantly increased positivity in either test (OR 0.68, 95% CI 0.32-1.5 for TST and OR 0.51, 95% CI 0.14-1.9 for QFT-GIT). Eleven children were diagnosed with active TB at baseline. QFT-GIT had a higher sensitivity for active TB (88%, 95% CI 47-98%) than TST (55%, 95% CI 24-83%) while specificities were similar (respectively 58% and 55%). Five initially asymptomatic childhood contacts progressed to active TB disease during follow-up. Conclusion Replacement of TST by the QFT-GIT for detection of M. tuberculosis infection is not recommended in this resource-constrained setting as test results showed substantial concordance and TST positivity was not affected by previous BCG vaccination. The QFT-GIT had a higher sensitivity than the TST for the detection of TB disease. However, the value of the QFT-GIT as an adjunct in diagnosing TB disease is limited by a high variability in QFT-GIT results over time.
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Affiliation(s)
- Lilly M Verhagen
- Laboratorio de Tuberculosis, Instituto de Biomedicina, Universidad Central de Venezuela, Caracas, Venezuela.
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Scheel CM, Gómez BL. Diagnostic Methods for Histoplasmosis: Focus on Endemic Countries with Variable Infrastructure Levels. CURRENT TROPICAL MEDICINE REPORTS 2014; 1:129-137. [PMID: 31187020 DOI: 10.1007/s40475-014-0020-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Diagnosis of histoplasmosis remains challenging in resource-limited regions where HIV/AIDS is epidemic and histoplasmosis is endemic. Early and rapid detection of histoplasmosis is essential to preventing morbidity and mortality, yet few diagnostic options are available in low-resource areas of the world. The aim of this review is to provide an overview of the current status of the diagnosis of histoplasmosis, including an update on recent developments and utilization of new technologies. We discuss the specific diagnostic challenges faced in endemic regions, emphasizing the need for greater availability and standardization of rapid diagnostics for this endemic and neglected disease. While significant progress has been made in the development of new methods, clinical utility must be established by means of formal and extensive clinical studies.
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Affiliation(s)
- Christina M Scheel
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, 1600 Clifton Road NE, MS G11, Atlanta, GA, USA
| | - Beatriz L Gómez
- Corporación para Investigaciones Biólogicas, Cra. 72 No 78 B 141, Medellín, Colombia
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Dall Bello AG, Severo CB, Oliveira FDM, Hallal Junior RJ, Hochhergger B, Severo LC. Histoplasmosis presenting with multiple pulmonary nodules. A case mimicking radiological features of pulmonary metastasis. Rev Inst Med Trop Sao Paulo 2013; 55:S0036-46652013000300209. [PMID: 23740014 DOI: 10.1590/s0036-46652013000300013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2012] [Accepted: 11/09/2012] [Indexed: 11/22/2022] Open
Abstract
We present a case of histoplasmosis with multiple pulmonary nodules in a patient with a history of melanoma. This case closely simulated malignancy, including the presence of feeding vessel sign, which occurs in pulmonary metastasis. We emphasize the need to be aware of this infection in areas where histoplasmosis is endemic.
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Affiliation(s)
- Aline Gehlen Dall Bello
- Programa de Pós-Graduação em Ciências Pneumológicas, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, RG, Brazil
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Sifuentes-Osornio J, Corzo-León DE, Ponce-de-León LA. Epidemiology of Invasive Fungal Infections in Latin America. CURRENT FUNGAL INFECTION REPORTS 2012; 6:23-34. [PMID: 22363832 PMCID: PMC3277824 DOI: 10.1007/s12281-011-0081-7] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
The pathogenic role of invasive fungal infections (IFIs) has increased during the past two decades in Latin America and worldwide, and the number of patients at risk has risen dramatically. Working habits and leisure activities have also been a focus of attention by public health officials, as endemic mycoses have provoked a number of outbreaks. An extensive search of medical literature from Latin America suggests that the incidence of IFIs from both endemic and opportunistic fungi has increased. The increase in endemic mycoses is probably related to population changes (migration, tourism, and increased population growth), whereas the increase in opportunistic mycoses may be associated with the greater number of people at risk. In both cases, the early and appropriate use of diagnostic procedures has improved diagnosis and outcome.
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Affiliation(s)
- Jose Sifuentes-Osornio
- Laboratory of Microbiology, Salvador Zubiran National Institute of Medical Science and Nutrition, 15 Vasco de Quiroga, sección XVI, Tlalpan, México City, ZC 14000 Mexico
| | - Dora E. Corzo-León
- Infectious Diseases, Salvador Zubiran National Institute of Medical Science and Nutrition, México City, Mexico
| | - L. Alfredo Ponce-de-León
- Laboratory of Microbiology, Salvador Zubiran National Institute of Medical Science and Nutrition, 15 Vasco de Quiroga, sección XVI, Tlalpan, México City, ZC 14000 Mexico
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Colombo AL, Tobón A, Restrepo A, Queiroz-Telles F, Nucci M. Epidemiology of endemic systemic fungal infections in Latin America. Med Mycol 2011; 49:785-98. [PMID: 21539506 DOI: 10.3109/13693786.2011.577821] [Citation(s) in RCA: 137] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Although endemic mycoses are a frequent health problem in Latin American countries, clinical and epidemiological data remain scarce and fragmentary. These mycoses have a significant impact on public health, and early diagnosis and appropriate treatment remain important. The target population for endemic disease in Latin America is mostly represented by low-income rural workers with limited access to a public or private health system. Unfortunately, diagnostic tools are not widely available in medical centers in Latin America; consequently, by the time patients are diagnosed with fungal infection, many are already severely ill. Among immunocompromised patients, endemic mycoses usually behave as opportunistic infections causing disseminated rather than localized disease. This paper reviews the epidemiology of the most clinically significant endemic mycoses in Latin America: paracoccidioidomycosis, histoplasmosis, and coccidioidomycosis. The burdens of disease, typically affected populations, and clinical outcomes also are discussed.
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Affiliation(s)
- Arnaldo Lopes Colombo
- Division of Infectious Diseases, Department of Medicine, Federal University of São Paulo, São Paulo, Brazil.
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Marchiori PE, Lino AMM, Machado LR, Pedalini LM, Boulos M, Scaff M. Neuroinfection survey at a neurological ward in a Brazilian tertiary teaching hospital. Clinics (Sao Paulo) 2011; 66:1021-5. [PMID: 21808869 PMCID: PMC3129959 DOI: 10.1590/s1807-59322011000600017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2011] [Accepted: 03/10/2011] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES This study was undertaken to characterize the neuroinfection profile in a tertiary neurological ward. INTRODUCTION Neuroinfection is a worldwide concern and bacterial meningitis, tetanus and cerebral malaria have been reported as the commonest causes in developing countries. METHODS From 1999 to 2007, all patients admitted to the Neurology Ward of Hospital das Clínicas, São Paulo University School of Medicine because of neuroinfection had their medical records reviewed. Age, gender, immunological status, neurological syndrome at presentation, infectious agent and clinical outcome were recorded. RESULTS Three hundred and seventy four cases of neuroinfectious diseases accounted for 4.2% of ward admissions and the identification of infectious agent was successful in 81% of cases. Mean age was 40.5 + 13.4 years, 63.8% were male, 19.7% were immunocompromised patients and meningoencephalitis was the most common clinical presentation despite infectious agent. Viruses and bacteria were equally responsible for 29.4% of neuroinfectious diseases; parasitic, fungal and prion infections accounted for 28%, 9.6% and 3.5% respectively. Human immunodeficiency virus (HIV), herpes simplex virus 1 (HSV1), Mycobacterium tuberculosis, Treponema pallidum, Taenia solium, Schistosoma mansoni, Cryptococcus neoformans and Histoplasma capsulatum were the more common infectious pathogens in the patients. Infection mortality rate was 14.2%, of which 62.3% occurred in immunocompetent patients. CONCLUSION Our institution appeared to share some results with developed and developing countries. Comparison with literature may be considered as quality control to health assistance.
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Affiliation(s)
- Paulo E Marchiori
- Neurology Department, Faculdade de Medicina, Hospital das Clinicas, Universidade de São Paulo, São Paulo, Brazil.
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Muñoz B, Martínez MA, Palma G, Ramírez A, Frías MG, Reyes MR, Taylor ML, Higuera AL, Corcho A, Manjarrez ME. Molecular characterization of Histoplasma capsulatum isolated from an outbreak in treasure hunters Histoplasma capsulatum in treasure hunters. BMC Infect Dis 2010; 10:264. [PMID: 20825675 PMCID: PMC2944350 DOI: 10.1186/1471-2334-10-264] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2009] [Accepted: 09/08/2010] [Indexed: 11/17/2022] Open
Abstract
Background In Mexico, primary pulmonary histoplasmosis is the most relevant clinical form of the disease. The geographical distribution of specific strains of Histoplasma capsulatum circulating in Mexico has not been fully established. Outbreaks must be reported in order to have current, updated information on this disease, identifying new endemic areas, manner of exposure to the fungi, and molecular characterization of the causative agents. We report a recent outbreak of histoplasmosis in treasure hunters and the molecular characterization of two isolates obtained from these patients. Methods Six patients admitted to the National Institute of Respiratory Diseases (INER) in Mexico City presented severe respiratory symptoms suggestive of histoplasmosis. They acquired the infection in the Veracruz (VZ) endemic zone. Diagnosis was made by X-ray and Computed tomography (CT), liver function, immunological techniques, and culture. Identification of H. capsulatum isolates was confirmed by using Polymerase chain reaction (PCR) was conducted with a probe from the M antigen, and the isolates were characterized by means of Random amplification of polymorphic DNA (RAPD)-PCR employed the 1253 oligonucleotide and a mixture of oligonucleotides 1281 and 1283. These were compared to eight reference strain isolates from neighboring areas. Results X-ray and CT revealed disseminated micronodular images throughout lung parenchyma, as well as bilateral retrocaval, prevascular, subcarinal, and hilar adenopathies, hepatosplenomegaly, and altered liver function tests. Five of the six patients developed disseminated histoplasmosis. Two H. capsulatum strains were isolated. The same band profile was detected in both strains, indicating that both isolates corresponded to the sole H. capsulatum strain. Molecular characterization of the isolates was similar in 100% with the EH-53 Hidalgo human (HG) strain (reference strain integrated into the LAm A clade described for Latin America). Conclusions The two isolates appeared to possess the same polymorphic pattern; they are indistinguishable from each other and from EH-53. It is important to remain updated on recent outbreaks of histoplasmosis, the manner of exposure to the fungi, as well as the molecular characterization of the isolates. The severity of cases indicates that this strain is highly virulent and that it is probably prevalent in Hidalgo and Veracruz states.
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Affiliation(s)
- Bertha Muñoz
- Laboratorio de Micología Médica, Depto, de Investigación en Virología, Instituto Nacional de Enfermedades Respiratorias (INER), Calzada de Tlalpan 4502, Sección XVI, Tlalpan,14080 México, DF, México
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Histoplasma capsulatum var. duboisii infection in a patient with AIDS: rapid diagnosis using polymerase chain reaction-sequencing. Diagn Microbiol Infect Dis 2009; 64:85-9. [PMID: 19304436 DOI: 10.1016/j.diagmicrobio.2009.01.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2008] [Revised: 12/30/2008] [Accepted: 01/06/2009] [Indexed: 11/19/2022]
Abstract
We describe an original case of disseminated infection with Histoplasma capsulatum (Hc) var. duboisii in an African patient with AIDS who migrated to Switzerland. The diagnosis of histoplasmosis was suggested using direct examination of tissues and confirmed in 24 h with a panfungal polymerase chain reaction assay. The variety duboisii of Hc was established using DNA sequencing of the polymorphic genomic region OLE. Molecular tools allow diagnosis of histoplasmosis in 24 h, which is drastically shorter than culture procedures.
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