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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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Cavalcante Filho JRM, Spir PRN, Cortez GM, Malveira AS, Gaia FFP. Intramedullary histoplasmosis lesion in children: A case report. Surg Neurol Int 2022; 13:83. [PMID: 35399893 PMCID: PMC8986645 DOI: 10.25259/sni_1064_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 01/18/2022] [Indexed: 11/17/2022] Open
Abstract
Background: Histoplasmosis is a fungal disease endemic in some regions of the United States of America, Canada, and Latin America. The geographic characteristics, humidity, soil, and climate are responsible for such distribution. In Brazil, there are case reports of histoplasmosis throughout its territory, being considered an endemic region. It is considered an opportunistic disease, affecting mostly immunocompromised patients. To the present date, scientific publications dealing with pediatric cases of histoplasmosis are restricted to case series. Spinal cord injuries caused by histoplasmosis are rare, even in the adult population, being described in few studies. Case Description: The present report deals with a 4-year-old patient, from the southeast region of Brazil, who started a condition of fever, weight loss, cervicobrachialgia, and symmetrical tetraparesis, with evolution over 2 months. In the diagnostic investigation, she was found to have primary immunodeficiency and neuroimaging examinations showed a cervical spinal cord lesion at the level of C4-C6. The anatomopathological diagnosis of histoplasmosis was possible after surgery for decompression and biopsy of the lesion. Conclusion: According to our research, there are no reports in the literature that address the situation of spinal cord compression syndrome due to histoplasmosis in the pediatric population.
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Affiliation(s)
| | | | - Gustavo Maldonado Cortez
- Postdoctoral Fellowship, Lyerly Neurosurgery, Baptist Neurological Institute, Jacksonville, Florida, United States,
| | - Adib Saraty Malveira
- Neurosurgery Resident, Regional Hospital of Presidente Prudente, São Paulo, Brazil,
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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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4
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Novel clinical and dual infection by Histoplasma capsulatum genotypes in HIV patients from Northeastern, Brazil. Sci Rep 2019; 9:11789. [PMID: 31409874 PMCID: PMC6692370 DOI: 10.1038/s41598-019-48111-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 07/30/2019] [Indexed: 12/20/2022] Open
Abstract
Histoplasmosis is a worldwide-distributed deep mycosis that affects healthy and immunocompromised hosts. Severe and disseminated disease is especially common in HIV-infected patients. At least 11 phylogenetic species are recognized and the majority of diversity is found in Latin America. The northeastern region of Brazil has one of the highest HIV/AIDS prevalence in Latin America and Ceará State has one of the highest death rates due to histoplasmosis in the world, where the mortality rate varies between 33-42%. The phylogenetic distribution and population genetic structure of 51 clinical isolates from Northeast Brazil was studied. For that morphological characteristics, exoantigens profile, and fungal mating types were evaluated. The genotypes were deduced by a MSLT in order to define local population structure of this fungal pathogen. In addition, the relationships of H. capsulatum genotypes with clinically relevant phenotypes and clinical aspects were investigated. The results suggest two cryptic species, herein named population Northeast BR1 and population Northeast BR2. These populations are recombining, exhibit a high level of haplotype diversity, and contain different ratios of mating types MAT1-1 and MAT1-2. However, differences in phenotypes or clinical aspects were not observed within these new cryptic species. A HIV patient can be co-infected by two or more genotypes from Northeast BR1 and/or Northeast BR2, which may have significant impact on disease progression due to the impaired immune response. We hypothesize that co-infections could be the result of multiple exposure events and may indicate higher risk of disseminated histoplasmosis, especially in HIV infected patients.
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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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Nacher M, Leitao TS, Gómez BL, Couppié P, Adenis A, Damasceno L, Demar M, Samayoa B, Cáceres DH, Pradinaud R, Sousa ADQ, Arathoon E, Restrepo A. The Fight against HIV-Associated Disseminated Histoplasmosis in the Americas: Unfolding the Different Stories of Four Centers. J Fungi (Basel) 2019; 5:jof5020051. [PMID: 31212897 PMCID: PMC6617033 DOI: 10.3390/jof5020051] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 06/13/2019] [Accepted: 06/14/2019] [Indexed: 11/17/2022] Open
Abstract
Disseminated histoplasmosis is a major opportunistic infection of HIV-infected patients, killing thousands in Latin America each year. Yet, it remains a neglected disease that is often confused with tuberculosis, for lack of simple, affordable, and rapid diagnostic tools. There is great heterogeneity in the level of histoplasmosis awareness. The purpose of this report was to describe how the historical “awakening” to the threat of histoplasmosis came to be in four different centers that have actively described this disease: In Brazil, the Sao José hospital in Fortaleza; in Colombia, the Corporación para Investigaciones Biológicas in Medellin; in French Guiana, Cayenne Hospital; and in Guatemala, the Association de Salud Integral in Guatemala city. In Brazil and French Guiana, the search for leishmaniasis on the buffy coat or skin smears, respectively, led to the rapid realization that HIV patients were suffering from disseminated histoplasmosis. With time and progress in fungal culture, the magnitude of this problem turned it into a local priority. In Colombia and Guatemala, the story is different because for these mycology centers, it was no surprise to find histoplasmosis in HIV patients. In addition, collaborations with the CDC to evaluate antigen-detection tests resulted in researchers and clinicians developing the capacity to rapidly screen most patients and to demonstrate the very high burden of disease in these countries. While the lack of awareness is still a major problem, it is instructive to review the ways through which different centers became histoplasmosis-aware. Nevertheless, as new rapid diagnostic tools are becoming available, their implementation throughout Latin America should rapidly raise the level of awareness in order to reduce the burden of histoplasmosis deaths.
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Affiliation(s)
- Mathieu Nacher
- Centre d'Investigation Clinique Antilles Guyane, Inserm CIC1424, Centre Hospitalier de Cayenne, Cayenne, French Guiana.
- EA3593 Ecosystèmes Amazoniens et Pathologie Tropicale (EPaT), Université de Guyane, DFR Santé, 97300 Cayenne, French Guiana.
| | - Terezinha Silva Leitao
- Departamento de Doenças Infecciosas, Universidade Federal do Ceará, Fortaleza, 60020-181 Ceará, Brasil.
| | - Beatriz L Gómez
- Studies in Translational Microbiology and Emerging Diseases (MICROS) Research Group, School of Medicine and Health Sciences, Universidad del Rosario, 110111 Bogota, Colombia.
| | - Pierre Couppié
- EA3593 Ecosystèmes Amazoniens et Pathologie Tropicale (EPaT), Université de Guyane, DFR Santé, 97300 Cayenne, French Guiana.
- Service de Dermatologie Vénéréologie, Centre Hospitalier de Cayenne, 97300 Cayenne, French Guiana.
| | - Antoine Adenis
- Centre d'Investigation Clinique Epidémiologie Clinique Antilles Guyane CIC INSERM 1424, Cayenne General Hospital, Cayenne, French Guiana.
| | - Lisandra Damasceno
- Departamento de Doenças Infecciosas, Universidade Federal do Ceará, Fortaleza, 60020-181 Ceará, Brasil.
| | - Magalie Demar
- EA3593 Ecosystèmes Amazoniens et Pathologie Tropicale (EPaT), Université de Guyane, DFR Santé, 97300 Cayenne, French Guiana.
- Laboratoire de Parasitologie-Mycologie, Centre Hospitalier de Cayenne, 97300 Cayenne, French Guiana.
| | - Blanca Samayoa
- Asociación de Salud Integral & Hospital General San Juan de Dios, 01001 Guatemala City, Guatemala, .
| | - Diego H Cáceres
- Studies in Translational Microbiology and Emerging Diseases (MICROS) Research Group, School of Medicine and Health Sciences, Universidad del Rosario, 110111 Bogota, Colombia.
| | - Roger Pradinaud
- Service de Dermatologie Vénéréologie, Centre Hospitalier de Cayenne, 97300 Cayenne, French Guiana.
| | | | - Eduardo Arathoon
- La Clinica Familiar de Luis Angel Garcia, 01001 Guatemala City, Guatemala.
| | - Angela Restrepo
- Corporacion para Investigaciones Biologicas, Hospital Pablo Tobon Uribe, 11001 Medellin, Colombia.
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Damasceno LS, Vite-Garín T, Ramírez JA, Rodríguez-Arellanes G, Almeida MAD, Muniz MDM, Mesquita JRLD, Leitão TDMJS, Taylor ML, Zancopé-Oliveira RM. Mixed infection by Histoplasma capsulatum isolates with different mating types in Brazilian AIDS-patients. Rev Inst Med Trop Sao Paulo 2019; 61:e8. [PMID: 30785562 PMCID: PMC6376931 DOI: 10.1590/s1678-9946201961008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Accepted: 12/20/2018] [Indexed: 11/24/2022] Open
Abstract
Mixed infection by Histoplasma capsulatum isolates with
different mating types, in AIDS-patients are described in this study.
Morphological, mating type-specific PCR assay and multilocus sequencing type
analysis of H. capsulatum isolates recovered from two Brazilian
AIDS-patients were performed. Five H. capsulatum isolates were
recovered at different times from the two patients. Three isolates were obtained
from bone marrow (day 1 – CE0411) and buffy coat cultures (day 1 – CE0311; day 2
– CE0511) of patient 1, and two isolates were isolated from buffy coat cultures
(day 3 – CE2813; day 12 – CE2513) of patient 2. The mycelial colonies depicted
different textures and pigmentation features. Dimorphic conversion to the
yeast-phase in ML-Gema medium was achieved in all isolates. MAT1-1 idiomorph was
identified in CE0311, CE0411 and CE2813 isolates; MAT1-2 idiomorph was found in
CE0511 and CE2513 isolates. These H. capsulatum isolates were
grouped within LAm A clade, highlighting that CE0311 and CE0411 isolates formed
a subgroup supported by a high bootstrap value. The CE0511, CE2513, and CE2813
isolates clustered together with a Brazilian H151 isolate. This research reports
mixed infections caused by H. capsulatum isolates with
different mating types in Brazilian AIDS-patients for the first time in the
literature.
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Affiliation(s)
- Lisandra Serra Damasceno
- Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Laboratório de Micologia, Setor Imunodiagnóstico, Rio de Janeiro, Rio de Janeiro, Brazil.,Hospital São José de Doenças Infecciosas, Fortaleza, Ceará, Brazil
| | - Tania Vite-Garín
- Universidad Nacional Autónoma de México, Facultad de Medicina, Departamento de Microbiología y Parasitología, Laboratorio de Inmunología de Hongos, Ciudad de México, México
| | - José Antonio Ramírez
- Universidad Nacional Autónoma de México, Facultad de Medicina, Departamento de Microbiología y Parasitología, Laboratorio de Inmunología de Hongos, Ciudad de México, México
| | - Gabriela Rodríguez-Arellanes
- Universidad Nacional Autónoma de México, Facultad de Medicina, Departamento de Microbiología y Parasitología, Laboratorio de Inmunología de Hongos, Ciudad de México, México
| | - Marcos Abreu de Almeida
- Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Laboratório de Micologia, Setor Imunodiagnóstico, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Mauro de Medeiros Muniz
- Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Laboratório de Micologia, Setor Imunodiagnóstico, Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Terezinha do Menino Jesus Silva Leitão
- Hospital São José de Doenças Infecciosas, Fortaleza, Ceará, Brazil.,Universidade Federal do Ceará, Faculdade de Medicina, Departamento de Saúde Comunitária, Fortaleza, Ceará, Brazil
| | - Maria Lucia Taylor
- Universidad Nacional Autónoma de México, Facultad de Medicina, Departamento de Microbiología y Parasitología, Laboratorio de Inmunología de Hongos, Ciudad de México, México
| | - Rosely Maria Zancopé-Oliveira
- Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Laboratório de Micologia, Setor Imunodiagnóstico, Rio de Janeiro, Rio de Janeiro, Brazil
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8
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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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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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10
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Correia FGS, Alencar CH, Damasceno LS, Ramos IC, Pontes LB, Leitão TDMJS. Spatial distribution of disseminated histoplasmosis and AIDS co-infection in an endemic area of Northeastern Brazil. Rev Soc Bras Med Trop 2016; 49:227-31. [PMID: 27192593 DOI: 10.1590/0037-8682-0327-2015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2015] [Accepted: 03/14/2016] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The spatial distribution of disseminated histoplasmosis (DH) and acquired immunodeficiency syndrome (AIDS) co-infection in adult residents of Fortaleza, Ceará, Brazil was evaluated. METHODS Socio-demographic data for the DH/AIDS cases were obtained from a reference hospital, and socio-environmental indicators were obtained from an official Brazilian institute. Kernel analysis and local indicators of spatial autocorrelation (LISA) cluster maps were used to estimate the case density within the city. RESULTS DH/AIDS cases were concentrated in the Northwestern and Southwestern peripheral areas of the city, related with low human development indices, but different from AIDS cases distribution. CONCLUSION Risk factors other than AIDS infection must affect histoplasmosis development in this area.
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Affiliation(s)
| | - Carlos Henrique Alencar
- Departamento de Saúde Coletiva, Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza, Ceará, Brazil
| | - Lisandra Serra Damasceno
- Departamento de Saúde Coletiva, Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza, Ceará, Brazil
| | - Isadora Cavalcanti Ramos
- Departamento de Saúde Coletiva, Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza, Ceará, Brazil
| | - Lícia Borges Pontes
- Departamento de Saúde Coletiva, Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza, Ceará, Brazil
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11
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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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12
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Almeida MDA, Pizzini CV, Damasceno LS, Muniz MDM, Almeida-Paes R, Peralta RHS, Peralta JM, Oliveira RDVC, Vizzoni AG, de Andrade CLT, Zancopé-Oliveira RM. Validation of western blot for Histoplasma capsulatum antibody detection assay. BMC Infect Dis 2016; 16:87. [PMID: 26905567 PMCID: PMC4765212 DOI: 10.1186/s12879-016-1427-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 02/10/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Histoplasmosis is worldwide systemic mycoses caused by the dimorphic fungus Histoplasma capsulatum. The isolation and identification of H. capsulatum in culture is the reference test for histoplasmosis diagnosis confirmation. However, in the absence of it, serology has been used as a presumptive diagnosis through antibody and antigen detection. The purpose of the present study was to validate an immunoassay method (western blot) for antibodies detection in the diagnosis of histoplasmosis. METHODS To validate the western blot (WB) a study was conducted using 118 serum samples from patients with histoplasmosis and 118 serum controls collected from January 2000 to December 2013 in residents of the Rio de Janeiro State, Brazil. Diagnostic validation parameters were calculated based on the categorization of results obtained in a 2 × 2 table and subjected to statistical analysis. In addition, the viability of deglycosylated histoplasmin antigen (ptHMIN) onto nitrocellulose membranes previously sensitized was evaluated during the same period. RESULTS The WB test showed sensitivity of 94.9 %, specificity of 94.1 %, positive predictive value of 94.1 %, negative predictive value of 94.9 %, accuracy of 94.5 %, and almost perfect precision. Besides, the strips have proved to be viable for using at least 5 years after ptHMIN antigen sensitization. CONCLUSION Western blot test using ptHMIN provides sensitive, specific, and faster results. Therefore, could be considered a useful tool in the diagnosis of histoplasmosis being used by public health system, even in situations where laboratory facilities are relatively limited.
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Affiliation(s)
- Marcos de Abreu Almeida
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Avenida Brasil, 4365, Manguinhos, Rio de Janeiro, RJ, Brazil.
| | - Cláudia Vera Pizzini
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Avenida Brasil, 4365, Manguinhos, Rio de Janeiro, RJ, Brazil.
| | - Lisandra Serra Damasceno
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Avenida Brasil, 4365, Manguinhos, Rio de Janeiro, RJ, Brazil.
| | - Mauro de Medeiros Muniz
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Avenida Brasil, 4365, Manguinhos, Rio de Janeiro, RJ, Brazil.
| | - Rodrigo Almeida-Paes
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Avenida Brasil, 4365, Manguinhos, Rio de Janeiro, RJ, Brazil.
| | | | - José Mauro Peralta
- Instituto de Microbiologia Prof. Paulo de Goes, Universidade Federal do Rio de Janeiro, Avenida Carlos Chagas Filho, Cidade Universitária, Ilha do Fundão, Rio de Janeiro, RJ, 373, Brazil.
| | | | - Alexandre Gomes Vizzoni
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Avenida Brasil, 4365, Manguinhos, Rio de Janeiro, RJ, Brazil.
| | | | - Rosely Maria Zancopé-Oliveira
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Avenida Brasil, 4365, Manguinhos, Rio de Janeiro, RJ, Brazil.
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13
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Multiple opportunistic fungal infections in an individual with severe HIV disease: A case report. Rev Iberoam Micol 2016; 33:118-21. [PMID: 26896884 DOI: 10.1016/j.riam.2015.09.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Revised: 07/09/2015] [Accepted: 09/07/2015] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Fungal infections have been commonly diagnosed in individuals with advanced HIV disease. Cryptococcosis, pneumocystosis, and histoplasmosis are the most frequent systemic mycoses in people suffering from HIV/AIDS. CASE REPORT We report a case of multiple fungal infections in an advanced AIDS-patient. A 33-year-old HIV-positive man from Brazil was hospitalized due to diarrhea, dyspnea, emaciation, hypoxemia, extensive oral thrush, and a CD4+ T lymphocyte count of 20cells/mm(3). Honeycombed-structures consistent with Pneumocystis jirovecii were observed by direct immunofluorescence in induced sputum. Cryptococcus neoformans was recovered from respiratory secretion and cerebrospinal fluid cultures. Histopathology of the bone marrow also revealed the presence of Histoplasma capsulatum. Molecular assays were performed in a sputum sample. Nested-PCR confirmed the presence of P. jirovecii and H. capsulatum; qPCR multiplex was positive for C. neoformans and H. capsulatum. With the treatment of antifungal drugs the patient progressed satisfactorily. CONCLUSIONS The diagnosis of several systemic mycoses demonstrates the vulnerability of advanced AIDS-patients. Thus, the detection of AIDS cases in the early stages of infection is necessary for a prompt and adequate introduction of HAART therapy, and the use of prophylaxis to control opportunistic infections.
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14
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Damasceno LS, Leitão TMJS, Taylor ML, Muniz MM, Zancopé-Oliveira RM. The use of genetic markers in the molecular epidemiology of histoplasmosis: a systematic review. Eur J Clin Microbiol Infect Dis 2015; 35:19-27. [PMID: 26589702 DOI: 10.1007/s10096-015-2508-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 10/08/2015] [Indexed: 10/22/2022]
Abstract
Histoplasmosis is a systemic mycosis caused by Histoplasma capsulatum, a dimorphic fungal pathogen that can infect both humans and animals. This disease has worldwide distribution and affects mainly immunocompromised individuals. In the environment, H. capsulatum grows as mold but undergoes a morphologic transition to the yeast morphotype under special conditions. Molecular techniques are important tools to conduct epidemiologic investigations for fungal detection, identification of infection sources, and determination of different fungal genotypes associated to a particular disease symptom. In this study, we performed a systematic review in the PubMed database to improve the understanding about the molecular epidemiology of histoplasmosis. This search was restricted to English and Spanish articles. We included a combination of specific keywords: molecular typing [OR] genetic diversity [OR] polymorphism [AND] H. capsulatum; molecular epidemiology [AND] histoplasmosis; and molecular epidemiology [AND] Histoplasma. In addition, we used the specific terms: histoplasmosis [AND] outbreaks. Non-English or non-Spanish articles, dead links, and duplicate results were excluded from the review. The results reached show that the main methods used for molecular typing of H. capsulatum were: restriction fragment length polymorphism, random amplified polymorphic DNA, microsatellites polymorphism, sequencing of internal transcribed spacers region, and multilocus sequence typing. Different genetic profiles were identified among H. capsulatum isolates, which can be grouped according to their source, geographical origin, and clinical manifestations.
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Affiliation(s)
- L S Damasceno
- FIOCRUZ-Fundação Oswaldo Cruz, Laboratório de Micologia, Setor Imunodiagnóstico, INI-Instituto Nacional de Infectologia Evandro Chagas, 21045-900, Rio de Janeiro, RJ, Brazil
| | - T M J S Leitão
- Departamento de Saúde Comunitária, Faculdade de Medicina, UFC-Universidade Federal do Ceará, 60430-140, Fortaleza, CE, Brazil
| | - M L Taylor
- Departamento de Microbiología y Parasitología, Laboratorio de Inmunología de Hongos, Facultad de Medicina, UNAM-Universidad Nacional Autónoma de México, 04510, México, DF, Mexico
| | - M M Muniz
- FIOCRUZ-Fundação Oswaldo Cruz, Laboratório de Micologia, Setor Imunodiagnóstico, INI-Instituto Nacional de Infectologia Evandro Chagas, 21045-900, Rio de Janeiro, RJ, Brazil
| | - R M Zancopé-Oliveira
- FIOCRUZ-Fundação Oswaldo Cruz, Laboratório de Micologia, Setor Imunodiagnóstico, INI-Instituto Nacional de Infectologia Evandro Chagas, 21045-900, Rio de Janeiro, RJ, Brazil.
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15
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Could Histoplasma capsulatum Be Related to Healthcare-Associated Infections? BIOMED RESEARCH INTERNATIONAL 2015; 2015:982429. [PMID: 26106622 PMCID: PMC4461736 DOI: 10.1155/2015/982429] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Revised: 05/12/2015] [Accepted: 05/12/2015] [Indexed: 02/07/2023]
Abstract
Healthcare-associated infections (HAI) are described in diverse settings. The main etiologic agents of HAI are bacteria (85%) and fungi (13%). Some factors increase the risk for HAI, particularly the use of medical devices; patients with severe cuts, wounds, and burns; stays in the intensive care unit, surgery, and hospital reconstruction works. Several fungal HAI are caused by Candida spp., usually from an endogenous source; however, cross-transmission via the hands of healthcare workers or contaminated devices can occur. Although other medically important fungi, such as Blastomyces dermatitidis, Paracoccidioides brasiliensis, and Histoplasma capsulatum, have never been considered nosocomial pathogens, there are some factors that point out the pros and cons for this possibility. Among these fungi, H. capsulatum infection has been linked to different medical devices and surgery implants. The filamentous form of H. capsulatum may be present in hospital settings, as this fungus adapts to different types of climates and has great dispersion ability. Although conventional pathogen identification techniques have never identified H. capsulatum in the hospital environment, molecular biology procedures could be useful in this setting. More research on H. capsulatum as a HAI etiologic agent is needed, since it causes a severe and often fatal disease in immunocompromised patients.
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16
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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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17
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Damasceno LS, Ramos AN, Alencar CH, Gonçalves MVF, de Mesquita JRL, Soares ATD, Coutinho AGN, Dantas CC, Leitão TDMJS. Disseminated histoplasmosis in HIV-infected patients: determinants of relapse and mortality in a north-eastern area of Brazil. Mycoses 2014; 57:406-13. [PMID: 24612078 DOI: 10.1111/myc.12175] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Revised: 12/07/2013] [Accepted: 01/25/2014] [Indexed: 11/30/2022]
Abstract
Many relapses and deaths resulting from disseminated histoplasmosis (DH) in acquired immunodeficiency syndrome (AIDS) patients have been observed in an endemic area in north-eastern Brazil. The objective of this study was to evaluate the risk factors associated with the clinical outcomes of DH/AIDS coinfection in patients from the state of Ceará, Brazil. A retrospective cohort of AIDS patients, after their hospital discharge due to first DH episode in the period 2002-2008, was followed until December 31, 2010, to investigate the factors associated with relapse and mortality. A total of 145 patients were evaluated in the study. Thirty patients (23.3%) relapsed and the overall mortality was 30.2%. The following variables were significantly (P < 0.05) associated with relapse and overall mortality (univariate analysis): non-adherence to highly active antiretroviral therapy (HAART), irregular use of an antifungal, non-recovery of the CD4+ count and having AIDS before DH; histoplasmosis relapse was also significantly associated with mortality. In the multivariate analysis, non-adherence to HAART was the independent risk factor that was associated with both relapse (Adj OR = 6.28) and overall mortality (Adj OR = 8.03); efavirenz usage was discovered to be significant only for the overall mortality rate (Adj OR = 4.50). Adherence to HAART was the most important variable that influenced the outcomes in this specific population.
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Affiliation(s)
- Lisandra Serra Damasceno
- Department of Community Health, School of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil; Hospital São José of Infectious Disease, Fortaleza, CE, Brazil
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18
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Abstract
Endemic mycoses remain a significant cause of morbidity and mortality among immunocompromised patients. As the number of immunosuppressed individuals increases worldwide, the incidence of endemic mycoses is also expected to rise. In immunocompromised patients, endemic mycoses can present in atypical fashion, cause more severe and/or disseminated disease, and result in higher mortality. Despite several noteworthy advances over the past decade, significant challenges remain with regard to the prevention, diagnosis, and therapy of endemic mycoses in immunocompromised hosts. This review highlights important developments related to the epidemiology, diagnosis, treatment, and prevention of commonly encountered endemic mycoses. We also discuss emerging topics, knowledge gaps, and areas of future research.
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