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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.
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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
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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.
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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.)
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Sekar P, Nalintya E, Kwizera R, Mukashyaka C, Niyonzima G, Namakula LO, Nerima P, Fieberg A, Dai B, Ellis J, Boulware DR, Meya DB, Bahr NC, Rajasingham R. Prevalence of Histoplasma Antigenuria among Outpatient Cohort with Advanced HIV in Kampala, Uganda. J Fungi (Basel) 2023; 9:757. [PMID: 37504745 PMCID: PMC10381727 DOI: 10.3390/jof9070757] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 07/12/2023] [Accepted: 07/13/2023] [Indexed: 07/29/2023] Open
Abstract
In sub-Saharan Africa, an estimated 25% of people with HIV present with advanced HIV and are at high risk of opportunistic infections. Whereas histoplasmosis has occasionally been seen in Uganda, the understanding of the local risk of acute infection is limited. We sought to determine the prevalence of Histoplasma antigenuria using an enzyme immunoassay (EIA, clarus Histoplasma GM EIA, IMMY; Norman, OK, USA) in a cohort of outpatients with advanced HIV disease in Kampala, Uganda. Among the persons with positive urine Histoplasma antigen tests, we assessed their clinical presentation and outcomes. The EIA was run on stored urine samples as per the manufacturer's instructions. Specimens ≥1 EIA units were considered positive. Among the 388 tested urine samples, 4 (1.2%) were positive for Histoplasma antigen. The histoplasmosis prevalence among participants with a CD4 < 100 cells/mcL was 2.5% (4/158). Three of the four participants with a positive Histoplasma antigen test reported systemic symptoms consistent with histoplasmosis. All four participants had a positive urine lipoarabinomannan test and were treated for tuberculosis. By the four-week follow-up visit, all participants were clinically improved, alive, and in care without antifungal therapy. In advanced HIV, the clinical presentations of tuberculosis and histoplasmosis overlap. The value of histoplasmosis screening and pre-emptive treatment is an area of future research.
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Affiliation(s)
- Preethiya Sekar
- Infectious Diseases Institute, Makerere University, Kampala P.O. Box 22418, Uganda
| | - Elizabeth Nalintya
- Infectious Diseases Institute, Makerere University, Kampala P.O. Box 22418, Uganda
| | - Richard Kwizera
- Infectious Diseases Institute, Makerere University, Kampala P.O. Box 22418, Uganda
| | - Claudine Mukashyaka
- Infectious Diseases Institute, Makerere University, Kampala P.O. Box 22418, Uganda
| | - Godfrey Niyonzima
- Infectious Diseases Institute, Makerere University, Kampala P.O. Box 22418, Uganda
| | | | - Patricia Nerima
- Infectious Diseases Institute, Makerere University, Kampala P.O. Box 22418, Uganda
| | - Ann Fieberg
- Division of Infectious Diseases and International Medicine, Department of Medicine, University of Minnesota, Minneapolis, MN 55455, USA
| | - Biyue Dai
- Division of Infectious Diseases and International Medicine, Department of Medicine, University of Minnesota, Minneapolis, MN 55455, USA
| | - Jayne Ellis
- Clinical Research Department, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - David R Boulware
- Division of Infectious Diseases and International Medicine, Department of Medicine, University of Minnesota, Minneapolis, MN 55455, USA
| | - David B Meya
- Infectious Diseases Institute, Makerere University, Kampala P.O. Box 22418, Uganda
| | - Nathan C Bahr
- Division of Infectious Diseases, University of Kansas, Kansas City, KS 66160, USA
| | - Radha Rajasingham
- Division of Infectious Diseases and International Medicine, Department of Medicine, University of Minnesota, Minneapolis, MN 55455, USA
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López LF, Tobón ÁM, Cáceres DH, Chiller T, Litvintseva AP, Gade L, González Á, Gómez BL. Application of Real-Time PCR Assays for the Diagnosis of Histoplasmosis in Human FFPE Tissues Using Three Molecular Targets. J Fungi (Basel) 2023; 9:700. [PMID: 37504689 PMCID: PMC10381543 DOI: 10.3390/jof9070700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 06/15/2023] [Accepted: 06/19/2023] [Indexed: 07/29/2023] Open
Abstract
Histoplasmosis is a fungal infection caused by the thermally dimorphic fungus Histoplasma capsulatum. This infection causes significant morbidity and mortality in people living with HIV/AIDS, especially in countries with limited resources. Currently used diagnostic tests rely on culture and serology but with some limitations. No molecular assays are commercially available and the results from different reports have been variable. We aimed to evaluate quantitative real-time PCR (qPCR) targeting three protein-coding genes of Histoplasma capsulatum (100-kDa, H and M antigens) for detection of this fungus in formalin-fixed paraffin-embedded (FFPE) samples from patients with proven histoplasmosis. The sensitivity of 100-kDa, H and M qPCR assays were 93.9%, 91% and 57%, respectively. The specificity of 100-kDa qPCR was 93% when compared against samples from patients with other mycoses and other infections, and 100% when samples from patients with non-infectious diseases were used as controls. Our findings demonstrate that real-time PCR assays targeting 100-kDa and H antigen showed the most reliable results and can be successfully used for diagnosing this mycosis when testing FFPE samples.
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Affiliation(s)
- Luisa F López
- Medical and Experimental Mycology Group, Corporación para Investigaciones Biológicas (CIB), Medellín 050034, Colombia
| | - Ángela M Tobón
- Instituto Colombiano de Medicina Tropical, Universidad CES, Medellín 055450, Colombia
| | - Diego H Cáceres
- Medical and Experimental Mycology Group, Corporación para Investigaciones Biológicas (CIB), Medellín 050034, Colombia
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | - Tom Chiller
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | | | - Lalitha Gade
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | - Ángel González
- Basic and Applied Microbiology Research Group (MICROBA), School of Microbiology, Universidad de Antioquia, Medellín 050010, Colombia
| | - 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
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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.
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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
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Oladele RO, Osaigbovo II, Akanmu AS, Adekanmbi OA, Ekeng BE, Mohammed Y, Alex-Wele MA, Okolo MO, Ayanbeku ST, Unigwe US, Akase IE, Dan-Jumbo A, Isralski D, Denning DW, Pasqualotto AC, Chiller T. Prevalence of Histoplasmosis among Persons with Advanced HIV Disease, Nigeria. Emerg Infect Dis 2022; 28:2261-2269. [PMID: 36286009 PMCID: PMC9622240 DOI: 10.3201/eid2811.220542] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/29/2023] Open
Abstract
We sought to determine the prevalence of probable disseminated histoplasmosis among advanced HIV disease (AHD) patients in Nigeria. We conducted a cross-sectional study in 10 sites across 5 of 6 geopolitical zones in Nigeria. We identified patients with urinary samples containing CD4 cell counts <200 cells/mm3 or World Health Organization stage 3 or 4 disease who also had >2 clinical features of disseminated histoplasmosis, and we tested them for Histoplasma antigen using a Histoplasma enzyme immune assay. Of 988 participants we recruited, 76 (7.7%) were antigen-positive. The 76 Histoplasma antigen-positive participants had significantly lower (p = 0.03) CD4 counts; 9 (11.8%) were also co-infected with tuberculosis. Most antigen-positive participants (50/76; 65.8%; p = 0.015) had previously received antiretroviral treatment; 26/76 (34.2%) had not. Because histoplasmosis is often a hidden disease among AHD patients in Nigeria, Histoplasma antigen testing should be required in the AHD package of care.
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Rubaihayo J, Mbona Tumwesigye N, Birungi J. Temporal and Spatial Distribution of Opportunistic Infections Associated with the Human Immunodeficiency Virus (HIV) in Uganda. Infect Dis (Lond) 2022. [DOI: 10.5772/intechopen.105344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The human immunodeficiency virus (HIV) remains one of the greatest challenges of the twenty-first century in the absence of an effective vaccine or cure. It is estimated globally that close to 38 million people are currently living with the HIV virus and more than 36 million have succumbed to this deadly virus from the time the first case was reported in early 1980s. The virus degrades the human body immunity and makes it more vulnerable to different kinds of opportunistic infections (OIs). However, with the introduction of highly active anti-retroviral therapy (HAART) in 2003, the pattern and frequency of OIs has been progressively changing though with variations in the different parts of the World. So this chapter discusses the temporal and spatial patterns of OIs in Uganda.
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Adamian CMC, de Lima Mota MA, Martins AAF, Aragão MC, Carvalho MS, Meneses GC, Silva Júnior GBD, Leitão TDMJS, De Francesco Daher E. Progressive disseminated histoplasmosis in HIV-positive patients. Int J STD AIDS 2022; 33:544-553. [PMID: 35343333 DOI: 10.1177/09564624221076605] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Histoplasmosis is the most common endemic mycosis among people living with advanced HIV infection. PURPOSE Describe general aspects and challenges of this disease and its association with HIV. RESEARCH DESIGN Review of literature. STUDY SAMPLE Articles found using different combinations of terms including "disseminated histoplasmosis" and AIDS/HIV or immunosuppression in PubMed, Scopus, WHO Global health library, and Scielo database. ANALYSIS We look for information on epidemiology, pathogenesis, diagnosis, and treatment of histoplasmosis in AIDS patients. RESULTS Histoplasmosis is caused by Histoplasma capsulatum, a dimorphic fungus encountered throughout the world, mainly in soil enriched with bat and bird excreta. Progressive disseminated histoplasmosis is the main presentation of this mycosis in people living with advanced HIV and is fatal if left untreated. Symptoms include a systemic disease characterized by fever, weight loss, night sweats, skin manifestations, hepatomegaly, splenomegaly, and septic shock. Diagnostic tests include culture, visualization of H. capsulatum by direct and histopathological examination, serology, antigen, molecular, and skin testing. Patients with disseminated disease require aggressive and prolonged treatment to eradicate the pathogen and include amphotericin B and itraconazole. In many low income countries of endemic regions, histoplasmosis in HIV-positive patients is often undiagnosed or misdiagnosed as another opportunistic infection, due to the similarity in clinical manifestations and to the paucity of better diagnostic tests. CONCLUSION Histoplasmosis remains a neglected disease. Few studies about the disease and expensive treatments make it difficult to reduce the morbidity and mortality of this condition. Public health services and physicians must be aware of histoplasmosis' burden among the HIV-positive population.
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Affiliation(s)
- Caio Manuel Caetano Adamian
- Medical Sciences Post-Graduate Program, Department of Internal Medicine, 28121Federal University of Ceará, Fortaleza, Brazil
| | - Matheus Alves de Lima Mota
- Medical Sciences Post-Graduate Program, Department of Internal Medicine, 28121Federal University of Ceará, Fortaleza, Brazil.,School of Medicine, 28128University of Fortaleza, Fortaleza, Brazil
| | - Augusto Adler Freire Martins
- Medical Sciences Post-Graduate Program, Department of Internal Medicine, 28121Federal University of Ceará, Fortaleza, Brazil
| | - Matheus Cardoso Aragão
- Medical Sciences Post-Graduate Program, Department of Internal Medicine, 28121Federal University of Ceará, Fortaleza, Brazil
| | - Marina Santos Carvalho
- Medical Sciences Post-Graduate Program, Department of Internal Medicine, 28121Federal University of Ceará, Fortaleza, Brazil
| | | | | | | | - Elizabeth De Francesco Daher
- Medical Sciences Post-Graduate Program, Department of Internal Medicine, 28121Federal University of Ceará, Fortaleza, Brazil
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A Simple Predictive Score to Distinguish between Disseminated Histoplasmosis and Tuberculosis in Patients with HIV. J Fungi (Basel) 2021; 8:jof8010016. [PMID: 35049956 PMCID: PMC8777677 DOI: 10.3390/jof8010016] [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: 11/22/2021] [Revised: 12/23/2021] [Accepted: 12/24/2021] [Indexed: 11/16/2022] Open
Abstract
Disseminated histoplasmosis is a common differential diagnosis of tuberculosis in disease-endemic areas. We aimed to find a predictive score to orient clinicians towards disseminated histoplasmosis or tuberculosis when facing a non-specific infectious syndrome in patients with advanced HIV disease. We reanalyzed data from a retrospective study in Cayenne Hospital between January 1997-December 2008 comparing disseminated histoplasmosis and tuberculosis: 100 confirmed disseminated histoplasmosis cases and 88 confirmed tuberculosis cases were included. A simple logit regression model was constructed to predict whether a case was tuberculosis or disseminated histoplasmosis. From this model, a score may be obtained, where the natural logarithm of the probability of disseminated histoplasmosis/tuberculosis = +3.917962 × WHO performance score (1 if >2, 0 if ≤2) -1.624642 × Pulmonary presentation (1 yes, 0 no) +2.245819 × Adenopathies > 2 cm (1 yes, 0 no) -0.015898 × CD4 count - 0.001851 × ASAT - 0.000871 × Neutrophil count - 0.000018 × Platelet count + 6.053793. The area under the curve was 98.55%. The sensitivity of the model to distinguish between disseminated histoplasmosis and tuberculosis was 95% (95% CI = 88.7-98.3%), and the specificity was 93% (95% CI = 85.7.3-97.4%). In conclusion, we here present a clinical-biological predictive score, using simple variables available on admission, that seemed to perform very well to discriminate disseminated histoplasmosis from tuberculosis in French Guiana in well characterized patients.
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Detection of Cytokines and Collectins in Bronchoalveolar Fluid Samples of Patients Infected with Histoplasma capsulatum and Pneumocystis jirovecii. J Fungi (Basel) 2021; 7:jof7110938. [PMID: 34829225 PMCID: PMC8623738 DOI: 10.3390/jof7110938] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 10/26/2021] [Accepted: 10/27/2021] [Indexed: 12/21/2022] Open
Abstract
Histoplasmosis and pneumocystosis co-infections have been reported mainly in immunocompromised humans and in wild animals. The immunological response to each fungal infection has been described primarily using animal models; however, the host response to concomitant infection is unknown. The present work aimed to evaluate the pulmonary immunological response of patients with pneumonia caused either by Histoplasma capsulatum, Pneumocystis jirovecii, or their co-infection. We analyzed the pulmonary collectin and cytokine patterns of 131 bronchoalveolar lavage samples, which included HIV and non-HIV patients infected with H. capsulatum, P. jirovecii, or both fungi, as well as healthy volunteers and HIV patients without the studied fungal infections. Our results showed an increased production of the surfactant protein-A (SP-A) in non-HIV patients with H. capsulatum infection, contrasting with HIV patients (p < 0.05). Significant differences in median values of SP-A, IL-1β, TNF-α, IFN-γ, IL-18, IL-17A, IL-33, IL-13, and CXCL8 were found among all the groups studied, suggesting that these cytokines play a role in the local inflammatory processes of histoplasmosis and pneumocystosis. Interestingly, non-HIV patients with co-infection and pneumocystosis alone showed lower levels of SP-A, IL-1β, TNF-α, IFN-γ, IL-18, IL-17A, and IL-23 than histoplasmosis patients, suggesting an immunomodulatory ability of P. jirovecii over H. capsulatum response.
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11
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Forno D, Samayoa B, Medina N, Arathoon E, Mejia CR, Gordillo R, Cedillos R, Rodas J, Ahlquist Cleveland A, Chiller T, Caceres DH. Diagnosis of fungal opportunistic infections in people living with HIV from Guatemala and El Salvador. Mycoses 2021; 64:1563-1570. [PMID: 34536307 PMCID: PMC8781144 DOI: 10.1111/myc.13368] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 09/13/2021] [Accepted: 09/13/2021] [Indexed: 01/13/2023]
Abstract
Objectives Histoplasmosis and cryptococcosis are important public health problems in people living with HIV (PLHIV) in Central America. Conventional laboratory tests, such as culture and microscopy, are not optimal; however, antigen (Ag) tests are rapid, highly sensitive, and specific for diagnosis of fungal opportunistic infections (OI). The aim of this study was to describe the results of a laboratory‐based surveillance system for histoplasmosis and cryptococcosis. Methods An observational cross‐sectional study based on laboratory surveillance, was carried out in two hospitals in Guatemala and one hospital in El Salvador, between July 2012 and December 2014. Diagnosis of histoplasmosis and cryptococcosis in PLHIV were performed by culture and Ag test. Results A total of 160 PLHIV were diagnosed with fungal OI, of which, 96 (60%) were diagnosed with histoplasmosis, 62 (39%) were with cryptococcosis, and two patients (1%) were diagnosed with both fungal diseases. Of the 160 patients analysed in this study, 94 (59%) were diagnosed using only an Ag assay. CD4 cell count data were available for 136 (85%) patients; 127 (93%) patients had a CD4 count <200; and 90 (66%) had counts <50 CD4 cells per µl. Antiretroviral therapy utilisation at diagnosis was low (33%). Seventy‐one out of 160 (44%) were co‐infected with tuberculosis or other OIs. Conclusion More than half of the patients in this study were diagnosed only by rapid laboratory Ag tests. A high per cent of the patients had advanced HIV disease.
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Affiliation(s)
- Diana Forno
- Division of Global HIV & TB at the Central America Regional Office for the Centers for Disease Control and Prevention (CDC), Guatemala City, Guatemala
| | - Blanca Samayoa
- Asociación de Salud Integral, Guatemala City, Guatemala.,Facultad de Ciencias Químicas y Farmacia, Universidad de San Carlos de Guatemala, Guatemala City, Guatemala
| | - Narda Medina
- Asociación de Salud Integral, Guatemala City, Guatemala.,Clinica Familiar "Luis Ángel García", Hospital General San Juan de Dios, Guatemala City, Guatemala
| | - Eduardo Arathoon
- Asociación de Salud Integral, Guatemala City, Guatemala.,Clinica Familiar "Luis Ángel García", Hospital General San Juan de Dios, Guatemala City, Guatemala
| | | | | | | | - Jose Rodas
- Division of Global HIV & TB at the Central America Regional Office for the Centers for Disease Control and Prevention (CDC), Guatemala City, Guatemala
| | | | - Tom Chiller
- Mycotic Diseases Branch, CDC, Atlanta, GA, USA
| | - Diego H Caceres
- Mycotic Diseases Branch, CDC, Atlanta, GA, USA.,Department of Medical Microbiology, Radboud University Medical Center and Center of Expertise in Mycology Radboudumc/CWZ, Nijmegen, The Netherlands
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12
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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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13
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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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14
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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.
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15
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Kuate MPN, Nyasa R, Mandengue C, Tendongfor N, Bongomin F, Denning DW. Screening for acute disseminated histoplasmosis in HIV disease using urinary antigen detection enzyme immunoassay: A pilot study in Cameroon. J Microbiol Methods 2021; 185:106226. [PMID: 33878445 DOI: 10.1016/j.mimet.2021.106226] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 04/15/2021] [Accepted: 04/15/2021] [Indexed: 11/28/2022]
Abstract
Acute disseminated histoplasmosis (ADH) is an AIDS-defining illness and reported in Cameroon, but there are few data about its incidence. Between June and August 2019, we conducted a descriptive cross-sectional study to screen for histoplasmosis in a population of adults with HIV infection, irrespective of their CD4 T-cell counts, using Histoplasma urine antigen detection enzyme immunoassay (EIA) and histoplasmin skin test. Of the 138 participants screened, 36 (26%) had detectable antigen in urine, using an OD cut off of 0.045. Skin lesions were present in two (6%) cases. Of 39 patients tested for histoplasmin skin test positivity, one was positive. Histoplasma antigenuria was associated with a positive history of chest infection (Odds ratio: 3.632, 95% confidence interval: 1.635-8.071, p= 0.001). As 30 (21.7%) of titres were between 0.045 (the current cut off) and 0.25, the cut off may need adjustment in Cameroon, using disease confirmation with alternative, highly sensitive diagnostic approaches such as PCR and bone marrow examination. H. capsulatum infection appears to be common among HIV-infected patients attending outpatient clinics at the Buea Regional Hospital. There is an acute need to improve awareness and management of HIV patients with respect to H. capsulatum infection.
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Affiliation(s)
| | - Raymond Nyasa
- Department of Microbiology and Parasitology, University of Buea, Buea, Cameroon
| | - Christine Mandengue
- Department of Internal Medicine, Dermatology Unit, Université des Montagnes, Bangangte, Cameroon
| | - Nicholas Tendongfor
- Department of Public Health and Hygiene, Faculty of Health Sciences, University of Buea, Cameroon
| | - Felix Bongomin
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Gulu University, Gulu, Uganda
| | - David W Denning
- Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom; The Global Action Fund for Fungal Infections, Genève, Switzerland
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16
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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.
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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
| | - 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
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17
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Nacher M, Valdes A, Adenis A, Blaizot R, Abboud P, Demar M, Djossou F, Epelboin L, Misslin C, Ntab B, Louvel D, Drak Alsibai K, Couppié P. Gastrointestinal disseminated histoplasmosis in HIV-infected patients: A descriptive and comparative study. PLoS Negl Trop Dis 2021; 15:e0009050. [PMID: 33481806 PMCID: PMC7857560 DOI: 10.1371/journal.pntd.0009050] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 02/03/2021] [Accepted: 12/08/2020] [Indexed: 12/13/2022] Open
Abstract
Disseminated histoplasmosis is one the main AIDS-defining opportunistic infections in HIV-infected patients, notably in Latin America. The non-specific and proteiform clinical presentation leads to diagnostic delays that may lead to fatal outcomes. This retrospective multicentric study aimed to describe the frequency and manifestations of gastrointestinal histoplasmosis in French Guiana, and to compare patients with disseminated histoplasmosis with or without gastrointestinal involvement. Between January 1, 1981 and October 1, 2014 co-infections with HIV and histoplasmosis were enrolled. Inclusion criteria were: age >18 years, confirmed HIV infection; first proven episode of histoplasmosis. Among 349 cases of disseminated histoplasmosis, 245 (70%) had a gastrointestinal presentation. Half of patients with gastrointestinal signs had abdominal pain or diarrhea, mostly watery. Half of patients with abdominal pain had diarrhea (63/124) and half of those with diarrhea (63/123) had abdominal pain. A significant proportion of patients also had hepatomegaly and, to a lesser degree, splenomegaly. After adjusting for potential confounding, the presence of lymphadenopathies >2cm (AOR = 0.2, IC95 = 0.04–0.7, P = 0.01), Haitian origin (AOR = 0.04, IC95 = 0.004–0.4, P = 0.006) were associated with a lower prevalence of gastrointestinal signs and positive gastrointestinal presence of H. capsulatum. Persons with a gastrointestinal H. capsulatum were more likely to have a decreased prothrombin time, lower ferritin, lower liver enzymes, and lower concentrations of LDH than those without gastrointestinal signs and symptoms. They also had a shorter interval between symptoms onset and diagnosis. Patients with a positive gastrointestinal identification of H. capsulatum were less likely to die at 1 month than those without a gastrointestinal presentation (respectively, 4.6% vs 18.5%, P = 0.01). Subacute or chronic gastrointestinal presentations are very frequent during disseminated histoplasmosis, they seem less severe, and should lead to suspect the diagnosis in endemic areas. There were populational or geographic differences in the frequency of gastrointestinal manifestations that could not be explained. This retrospective multicentric study aimed to describe the frequency and manifestations of gastrointestinal histoplasmosis in French Guiana, and to compare patients with disseminated histoplasmosis with or without gastrointestinal involvement. Between January 1, 1981 and October 1, 2014 co-infections with HIV and histoplasmosis were enrolled. Inclusion criteria were: age >18 years, confirmed HIV infection; first proven episode of histoplasmosis. Among 349 cases of disseminated histoplasmosis, 245 (70%) had a gastrointestinal presentation. Half of patients with gastrointestinal signs had abdominal pain or diarrhea, mostly watery. Half of patients with abdominal pain had diarrhea (63/124) and half of those with diarrhea (63/123) had abdominal pain. A significant proportion of patients also had hepatomegaly and, to a lesser degree, splenomegaly. After adjusting for potential confounding, the presence of lymphadenopathies >2cm, Haitian origin were associated with a lower prevalence of gastrointestinal signs and presence of H. capsulatum. Persons with a gastrointestinal presentation were more likely to have a decreased prothrombin time, lower liver enzyme concentration, ferritin, and lower concentrations of LDH than those without gastrointestinal signs and symptoms. The delay between symptom’s onset and diagnosis was also shorter and the proportion of deaths at 1 month was significantly lower among those with gastrointestinal presence of H. capsulatum. Subacute or chronic gastrointestinal presentations are very frequent during disseminated histoplasmosis, they seem less severe, and should lead to suspect the diagnosis in endemic areas.
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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, Cayenne, French Guiana
- * E-mail:
| | - 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, Cayenne, French Guiana
| | - Romain Blaizot
- DFR Santé, Université de Guyane, Cayenne, Cayenne, French Guiana
- Department of dermatology, 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
| | - Balthazar Ntab
- Département d’Information Médicale, Centre hospitalier de l’Ouest Guyanais, Saint Laurent du Maroni, French Guiana
| | - Dominique Louvel
- Service de Médecine B, Gastroentérologie, Centre Hospitalier Andrée Rosemon, Cayenne, French Guiana
| | - Kinan Drak Alsibai
- Service d’Anatomopathologie, Centre Hospitalier Andrée Rosemon, Cayenne, French Guiana
| | - Pierre Couppié
- DFR Santé, Université de Guyane, Cayenne, Cayenne, French Guiana
- Department of dermatology, Centre hospitalier Andree Rosemon Cayenne, Cayenne, French Guiana
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18
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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.
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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
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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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Anot K, Sharma S, Gupta M, Kaur D. Disseminated histoplasmosis and tuberculosis: dual infection in a non-endemic region. BMJ Case Rep 2020; 13:13/8/e235531. [PMID: 32843417 DOI: 10.1136/bcr-2020-235531] [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: 01/19/2023] Open
Abstract
Histoplasmosis is a systemic fungal infection caused by Histoplasma capsulatum, a dimorphic fungus that spreads commonly by contamination of soil with bird and bat droppings. The infection remains latent in most patients until manifested by reduced immune status, for example, HIV/AIDS, corticosteroid/immunosuppressive therapy or in solid organ transplant recipients. Tuberculosis and histoplasmosis may cooccur rarely in HIV and the clinical resemblance of both diseases may hinder identification of patients' harbouring dual infection, especially in regions non-endemic for histoplasmosis. We report a case of disseminated histoplasmosis with disseminated tuberculosis in an incidentally detected patient with HIV-positive who presented with reports of fever and skin rash for 10 days. The Mantoux positivity and CT of chest and abdomen revealing multiple necrotic lymph nodes coupled with bone marrow and skin biopsy divulging histoplasmosis and tuberculosis helped us clinch the concurrent infection.
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Affiliation(s)
- Karuna Anot
- Department of General Medicine, Government Medical College and Hospital, Chandigarh, India
| | - Sanjana Sharma
- Department of General Medicine, Government Medical College and Hospital, Chandigarh, India
| | - Monica Gupta
- Department of General Medicine, Government Medical College and Hospital, Chandigarh, India
| | - Daljinderjit Kaur
- Department of General Medicine, Government Medical College and Hospital, Chandigarh, India
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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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Nacher M, Adenis A, Abboud P, Djossou F, Demar M, Epelboin L, Couppié P. HIV patients dying on anti-tuberculosis treatment: are undiagnosed infections still a problem in French Guiana? BMC Res Notes 2020; 13:209. [PMID: 32276647 PMCID: PMC7149834 DOI: 10.1186/s13104-020-05054-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 03/31/2020] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE Despite scaling-up testing and antiretroviral treatment in Latin America, advanced HIV remains a significant public health problem. The objective of the present study was look for historical risk factors for death in French Guiana's HIV cohort taking into account the immunological status, the main opportunistic infections, and their treatment. A retrospective cohort study was conducted on data collected between 1992 and 2008 to identify factors associated with death in a cohort 2323 patients. RESULTS There were 370 deaths for a total 9608 patient-years. Being on tuberculosis treatment was associated with a greater hazard of death. The diagnosis of confirmed tuberculosis, of histoplasmosis, of toxoplasmosis, and pneumocystosis were independently associated with death. Interactions terms between cotrimoxazole treatment and pneumocystosis, or between confirmed tuberculosis and tuberculosis treatment showed a protective treatment-effect. All patients having received anti-tuberculosis treatment (n = 347) did not have a final diagnosis of tuberculosis (n = 93). For histoplasmosis, 199 patients received antifungal treatment while 141 were diagnosed as having histoplasmosis. The number of patients on anti-tuberculosis drugs was far greater that the number of patients with confirmed tuberculosis, and these patients on treatment without confirmed tuberculosis had a twofold greater risk of dying.
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Affiliation(s)
- Mathieu Nacher
- Centre d'Investigation Clinique, CIC INSERM 1424, Centre Hospitalier de Cayenne, 97300, Cayenne, French Guiana. .,Département de Formation et de Recherche Santé (DFR Santé), Université de Guyane, 97300, Cayenne, French Guiana.
| | - Antoine Adenis
- Centre d'Investigation Clinique, CIC INSERM 1424, Centre Hospitalier de Cayenne, 97300, Cayenne, French Guiana
| | - Philippe Abboud
- Department of Infectious and Tropical Diseases, Centre Hospitalier de Cayenne, 97300, Cayenne, French Guiana
| | - Felix Djossou
- Département de Formation et de Recherche Santé (DFR Santé), Université de Guyane, 97300, Cayenne, French Guiana.,Department of Infectious and Tropical Diseases, Centre Hospitalier de Cayenne, 97300, Cayenne, French Guiana
| | - Magalie Demar
- UMR Tropical Biome and Immuno-pathophysiology, Université de Guyane, 97300, Cayenne, French Guiana.,Parasitology and Mycology Laboratory, Centre Hospitalier de Cayenne, 97300, Cayenne, French Guiana
| | - Loïc Epelboin
- Department of Infectious and Tropical Diseases, Centre Hospitalier de Cayenne, 97300, Cayenne, French Guiana
| | - Pierre Couppié
- Département de Formation et de Recherche Santé (DFR Santé), Université de Guyane, 97300, Cayenne, French Guiana.,Department of Dermatology, Centre Hospitalier de Cayenne, 97300, Cayenne, French Guiana
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Myint T, Leedy N, Villacorta Cari E, Wheat LJ. HIV-Associated Histoplasmosis: Current Perspectives. HIV AIDS-RESEARCH AND PALLIATIVE CARE 2020; 12:113-125. [PMID: 32256121 PMCID: PMC7090190 DOI: 10.2147/hiv.s185631] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Accepted: 02/27/2020] [Indexed: 12/12/2022]
Abstract
Histoplasmosis is an endemic mycosis caused by Histoplasma capsulatum. Infection develops by inhalation of microconidia from environmental sites inhabited by birds and bats. Disseminated disease is the usual presentation due to impaired cellular immunity. Common clinical manifestations include fever, fatigue, malaise, anorexia, weight loss, and respiratory symptoms. Histoplasma antigen detection is the most sensitive method for diagnosis. The sensitivity of the MVista® Quantitative Histoplasma antigen enzyme immunoassay is 95-100% in urine, over 90% in serum and bronchoalveolar lavage (BAL) antigen and 78% in cerebral spinal fluid (CSF). A proven diagnosis can be established by culture or pathology with sensitivities between 70% and 80%. The sensitivity of antibody detection by immunodiffusion or complement fixation was between 60% and 70%. Diagnosis using molecular methods has not been adequately validated for implementation and FDA cleared assays are unavailable. Liposomal amphotericin B should be used for 1-2 weeks followed by itraconazole for at least one year until CD4 counts are above 150 cells/mm3, HIV viral load is below 400 copies/mL and Histoplasma urine antigen is negative. Serum itraconazole level should be monitored to avoid drug toxicity. Antigen should be measured periodically to establish that treatment is effective and to assist in identifying relapse. The incidence of immune reconstitution inflammatory syndrome is low but it must be considered in patients who are thought to be failing antifungal treatment as it does not respond to changing antifungal agents but rather to initiation of corticosteroid therapy. In this review, we discuss pathogenesis, clinical manifestations, diagnosis and treatment based on personal experience and relevant publications.
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Affiliation(s)
- Thein Myint
- Division of Infectious Diseases, Department of Internal Medicine, University of Kentucky, Lexington, KY, USA
| | - Nicole Leedy
- Division of Infectious Diseases, Department of Internal Medicine, University of Kentucky, Lexington, KY, USA
| | - Evelyn Villacorta Cari
- Division of Infectious Diseases, Department of Internal Medicine, University of Kentucky, Lexington, KY, USA
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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: 6] [Impact Index Per Article: 1.5] [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.
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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.
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Montenegro-Idrogo JJ, Chiappe-Gonzalez A, Vargas-Gonzales R, Arévalo J, Ñavincopa M, Ticona E. [Disseminated histoplasmosis and haemophagocytic syndrome in HIV patients: A case series in a Peruvian hospital]. Rev Iberoam Micol 2019; 37:28-33. [PMID: 31864850 DOI: 10.1016/j.riam.2019.09.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 09/07/2019] [Accepted: 09/16/2019] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Disseminated histoplasmosis (DH) is an opportunistic fungal infection in severely immunocompromised patients with HIV infection. Haemophagocytic syndrome (HFS), which can occur in these co-infected patients when the immune response is significantly altered, is often associated with high mortality. AIMS To describe the epidemiological, clinical, analytical and microbiological characteristics, along with studying the presence of HFS, in patients with DH-HIV. METHODS A retrospective study was conducted on a case series using data from the clinical records of patients diagnosed with DH and HIV infection during the years 2014 and 2015. RESULTS DH was diagnosed in 8 (1.3%) of 597 HIV patients. All patients were in stage C3, and 75% (6/8) were not receiving combined antiretroviral therapy (CART). The remaining two patients had recently begun CART (possible immune reconstitution syndrome). Five (62.5%) of the 8 patients met criteria for HFS. The most frequent clinical symptoms were lymphoproliferative and consumptive syndrome, respiratory compromise, and cytopenia. Histoplasma was isolated in lymph nodes of 75% (6/8) of the patients, in blood samples in 25% (2/8), and also in intestinal tissue in one patient. The antifungal therapy was amphotericin B deoxycholate, without adjuvants. The overall mortality was 50%. CONCLUSIONS In this case series, DH-HIV co-infection frequently progressed to HFS with high mortality. The clinical picture may resemble that of other systemic opportunistic infections, such as tuberculosis, or can take place simultaneously with other infections. Clinical suspicion is important in patients with severe cytopenia and lymphoproliferative and consumptive syndrome in order to establish an early diagnosis and prescribing a timely specific therapy.
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Affiliation(s)
- Juan José Montenegro-Idrogo
- Servicio de Enfermedades Infecciosas y Tropicales, Hospital Nacional Dos de Mayo, Lima, Perú; Centro de Investigaciones Tecnológicas Biomédicas y Medioambientales (CITMB), Universidad Nacional Mayor de San Marcos, Lima, Perú; Unidad de Posgrado, Universidad Nacional Mayor de San Marcos, Lima, Perú.
| | - Alfredo Chiappe-Gonzalez
- Servicio de Enfermedades Infecciosas y Tropicales, Hospital Nacional Dos de Mayo, Lima, Perú; Unidad de Posgrado, Universidad Nacional Mayor de San Marcos, Lima, Perú
| | | | - Jorge Arévalo
- Servicio de Enfermedades Infecciosas y Tropicales, Hospital Nacional Dos de Mayo, Lima, Perú
| | - Marcos Ñavincopa
- Servicio de Enfermedades Infecciosas y Tropicales, Hospital Nacional Dos de Mayo, Lima, Perú
| | - Eduardo Ticona
- Servicio de Enfermedades Infecciosas y Tropicales, Hospital Nacional Dos de Mayo, Lima, Perú
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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.
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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
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Nevez G, Le Gal S. Pulmonary co-infection with Pneumocystis jirovecii and Histoplasma capsulatum in AIDS patients is not a rare event. Int J Infect Dis 2019; 87:126-127. [DOI: 10.1016/j.ijid.2019.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 08/14/2019] [Indexed: 10/26/2022] Open
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Caceres DH, Valdes A. Histoplasmosis and Tuberculosis Co-Occurrence in People with Advanced HIV. J Fungi (Basel) 2019; 5:E73. [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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Almeida MDA, Almeida-Silva F, Guimarães AJ, Almeida-Paes R, Zancopé-Oliveira RM. The occurrence of histoplasmosis in Brazil: A systematic review. Int J Infect Dis 2019; 86:147-156. [PMID: 31330326 DOI: 10.1016/j.ijid.2019.07.009] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 07/09/2019] [Accepted: 07/13/2019] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Histoplasmosis is a systemic disease caused by the dimorphic fungus Histoplasma capsulatum. Diagnosis is often delayed, or it is misdiagnosed as tuberculosis. In Brazil, the infection is common and cases of histoplasmosis have been described in all regions of the country; however, the real problem is underestimated since notification of histoplasmosis is not mandatory. METHODS Human histoplasmosis cases diagnosed in Brazil and published up to December 2018 were identified through a search conducted in the PubMed/MEDLINE, SciELO, and Web of Science databases. Moreover, the isolation of H. capsulatum from animals or environmental sources in Brazil was also evaluated. RESULTS A total of 207 articles fulfilled the inclusion criteria and were evaluated, involving a total of 3530 patients with a diagnosis of histoplasmosis during the period studied. Of these patients, 78.3% were male, giving a male-to-female ratio of approximately 4:1. Histoplasmosis presented a higher frequency in individuals between the fourth and fifth decades of life. Disseminated disease was the most common form of histoplasmosis. Isolation of H. capsulatum on culture media and histopathology using staining methods were the diagnostic methods with the best efficiency. The best results in the identification of the H. capsulatum were achieved for samples from mononuclear phagocyte system components, skin and mucosa, and hematological samples. Regarding predisposing factors for histoplasmosis, HIV infection was the most common underlying condition. The overall mortality rate was 33.1%. CONCLUSIONS This study represents the first available systematic review demonstrating Brazilian cases of histoplasmosis in the literature and highlights that the disease is more widespread in the Brazilian territory than has previously been thought.
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Affiliation(s)
- Marcos de Abreu Almeida
- Laboratório de Micologia, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil
| | - Fernando Almeida-Silva
- Laboratório de Micologia, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil
| | | | - Rodrigo Almeida-Paes
- Laboratório de Micologia, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil
| | - Rosely Maria Zancopé-Oliveira
- Laboratório de Micologia, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil.
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Carreto-Binaghi LE, Morales-Villarreal FR, García-de la Torre G, Vite-Garín T, Ramirez JA, Aliouat EM, Martínez-Orozco JA, Taylor ML. Histoplasma capsulatum and Pneumocystis jirovecii coinfection in hospitalized HIV and non-HIV patients from a tertiary care hospital in Mexico. Int J Infect Dis 2019; 86:65-72. [PMID: 31207386 DOI: 10.1016/j.ijid.2019.06.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 06/10/2019] [Accepted: 06/11/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Histoplasma capsulatum and Pneumocystis jirovecii are respiratory fungal pathogens that principally cause pulmonary disease. Coinfection with both pathogens is scarcely reported. This study detected this coinfection using specific molecular methods for each fungus in the bronchoalveolar lavage (BAL) of patients from a tertiary care hospital. MATERIALS AND METHODS BAL samples from 289 hospitalized patients were screened by PCR with specific markers for H. capsulatum (Hcp100) and P. jirovecii (mtLSUrRNA and mtSSUrRNA). The presence of these pathogens was confirmed by the generated sequences for each marker. The clinical and laboratory data for the patients were analyzed using statistical software. RESULTS The PCR findings separated three groups of patients, where the first was represented by 60 (20.8%) histoplasmosis patients, the second by 45 (15.6%) patients with pneumocystosis, and the last group by 12 (4.2%) patients with coinfection. High similarity among the generated sequences of each species was demonstrated by BLASTn and neighbor-joining algorithms. The estimated prevalence of H. capsulatum and P. jirovecii coinfection was higher in HIV patients.
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Affiliation(s)
- Laura E Carreto-Binaghi
- Laboratorio de Inmunología de Hongos, Unidad de Micología, Departamento de Microbiología-Parasitología, Facultad de Medicina, Universidad Nacional Autónoma de México (UNAM), CDMX, 04510, Mexico; Departamento de Investigación en Microbiología, Instituto Nacional de Enfermedades Respiratorias "Ismael Cosío Villegas" (INER), CDMX, 14080, Mexico.
| | | | | | - Tania Vite-Garín
- Laboratorio de Inmunología de Hongos, Unidad de Micología, Departamento de Microbiología-Parasitología, Facultad de Medicina, Universidad Nacional Autónoma de México (UNAM), CDMX, 04510, Mexico.
| | - Jose-Antonio Ramirez
- Laboratorio de Inmunología de Hongos, Unidad de Micología, Departamento de Microbiología-Parasitología, Facultad de Medicina, Universidad Nacional Autónoma de México (UNAM), CDMX, 04510, Mexico.
| | - El-Moukhtar Aliouat
- Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, U1019 - UMR 8204 - CIIL - Centre d'Infection et d'Immunité de Lille, Lille, France.
| | | | - Maria-Lucia Taylor
- Laboratorio de Inmunología de Hongos, Unidad de Micología, Departamento de Microbiología-Parasitología, Facultad de Medicina, Universidad Nacional Autónoma de México (UNAM), CDMX, 04510, Mexico.
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Lebowitz D, Celi L, Tshikung ON, Starobinski M, Chappuis F, Serratrice J. Fever of un-Swiss origin. Presse Med 2019; 48:740-744. [PMID: 31130333 DOI: 10.1016/j.lpm.2019.05.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 03/20/2019] [Accepted: 05/07/2019] [Indexed: 11/29/2022] Open
Affiliation(s)
- Dan Lebowitz
- Geneva university hospitals, division of general internal medicine, 1205 Geneva, Switzerland.
| | - Letizia Celi
- Geneva university hospitals, division of general internal medicine, 1205 Geneva, Switzerland
| | | | - Michel Starobinski
- Geneva university hospitals, division of hematology, 1205 Geneva, Switzerland
| | - François Chappuis
- Geneva university hospitals, division of tropical and humanitarian medicine, 1205 Geneva, Switzerland
| | - Jacques Serratrice
- Geneva university hospitals, division of general internal medicine, 1205 Geneva, Switzerland
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Valero C, Buitrago MJ, Gago S, Quiles-Melero I, García-Rodríguez J. A matrix-assisted laser desorption/ionization time of flight mass spectrometry reference database for the identification of Histoplasma capsulatum. Med Mycol 2019; 56:307-314. [PMID: 28992262 DOI: 10.1093/mmy/myx047] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 05/31/2017] [Indexed: 11/12/2022] Open
Abstract
The isolation of the pathogenic fungus Histoplasma capsulatum from cultures together with the visualization of typical intracellular yeast in tissues are the gold standard methods for diagnosis of histoplasmosis. However, cultures are time-consuming, require level 3 containment and experienced personnel, and usually call for an additional confirmation test. Matrix-Assisted Laser Desorption Ionization Time of Flight Mass Spectrometry (MALDI-ToF MS) has been established as a suitable tool for microbial identification in several clinical laboratories. A reference database has been constructed for the identification of H. capsulatum by MALDI-ToF MS by using six H. capsulatum strains previously identified by molecular methods. For validation, 63 fungal strains belonging to the Collection of the Spanish National Centre for Microbiology were tested against the new reference database combined with other commercial and in-house databases. In a blind assay, all H. capsulatum strains (n = 30) were correctly identified by the database and 86.6% had scores above 1.7. Considering both phases of the fungus for the same strain, the most reliable results were obtained with the mycelial phase, with only 13.3% of isolates having scores below 1.7. The new database was able to identify both morphological phases of the fungus. MALDI-ToF technology yields a prompt and simple identification from H. capsulatum yeast forms and early mycelial cultures. It allows for reducing response time and decreasing risk in fungus manipulation.
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Affiliation(s)
- Clara Valero
- Servicio de Micología, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - María J Buitrago
- Servicio de Micología, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - Sara Gago
- Servicio de Micología, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
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Falci DR, Monteiro AA, Braz Caurio CF, Magalhães TCO, Xavier MO, Basso RP, Melo M, Schwarzbold AV, Ferreira PRA, Vidal JE, Marochi JP, Godoy CSDM, Soares RDBA, Paste A, Bay MB, Pereira-Chiccola VL, Damasceno LS, Leitão TDMJS, Pasqualotto AC. Histoplasmosis, An Underdiagnosed Disease Affecting People Living With HIV/AIDS in Brazil: Results of a Multicenter Prospective Cohort Study Using Both Classical Mycology Tests and Histoplasma Urine Antigen Detection. Open Forum Infect Dis 2019; 6:ofz073. [PMID: 30997365 PMCID: PMC6461557 DOI: 10.1093/ofid/ofz073] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 02/12/2019] [Indexed: 02/01/2023] Open
Abstract
Background Histoplasmosis is highly endemic in the American continent. This condition is associated with a high mortality, particularly in people living with HIV/AIDS (PLWHA). Diagnosis of histoplasmosis is usually late in South America, as Histoplasma antigen detection is rarely available. Here we determined the prevalence, risk factors, and outcome of histoplasmosis in PLWHA in Brazilian hospitals. Methods This was a prospective cohort study (2016-2018) involving 14 tertiary medical centers in Brazil. We included hospitalized PLWHA presenting with fever and additional clinical findings. Patients were investigated at each participant center with classical mycology methods. Also, Histoplasma antigen detection was performed in urine samples (IMMY). Probable/proven histoplasmosis was defined according to European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group/National Institute of Allergy and Infectious Diseases Mycoses Study Group criteria. Results From 616 eligible patients, 570 were included. Histoplasmosis was identified in 21.6% (123/570) of patients. Urine antigen testing increased the diagnostic yield in 53.8%, in comparison with standard mycology methods. Variables independently associated with histoplasmosis were CD4+ count <50 cells/mm3, use of an antiretroviral (protective effect), and sample collection in the Northeast region of Brazil. Dyspnea at presentation was independently associated with death. Histoplasmosis was more frequent than tuberculosis in patients with low CD4+ counts. Overall 30-day mortality was 22.1%, decreasing to 14.3% in patients with antigen-based diagnosis. Conclusions Histoplasmosis is a very frequent condition affecting PLWHA in Brazil, particularly when CD4+ counts are lower than 50 cells/mm3. Antigen detection may detect earlier disease, with a probable impact on outcomes. Access to this diagnostic tool is needed to improve clinical management of PLWHA in endemic countries.
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Affiliation(s)
- Diego R Falci
- Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil
- Universidade La Salle, Canoas, Brazil
| | | | - Cassia Ferreira Braz Caurio
- Universidade Federal de Ciencias da Saude de Porto Alegre, Porto Alegre, Brazil
- Santa Casa de Misericordia de Porto Alegre, Porto Alegre, Brazil
| | | | - Melissa O Xavier
- Hospital Universitario da Universidade Federal do Rio Grande, Rio Grande, Brazil
| | - Rossana P Basso
- Hospital Universitario da Universidade Federal do Rio Grande, Rio Grande, Brazil
| | | | | | | | | | | | | | | | | | - Monica B Bay
- Universidade Federal do Rio Grande do Norte, Natal, Brazil
| | | | | | | | - Alessandro C Pasqualotto
- Universidade Federal de Ciencias da Saude de Porto Alegre, Porto Alegre, Brazil
- Santa Casa de Misericordia de Porto Alegre, Porto Alegre, Brazil
- Correspondence: A. C. Pasqualotto, MD, PhD, MBA, FECMM, Molecular Biology Laboratory at Santa Casa de Misericordia de Porto Alegre, Av Independencia 155, Hospital Dom Vicente Scherer, Heliponto, 90035-075, Porto Alegre, Brazil ()
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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.
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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
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Nabet C, Belzunce C, Blanchet D, Abboud P, Djossou F, Carme B, Aznar C, Demar M. Histoplasma capsulatum causing sinusitis: a case report in French Guiana and review of the literature. BMC Infect Dis 2018; 18:595. [PMID: 30477434 PMCID: PMC6258161 DOI: 10.1186/s12879-018-3499-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 11/01/2018] [Indexed: 11/13/2022] Open
Abstract
Background American histoplasmosis is a mycosis caused by Histoplasma capsulatum. A variety of clinical features of histoplasmosis have been commonly described ranging from asymptomatic infections to severe pulmonary infections. In immunocompromised individuals, progressive disseminated forms are frequent, leading to fatal outcome if untreated. However, H. capsulatum sinusitis is unusual with a few cases documented over the last three decades and may be underdiagnosed or confused with other fungal aetiologies, especially outside endemic regions. Case presentation In this study, we report an atypical case of Histoplasma capsulatum sinus fungus ball-like in a patient with Acquired Immunodeficiency Syndrome due to Human Immunodeficiency Virus complicated by a disseminated histoplasmosis with a death ending. Diagnosis relied on CT-Scan imaging and on both direct examination of H. capsulatum yeast forms (Gomory methenamine Grocott) in the sinus specimen (aspirate, biopsy) and on positivity of the culture further confirmed by qPCR. Conclusions Since last few decades, among the eight reviewed patients, H. capsulatum sinusitis occurred mostly in HIV-immunocompromised patients and for three cases as a sinusitis with disseminated histoplasmosis. Even if this is a rare clinical presentation, its diagnosis is crucial as it could represent an early expression of an Histoplasma capsulatum exposure that can evolve into a disseminated fatal infection when immunity decreases.
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Affiliation(s)
- C Nabet
- AcademicLaboratory of Parasitology and Mycology, Andrée Rosemon Hospital, 97306, Cayenne, French Guiana.,Faculty of Medicine, University of French Guiana, EA 3593 EPaT, Amazonian Ecosystems and Tropical Disease, Cayenne, French Guiana
| | - C Belzunce
- Unit of infectious diseases and Tropical medicine, Andrée Rosemon Hospital, Cayenne, French Guiana
| | - D Blanchet
- AcademicLaboratory of Parasitology and Mycology, Andrée Rosemon Hospital, 97306, Cayenne, French Guiana.,Faculty of Medicine, University of French Guiana, EA 3593 EPaT, Amazonian Ecosystems and Tropical Disease, Cayenne, French Guiana
| | - P Abboud
- Unit of infectious diseases and Tropical medicine, Andrée Rosemon Hospital, Cayenne, French Guiana.,Faculty of Medicine, University of French Guiana, EA 3593 EPaT, Amazonian Ecosystems and Tropical Disease, Cayenne, French Guiana
| | - F Djossou
- Unit of infectious diseases and Tropical medicine, Andrée Rosemon Hospital, Cayenne, French Guiana.,Faculty of Medicine, University of French Guiana, EA 3593 EPaT, Amazonian Ecosystems and Tropical Disease, Cayenne, French Guiana
| | - B Carme
- AcademicLaboratory of Parasitology and Mycology, Andrée Rosemon Hospital, 97306, Cayenne, French Guiana.,Faculty of Medicine, University of French Guiana, EA 3593 EPaT, Amazonian Ecosystems and Tropical Disease, Cayenne, French Guiana
| | - C Aznar
- AcademicLaboratory of Parasitology and Mycology, Andrée Rosemon Hospital, 97306, Cayenne, French Guiana.,Faculty of Medicine, University of French Guiana, EA 3593 EPaT, Amazonian Ecosystems and Tropical Disease, Cayenne, French Guiana
| | - M Demar
- AcademicLaboratory of Parasitology and Mycology, Andrée Rosemon Hospital, 97306, Cayenne, French Guiana. .,Faculty of Medicine, University of French Guiana, EA 3593 EPaT, Amazonian Ecosystems and Tropical Disease, Cayenne, French Guiana.
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Nacher M, Blanchet D, Bongomin F, Chakrabarti A, Couppié P, Demar M, Denning DW, Djossou F, Epelboin L, Govender N, Leitão T, Mac Donald S, Mandengue C, Marques da Silva SH, Oladele R, Panizo MM, Pasqualotto A, Ramos R, Swaminathan S, Rodriguez-Tudela JL, Vreden S, Zancopé-Oliveira R, Adenis A. Histoplasma capsulatum antigen detection tests as an essential diagnostic tool for patients with advanced HIV disease in low and middle income countries: A systematic review of diagnostic accuracy studies. PLoS Negl Trop Dis 2018; 12:e0006802. [PMID: 30339674 PMCID: PMC6209380 DOI: 10.1371/journal.pntd.0006802] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 10/31/2018] [Accepted: 08/29/2018] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION Disseminated histoplasmosis, a disease that often resembles and is mistaken for tuberculosis, is a major cause of death in patients with advanced HIV disease. Histoplasma antigen detection tests are an important addition to the diagnostic arsenal for patients with advanced HIV disease and should be considered for inclusion on the World Health Organization Essential Diagnostics List. OBJECTIVE Our objective was to systematically review the literature to evaluate the diagnostic accuracy of Histoplasma antigen tests in the context of advanced HIV disease, with a focus on low- and middle-income countries. METHODS A systematic review of the published literature extracted data on comparator groups, type of histoplasmosis, HIV status, performance results, patient numbers, whether patients were consecutively enrolled or if the study used biobank samples. PubMed, Scopus, Lilacs and Scielo databases were searched for published articles between 1981 and 2018. There was no language restriction. RESULTS Of 1327 screened abstracts we included a total of 16 studies in humans for further analysis. Most studies included used a heterogeneousgroup of patients, often without HIV or mixing HIV and non HIV patients, with disseminated or non-disseminated forms of histoplasmosis. Six studies did not systematically use mycologically confirmed cases as a gold standard but compared antigen detection tests against another antigen detection test. Patient numbers were generally small (19-65) in individual studies and, in most (7/10), no confidence intervals were given. The post test probability of a positive or negative test were good suggesting that this non invasive diagnostic tool would be very useful for HIV care givers at the level of reference hospitals or hospitals with the infrastructure to perform ELISA tests. The first results evaluating point of care antigen detection tests using a lateral flow assay were promising with high sensitivity and specificity. CONCLUSIONS Antigen detection tests are promising tools to improve detection of and ultimately reduce the burden of histoplasmosis mortality in patients with advanced HIV disease.
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Affiliation(s)
- Mathieu Nacher
- CIC INSERM 1424, Centre Hospitalier Andrée Rosemon, Cayenne, French Guiana
| | - Denis Blanchet
- Laboratoire de parasitologie mycologie, Centre Hospitalier Andrée Rosemon, Cayenne, French Guiana
| | - Felix Bongomin
- Global Fund for Fungal Infections (GAFFI), Geneva, Switzerland
| | | | - Pierre Couppié
- Service de Dermatologie Vénéréologie, Centre Hospitalier Andrée Rosemon, Cayenne, French Guiana
| | - Magalie Demar
- Laboratoire de parasitologie mycologie, Centre Hospitalier Andrée Rosemon, Cayenne, French Guiana
| | | | - Félix Djossou
- Service des maladies infectieuses et tropicales, Centre Hospitalier Andrée Rosemon, Cayenne, French Guiana
| | - Loïc Epelboin
- Service des maladies infectieuses et tropicales, Centre Hospitalier Andrée Rosemon, Cayenne, French Guiana
| | - Nelesh Govender
- Centre for Opportunistic, Tropical and Hospital Infections, National Institute for Communicable Diseases (NICD), Johannesburg, South Africa
| | | | | | | | | | - Rita Oladele
- College of Medicine University of Lagos, Lagos, Nigeria
| | | | | | - Ruth Ramos
- National Care and Treatment Center, Georgetown, Guyana
| | | | | | - Stephen Vreden
- SRCS, Academic hospital Paramaribo, Paramaribo, Suriname
| | | | - Antoine Adenis
- CIC INSERM 1424, Centre Hospitalier Andrée Rosemon, Cayenne, French Guiana
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Ramos IC, Soares YC, Damasceno LS, Libório MP, Farias LABG, Heukelbach J, Alencar CHMD, Leitão TDMJS. Predictive factors for disseminated histoplasmosis in AIDS patients with fever admitted to a reference hospital in Brazil. Rev Soc Bras Med Trop 2018; 51:479-484. [PMID: 30133631 DOI: 10.1590/0037-8682-0425-2017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 07/03/2018] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION In many settings, the lack of sensitive biomarkers of disseminated histoplasmosis (DH) leads to a clinical reliance on older diagnostic methods and delayed treatment initiation. The early recognition of DH is critical for survival, especially in patients with human immunodeficiency virus (HIV). This study aimed to identify clinical and laboratory findings associated with the definitive diagnosis of DH in low-income HIV patients in endemic areas. METHODS Febrile AIDS patients with suspected DH who were admitted to a reference hospital in northeastern Brazil from January 2006 to January 2007 were evaluated for clinical and laboratory findings associated with DH diagnosis. RESULTS One hundred seventeen patients with fever were included, and 48 (41%) cases of DH were determined by Histoplasma capsulatum identification. A higher fever (≥38.5ºC), maculopapular/papular rash, splenomegaly, hepatomegaly, wheezing, hemoglobin ≤9.5g/dL, platelets ≤80,000/µL, CD4 count ≤75/µL, aspartate aminotransferase (AST) level ≥2.5 times the upper limit of normal (ULN), lactate dehydrogenase (LDH) ≥5times the ULN; and international normalized ratio (INR) >2 times the ULN were significantly associated with DH. A multivariable analysis identified hepatomegaly [adjusted (a) prevalence ratio (PR)= 1.96; 95% confidence interval (CI): 1.21-3.16), CD4 count ≤75/µL (aPR = 2.02; 95% CI: 1.06-3.83), LDH ≥5 times the ULN (aPR = 2.23; 95% CI: 1.44-3.48), and maculopapular/papular rash (aPR = 1.70; 95% CI: 1.02-2.83) were independent risk factors for DH. CONCLUSIONS These easily assessed parameters can facilitate clinical decision-making for febrile AIDS patients with suspected DH in low socioeconomic and Histoplasma-endemic regions.
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Affiliation(s)
- Isadora Cavalcanti Ramos
- Departamento de Saúde Comunitária, Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza, CE, Brasil
| | - Yuri Coelho Soares
- Departamento de Saúde Comunitária, Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza, CE, Brasil
| | | | - Mariana Pitombeira Libório
- Hospital São José de Doenças Infecciosas, Fortaleza, CE, Brasil.,Departamento de Saúde Comunitária, Universidade de Fortaleza, Fortaleza, CE, Brasil
| | | | - Jorg Heukelbach
- Departamento de Saúde Comunitária, Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza, CE, Brasil
| | | | - Terezinha do Menino Jesus Silva Leitão
- Departamento de Saúde Comunitária, Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza, CE, Brasil.,Hospital São José de Doenças Infecciosas, Fortaleza, CE, Brasil
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Caceres DH, Tobón ÁM, Restrepo Á, Chiller T, Gómez BL. The important role of co-infections in patients with AIDS and progressive disseminated histoplasmosis (PDH): A cohort from Colombia. Med Mycol Case Rep 2018; 19:41-44. [PMID: 29379705 PMCID: PMC5775073 DOI: 10.1016/j.mmcr.2017.07.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Revised: 01/25/2017] [Accepted: 07/18/2017] [Indexed: 01/28/2023] Open
Abstract
A total of 23/45 (51%) patients with AIDS and histoplasmosis from Medellín, Colombia had other infections. Tuberculosis was the most common (n = 16/23, 70%). Pneumocystosis and cryptococcosis were found in three patients each (13%), bacterial infection and cytomegalovirus occurred each in two patients (9%) while toxoplasmosis, herpes virus and esophageal candidiasis were recorded in one patient each (4%). Of all co-infected patients, 18/23 (78%) had one, four (17%) had two and one (4%) had three additional opportunistic infections.
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Affiliation(s)
- Diego H. Caceres
- Medical and Experimental Mycology Unit, Corporación para Investigaciones Biológicas (CIB), Medellín, Colombia
| | - Ángela M. Tobón
- Medical and Experimental Mycology Unit, Corporación para Investigaciones Biológicas (CIB), Medellín, Colombia
- Hospital La Maria, Medellin, Colombia
| | - Ángela Restrepo
- Medical and Experimental Mycology Unit, Corporación para Investigaciones Biológicas (CIB), Medellín, Colombia
| | - Tom Chiller
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, (CDC), Atlanta, United States
| | - Beatriz L. Gómez
- Medical and Experimental Mycology Unit, Corporación para Investigaciones Biológicas (CIB), Medellín, Colombia
- School of Medicine and Health Sciences, Universidad del Rosario, Bogota, Colombia
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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.
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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
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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.
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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.
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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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Negroni R. Classic Histoplasmosis. Med Mycol 2015. [DOI: 10.1201/b18707-12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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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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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
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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
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Adenis A, Nacher M, Hanf M, Vantilcke V, Boukhari R, Blachet D, Demar M, Aznar C, Carme B, Couppie P. HIV-associated histoplasmosis early mortality and incidence trends: from neglect to priority. PLoS Negl Trop Dis 2014; 8:e3100. [PMID: 25144374 PMCID: PMC4140672 DOI: 10.1371/journal.pntd.0003100] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Accepted: 07/07/2014] [Indexed: 12/18/2022] Open
Abstract
Background Histoplasmosis is an endemic fungal infection in French Guiana. It is the most common AIDS-defining illness and the leading cause of AIDS-related deaths. Diagnosis is difficult, but in the past 2 decades, it has improved in this French overseas territory which offers an interesting model of Amazonian pathogen ecology. The objectives of the present study were to describe the temporal trends of incidence and mortality indicators for HIV-associated histoplasmosis in French Guiana. Methods A retrospective study was conducted to describe early mortality rates observed in persons diagnosed with incident cases of HIV-associated Histoplasma capsulatum var. capsulatum histoplasmosis admitted in one of the three main hospitals in French Guiana between 1992 and 2011. Early mortality was defined by death occurring within 30 days after antifungal treatment initiation. Data were collected on standardized case report forms and analysed using standard statistical methods. Results There were 124 deaths (45.3%) and 46 early deaths (16.8%) among 274 patients. Three time periods of particular interest were identified: 1992–1997, 1998–2004 and 2005–2011. The two main temporal trends were: the proportion of early deaths among annual incident histoplasmosis cases significantly declined four fold (χ2, p<0.0001) and the number of annual incident histoplasmosis cases increased three fold between 1992–1997 and 1998–2004, and subsequently stabilized. Conclusion From an occasional exotic diagnosis, AIDS-related histoplasmosis became the top AIDS-defining event in French Guiana. This was accompanied by a spectacular decrease of early mortality related to histoplasmosis, consistent with North American reference center mortality rates. The present example testifies that rapid progress could be at reach if awareness increases and leads to clinical and laboratory capacity building in order to diagnose and treat this curable disease. Histoplasmosis is an endemic fungal infection in French Guiana. It is the most common AIDS-defining illness and the leading cause of AIDS-related deaths. Diagnosis is difficult, but in the past 2 decades, it has improved. The objectives of the present study were to describe the temporal trends of incidence and mortality indicators for HIV-associated histoplasmosis in French Guiana. A retrospective study was conducted to describe early mortality rates observed in persons diagnosed with incident cases of HIV-associated histoplasmosis admitted in one of the three main hospitals of French Guiana between 1992 and 2011. Early mortality was defined by death occurring within 30 days after antifungal treatment initiation. Data were collected on standardized case report forms and analysed using standard statistical methods. Among 274 patients there were 46 early deaths (16.8%). The two main temporal trends were: the proportion of early deaths significantly divided four fold and the number of annual incident histoplasmosis cases increased three fold. The present example testifies that rapid progress could be at reach if awareness increases and leads to clinical and laboratory capacity building in order to diagnose and treat this curable disease.
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Affiliation(s)
- Antoine Adenis
- Inserm CIC 1424, Centre d'Investigation Clinique Antilles Guyane, Centre Hospitalier de Cayenne, Cayenne, France
- Equipe EA3593, Epidémiologie des Parasitoses et des Mycoses Tropicales, Université des Antilles et de la Guyane, Cayenne, France
- * E-mail:
| | - Mathieu Nacher
- Inserm CIC 1424, Centre d'Investigation Clinique Antilles Guyane, Centre Hospitalier de Cayenne, Cayenne, France
- Equipe EA3593, Epidémiologie des Parasitoses et des Mycoses Tropicales, Université des Antilles et de la Guyane, Cayenne, France
| | - Matthieu Hanf
- Inserm CIC 1424, Centre d'Investigation Clinique Antilles Guyane, Centre Hospitalier de Cayenne, Cayenne, France
- Equipe EA3593, Epidémiologie des Parasitoses et des Mycoses Tropicales, Université des Antilles et de la Guyane, Cayenne, France
| | - Vincent Vantilcke
- Service de Médecine Interne, Centre Hospitalier de l'Ouest Guyanais, Saint Laurent du Maroni, France
| | - Rachida Boukhari
- Laboratoire de Biologie Médicale, Centre Hospitalier de l'Ouest Guyanais, Saint Laurent du Maroni, France
| | - Denis Blachet
- Equipe EA3593, Epidémiologie des Parasitoses et des Mycoses Tropicales, Université des Antilles et de la Guyane, Cayenne, France
- Laboratoire Hospitalo-Universitaire de Parasitologie-Mycologie, Centre Hospitalier de Cayenne, Cayenne, France
| | - Magalie Demar
- Equipe EA3593, Epidémiologie des Parasitoses et des Mycoses Tropicales, Université des Antilles et de la Guyane, Cayenne, France
- Laboratoire Hospitalo-Universitaire de Parasitologie-Mycologie, Centre Hospitalier de Cayenne, Cayenne, France
- Unité des Maladies Infectieuses et Tropicales, Centre Hospitalier de Cayenne, Cayenne, France
| | - Christine Aznar
- Equipe EA3593, Epidémiologie des Parasitoses et des Mycoses Tropicales, Université des Antilles et de la Guyane, Cayenne, France
- Laboratoire Hospitalo-Universitaire de Parasitologie-Mycologie, Centre Hospitalier de Cayenne, Cayenne, France
| | - Bernard Carme
- Inserm CIC 1424, Centre d'Investigation Clinique Antilles Guyane, Centre Hospitalier de Cayenne, Cayenne, France
- Equipe EA3593, Epidémiologie des Parasitoses et des Mycoses Tropicales, Université des Antilles et de la Guyane, Cayenne, France
- Laboratoire Hospitalo-Universitaire de Parasitologie-Mycologie, Centre Hospitalier de Cayenne, Cayenne, France
| | - Pierre Couppie
- Equipe EA3593, Epidémiologie des Parasitoses et des Mycoses Tropicales, Université des Antilles et de la Guyane, Cayenne, France
- Service de Dermatologie Vénérologie, Centre Hospitalier de Cayenne, Cayenne, France
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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.
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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.
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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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Adenis AA, Aznar C, Couppié P. Histoplasmosis in HIV-Infected Patients: A Review of New Developments and Remaining Gaps. CURRENT TROPICAL MEDICINE REPORTS 2014; 1:119-128. [PMID: 24860719 PMCID: PMC4030124 DOI: 10.1007/s40475-014-0017-8] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Histoplasma capsulatum is responsible for histoplasmosis, a fungal disease with worldwide distribution that can affect both immunocompromised and imunocompetent individuals. During the highly active antiretroviral therapy (HAART) era, morbidity and mortality due to histoplasmosis remained a public heatlh problem in low-income and high-income countries. The true burden of HIV-associated histoplasmosis is either not fully known or neglected since it is not a notifiable disease. Progress has been made in DNA patterns of strains and understanding of pathogenesis, and hopefully these will help identify new therapeutic targets. Unfortunately, histoplasmosis is still widely mistaken for multidrug-resistant tuberculosis, leading to numerous avoidable deaths, even if they are easily distinguishable. The new diagnostic tools and therapeutics developments have still not been made available in most endemic regions. Still, recent developments are promising because of their good clinical characteristics and also because they will be commercially available and affordable. This review of published data and gaps may help define and guide future research.
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Affiliation(s)
- Antoine A. Adenis
- Inserm CIC 1424, Centre d’Investigation Clinique Antilles-Guyane, Centre Hospitalier de Cayenne, avenue des flamboyants, BP 6006, 97 300 Cayenne, France
- UAG EA 3593, Epidémiologie des Parasitoses et des Mycoses Tropicales, Université des Antilles et de la Guyane, Cayenne, France
| | - Christine Aznar
- UAG EA 3593, Epidémiologie des Parasitoses et des Mycoses Tropicales, Université des Antilles et de la Guyane, Cayenne, France
- Laboratoire Hospitalo-Universitaire de Parasitologie-Mycologie, Centre Hospitalier de Cayenne, Cayenne, France
| | - Pierre Couppié
- UAG EA 3593, Epidémiologie des Parasitoses et des Mycoses Tropicales, Université des Antilles et de la Guyane, Cayenne, France
- Service de Dermatologie Vénérologie,, Centre Hospitalier de Cayenne, Cayenne, France
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