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Viale MN, Caceres DH, Mansilla PE, Lopez-Joffre MC, Vivot FG, Motter AN, Toranzo AI, Canteros CE. Evaluation of the Analytical Performance of a Lateral Flow Assay for the Detection of Anti- Coccidioides Antibodies in Human Sera-Argentina. J Fungi (Basel) 2024; 10:322. [PMID: 38786677 PMCID: PMC11122317 DOI: 10.3390/jof10050322] [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: 03/19/2024] [Revised: 04/17/2024] [Accepted: 04/23/2024] [Indexed: 05/25/2024] Open
Abstract
Coccidiomycosis is a potentially life-threatening fungal infection endemic to certain regions of Argentina. The infection is caused by Coccidioides spp. and is primarily diagnosed by Coccidioides antibody (Ab) detection. Access to rapid, highly accurate diagnostic testing is critical to ensure prompt antifungal therapy. The sōna Coccidioides Ab Lateral Flow Assay (LFA) performs faster and requires less laboratory infrastructure and equipment compared with other Ab detection assays, potentially providing a substantial improvement for rapid case screening in coccidioidomycosis-endemic regions; however, validation of this test is needed. Thus, we aimed to evaluate the analytical performance of the sōna Coccidioides Ab (LFA) and compare agreement with anti-Coccidioides Ab detection assays. A total of 103 human sera specimens were tested, including 25 specimens from patients with coccidioidomycosis and 78 from patients without coccidioidomycosis. The sōna Coccidioides Ab Lateral Flow Assay (LFA) was performed with a sensitivity of 88%, and specificity and accuracy of 87%. Furthermore, the Coccidioides Ab LFA had good agreement with other anti-Coccidioides Ab detection assays. Our findings suggest the sōna Coccidioides Ab LFA has satisfactory performance and may be useful for diagnosing coccidioidomycosis in endemic regions.
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Affiliation(s)
- Mariana N. Viale
- Laboratorio Nacional de Referencia en Micología Clínica, Departamento Micología, Instituto Nacional de Enfermedades Infecciosas (INEI), Administración Nacional de Laboratorios e Institutos de Salud (ANLIS) “Dr. Carlos G. Malbrán”, Buenos Aires 1282, Argentina; (M.C.L.-J.); (F.G.V.); (A.I.T.); (C.E.C.)
| | - Diego H. Caceres
- Center of Expertise in Mycology Radboudumc/CWZ, 6525GA Nijmegen, The Netherlands;
- Studies in Translational Microbiology and Emerging Diseases (MICROS) Research Group, School of Medicine and Health Sciences, Universidad del Rosario, Bogota 111221, Colombia
- Immuno-Mycologics Inc. (IMMY), Norman, OK 73069, USA
| | - Patricia E. Mansilla
- Hospital Interzonal San Juan Bautista, San Fernando del Valle de Catamarca 4700, Argentina;
| | - María C. Lopez-Joffre
- Laboratorio Nacional de Referencia en Micología Clínica, Departamento Micología, Instituto Nacional de Enfermedades Infecciosas (INEI), Administración Nacional de Laboratorios e Institutos de Salud (ANLIS) “Dr. Carlos G. Malbrán”, Buenos Aires 1282, Argentina; (M.C.L.-J.); (F.G.V.); (A.I.T.); (C.E.C.)
| | - Flavia G. Vivot
- Laboratorio Nacional de Referencia en Micología Clínica, Departamento Micología, Instituto Nacional de Enfermedades Infecciosas (INEI), Administración Nacional de Laboratorios e Institutos de Salud (ANLIS) “Dr. Carlos G. Malbrán”, Buenos Aires 1282, Argentina; (M.C.L.-J.); (F.G.V.); (A.I.T.); (C.E.C.)
| | - Andrea N. Motter
- Unidad Operativa Centro de Contención Biológica, Administración Nacional de Laboratorios e Institutos de Salud (ANLIS) “Dr. Carlos G. Malbrán”, Buenos Aires 1282, Argentina;
| | - Adriana I. Toranzo
- Laboratorio Nacional de Referencia en Micología Clínica, Departamento Micología, Instituto Nacional de Enfermedades Infecciosas (INEI), Administración Nacional de Laboratorios e Institutos de Salud (ANLIS) “Dr. Carlos G. Malbrán”, Buenos Aires 1282, Argentina; (M.C.L.-J.); (F.G.V.); (A.I.T.); (C.E.C.)
| | - Cristina E. Canteros
- Laboratorio Nacional de Referencia en Micología Clínica, Departamento Micología, Instituto Nacional de Enfermedades Infecciosas (INEI), Administración Nacional de Laboratorios e Institutos de Salud (ANLIS) “Dr. Carlos G. Malbrán”, Buenos Aires 1282, Argentina; (M.C.L.-J.); (F.G.V.); (A.I.T.); (C.E.C.)
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Giusiano G, Tracogna F, Santiso G, Rojas F, Messina F, Sosa V, Chacón Y, Sosa MDLÁ, Mussin J, Cattana ME, Vazquez A, Formosa P, Fernández N, Piedrabuena M, Valdez R, Davalos F, Fernández M, Acuña A, Aguilera A, Guelfand L, Afeltra J, Garcia Effron G, Posse G, Amigot S, Serrano J, Sellares O, Álvarez C, Pineda G, Carnovale S, Zalazar L, Canteros C. Clinical and Demographic Features of Paracoccidioidomycosis in Argentina: A Multicenter Study Analysis of 466 Cases. J Fungi (Basel) 2023; 9:jof9040482. [PMID: 37108936 PMCID: PMC10145406 DOI: 10.3390/jof9040482] [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: 03/06/2023] [Revised: 04/01/2023] [Accepted: 04/12/2023] [Indexed: 04/29/2023] Open
Abstract
Information on paracoccidioidomycosis (PCM) in Argentina is fragmented and has historically been based on estimates, supported only by a series of a few reported cases. Considering the lack of global information, a national multicentric study in order to carry out a more comprehensive analysis was warranted. We present a data analysis including demographic and clinical aspects of a historical series of 466 cases recorded over 10 years (2012-2021). Patients were aged from 1 to 89 years. The general male: female (M:F) ratio was 9.5:1 with significant variation according to the age group. Interestingly, the age range 21-30 shows an M:F ratio of 2:1. Most of the cases (86%) were registered in northeast Argentina (NEA), showing hyperendemic areas in Chaco province with more than 2 cases per 10,000 inhabitants. The chronic clinical form occurred in 85.6% of cases and the acute/subacute form occurred in 14.4% of cases, but most of these juvenile type cases occurred in northwestern Argentina (NWA). In NEA, the incidence of the chronic form was 90.6%; in NWA, the acute/subacute form exceeded 37%. Diagnosis by microscopy showed 96% positivity but antibody detection displays 17% of false negatives. Tuberculosis was the most frequent comorbidity, but a diverse spectrum of bacterial, fungal, viral, parasitic, and other non-infectious comorbidities was recorded. This national multicenter registry was launched in order to better understand the current status of PCM in Argentina and shows the two endemic zones with a highly diverse epidemiology.
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Affiliation(s)
- Gustavo Giusiano
- Departamento Micología, Instituto de Medicina Regional, Universidad Nacional de Nordeste, CONICET, Resistencia 3500, Argentina
- Hospital Pediátrico Juan Pablo II, Corrientes 3400, Argentina
| | | | - Gabriela Santiso
- Unidad de Micología, Hospital de Enfermedades Infecciosas F. J. Muñiz, Uspallata, Buenos Aires 2272, Argentina
| | - Florencia Rojas
- Departamento Micología, Instituto de Medicina Regional, Universidad Nacional de Nordeste, CONICET, Resistencia 3500, Argentina
| | - Fernando Messina
- Unidad de Micología, Hospital de Enfermedades Infecciosas F. J. Muñiz, Uspallata, Buenos Aires 2272, Argentina
| | - Vanesa Sosa
- Servicio de Micología, Hospital Dr. Ramon Madariaga, Av. Marconi 3736, Posadas N3300, Argentina
| | - Yone Chacón
- Hospital Señor del Milagro, Salta 4400, Argentina
| | - Maria de Los Ángeles Sosa
- Laboratorio Central de Redes y Programas, Facultad de Ciencias Exactas y Naturales y Agrimensura, Instituto de Medicina Regional, Universidad Nacional del Nordeste, Placido Martínez, Corrientes 1044, Argentina
| | - Javier Mussin
- Departamento Micología, Instituto de Medicina Regional, Universidad Nacional de Nordeste, CONICET, Resistencia 3500, Argentina
| | | | - Andrea Vazquez
- Servicio de Microbiología, Hospital 4 de Junio Ramón Carrillo, Roque Sáenz Peña, Av. Malvinas Argentinas 1350, Sáenz Peña H3700, Argentina
| | - Patricia Formosa
- Hospital de Alta Complejidad Pte. J. D. Perón, Av. Pantaleón Gómez & Av. Dr. Nestor Kirchner, Formosa 3600, Argentina
| | - Norma Fernández
- Laboratorio de Micología, Hospital de Clínicas, José de San Martin, Buenos Aires 2351, Argentina
| | - Milagros Piedrabuena
- Laboratorio de Microbiología, Hospital San Martín, Pres. Juan Domingo Perón 450, Paraná 3100, Argentina
| | - Ruth Valdez
- Hospital Señor del Milagro, Salta 4400, Argentina
| | - Florencia Davalos
- Servicio de Microbiología, Hospital San Bernardo, Av. José Tobias 69, Salta 4400, Argentina
| | | | | | | | - Liliana Guelfand
- Sección Microbiología, Hospital General de Agudos Dr. Juan A. Fernández, Buenos Aires 1425, Argentina
| | - Javier Afeltra
- Unidad de Parasitología y Micología, Hospital General de Agudos José María Ramos Mejía, Ciudad Autónoma de Buenos Aires 1221, Argentina
| | - Guillermo Garcia Effron
- Laboratorio de Micología y Diagnóstico Molecular, Cátedra de Parasitología y Micología, Facultad de Bioquímica y Ciencias Biológicas, Universidad Nacional del Litoral, CONICET, Santa Fe 2750, Argentina
| | - Gladys Posse
- Hospital Nacional Prof. Dr. A. Posadas, Buenos Aires 1684, Argentina
| | - Susana Amigot
- CEMAR Microbiología, Dir. Bioquímica, Secretaría de Salud Pública, Rosario 2020, Argentina
| | - Julian Serrano
- Sección Micología, Hospital Independencia, Av. Belgrano Nte. 660, Santiago del Estero 4200, Argentina
| | | | - Christian Álvarez
- División Micología-Laboratorio de Salud Pública de Tucumán, Tucumán 4000, Argentina
| | - Gloria Pineda
- Hospital Universitario Austral, Pilar, Buenos Aires 1500, Argentina
| | - Susana Carnovale
- Hospital de Pediatría S.A.M.I.C. Prof. Juan P. Garraham, Pichincha 1890, Buenos Aires 1245, Argentina
| | - Laura Zalazar
- Facultad de Humanidades, Universidad Nacional del Nordeste, Las Heras 727, Resistencia H3500COI, Argentina
| | - Cristina Canteros
- Departamento de Micología, INEI-ANLIS "Dr. Carlos G. Malbrán", Buenos Aires 1281, Argentina
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Crossen AJ, Ward RA, Reedy JL, Surve MV, Klein BS, Rajagopal J, Vyas JM. Human Airway Epithelium Responses to Invasive Fungal Infections: A Critical Partner in Innate Immunity. J Fungi (Basel) 2022; 9:40. [PMID: 36675861 PMCID: PMC9862202 DOI: 10.3390/jof9010040] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 12/09/2022] [Accepted: 12/26/2022] [Indexed: 12/29/2022] Open
Abstract
The lung epithelial lining serves as the primary barrier to inhaled environmental toxins, allergens, and invading pathogens. Pulmonary fungal infections are devastating and carry high mortality rates, particularly in those with compromised immune systems. While opportunistic fungi infect primarily immunocompromised individuals, endemic fungi cause disease in immune competent and compromised individuals. Unfortunately, in the case of inhaled fungal pathogens, the airway epithelial host response is vastly understudied. Furthering our lack of understanding, very few studies utilize primary human models displaying pseudostratified layers of various epithelial cell types at air-liquid interface. In this review, we focus on the diversity of the human airway epithelium and discuss the advantages and disadvantages of oncological cell lines, immortalized epithelial cells, and primary epithelial cell models. Additionally, the responses by human respiratory epithelial cells to invading fungal pathogens will be explored. Future investigations leveraging current human in vitro model systems will enable identification of the critical pathways that will inform the development of novel vaccines and therapeutics for pulmonary fungal infections.
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Affiliation(s)
- Arianne J. Crossen
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Rebecca A. Ward
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Jennifer L. Reedy
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA 02114, USA
- Department of Medicine, Harvard Medical School, Boston, MA 02115, USA
| | - Manalee V. Surve
- Department of Medicine, Harvard Medical School, Boston, MA 02115, USA
- Center for Regenerative Medicine, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Bruce S. Klein
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI 53706, USA
- Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI 53706, USA
- Department of Medical Microbiology and Immunology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI 53706, USA
| | - Jayaraj Rajagopal
- Center for Regenerative Medicine, Massachusetts General Hospital, Boston, MA 02114, USA
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA 02114, USA
- Harvard Stem Cell Institute, Cambridge, MA 02138, USA
- Klarman Cell Observatory, Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA 02142, USA
| | - Jatin M. Vyas
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA 02114, USA
- Department of Medicine, Harvard Medical School, Boston, MA 02115, USA
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4
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Affiliation(s)
- George R Thompson
- Department of Internal Medicine, Division of Infectious Diseases, and Department of Medical Microbiology and Immunology, University of California-Davis Medical Center, Sacramento, California (G.R.T.)
| | - Tom M Chiller
- Centers for Disease Control and Prevention, Mycotic Diseases Branch, Atlanta, Georgia (T.M.C.)
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5
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Caceres DH, Echeverri Tirado LC, Bonifaz A, Adenis A, Gomez BL, Flores CLB, Canteros CE, Santos DW, Arathoon E, Soto ER, Queiroz‐Telles F, Schwartz IS, Zurita J, Damasceno LS, Garcia N, Fernandez NB, Chincha O, Araujo P, Rabagliati R, Chiller T, Giusiano G. Current situation of endemic mycosis in the Americas and the Caribbean: Proceedings of the first international meeting on endemic mycoses of the Americas (IMEMA). Mycoses 2022; 65:1179-1187. [PMID: 35971917 PMCID: PMC9804294 DOI: 10.1111/myc.13510] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 07/18/2022] [Accepted: 07/24/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND The Americas are home to biologically and clinically diverse endemic fungi, including Blastomyces, Coccidioides, Emergomyces, Histoplasma, Paracoccidioides and Sporothrix. In endemic areas with high risk of infection, these fungal pathogens represent an important public health problem. OBJECTIVES This report aims to summarise the main findings of the regional analysis carried out on the status of the endemic mycoses of the Americas, done at the first International Meeting on Endemic Mycoses of the Americas (IMEMA). METHODS A regional analysis for the Americas was done, the 27 territories were grouped into nine regions. A SWOT analysis was done. RESULTS All territories reported availability of microscopy. Seventy percent of territories reported antibody testing, 67% of territories reported availability of Histoplasma antigen testing. None of the territories reported the use of (1-3)-β-d-glucan. Fifty two percent of territories reported the availability of PCR testing in reference centres (mostly for histoplasmosis). Most of the territories reported access to medications such as trimethoprim-sulfamethoxazole, itraconazole, voriconazole and amphotericin B (AMB) deoxycholate. Many countries had limited access to liposomal formulation of AMB and newer azoles, such as posaconazole and isavuconazole. Surveillance of these fungal diseases was minimal. CONCLUSIONS A consensus emerged among meeting participants, this group concluded that endemic mycoses are neglected diseases, and due to their severity and lack of resources, the improvement of diagnosis, treatment and surveillance is needed.
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Affiliation(s)
- Diego H. Caceres
- Centers for Disease Control and Prevention (CDC)AtlantaGeorgiaUSA,Center of Expertise in Mycology Radboudumc/CWZNijmegenThe Netherlands,Studies in Translational Microbiology and Emerging Diseases (MICROS) Research Group, School of Medicine and Health SciencesUniversidad del RosarioBogotaColombia
| | - Laura C. Echeverri Tirado
- Medical Mycology Group, School of Medicine, Microbiology and Parasitology DepartmentUniversidad de AntioquiaMedellínAntioquiaColombia
| | | | - Antoine Adenis
- Centre d'Investigation Clinique Antilles Guyane Inserm 1424CayenneFrance,Centre Hospitalier de CayenneCayenneFrance
| | - Beatriz L. Gomez
- Studies in Translational Microbiology and Emerging Diseases (MICROS) Research Group, School of Medicine and Health SciencesUniversidad del RosarioBogotaColombia
| | | | - Cristina E. Canteros
- Departamento de Micología, Instituto Nacional de Enfermedades Infecciosas (INEI)Administración Nacional de Laboratorios e Institutos de Salud (ANLIS) "Dr. Carlos G. Malbrán"Buenos AiresArgentina
| | - Daniel Wagner Santos
- Department of Infectious Diseases and Infection ControlUniversidade Federal do Maranhão, UFMASão LuísMaranhãoBrazil,Instituto D'Or de Pesquisa e Ensino, IDOR, Hospital UDISão LuisMaranhãoBrazil
| | | | - Elia Ramirez Soto
- Centro Nacional de Enfermedades Tropicales (CENETROP)Santa CruzBolivia
| | | | - Ilan S. Schwartz
- Department of Medicine, Division of Infectious DiseasesUniversity of AlbertaEdmontonAlbertaCanada
| | - Jeannete Zurita
- Facultad de MedicinaPontificia Universidad Católica del EcuadorQuitoEcuador,Unidad de Investigaciones en Biomedicina, Zurita & Zurita LaboratoriosQuitoEcuador
| | - Lisandra Serra Damasceno
- Faculdade de MedicinaUniversidade Federal do CearáFortalezaCEBrazil,Hospital São José de Doenças Infecciosas, Secretaria de SaúdeCearáBrazil
| | - Nataly Garcia
- Sociedad Venezolana de MicrobiologíaCaracasVenezuela
| | - Norma B. Fernandez
- Sección Micologia, Division InfectologíaHospital de Clinicas “José de San Martín” Universidad de Buenos AiresBuenos AiresArgentina
| | - Omayra Chincha
- Universidad Peruana Cayetano Heredia (UPCH), Hospital Cayetano HerediaLimaPeru
| | - Patricia Araujo
- Departamento de Bacteriología y MicologíaLaboratorio Central de Salud Pública, Ministerio de Salud Pública y Bienestar SocialAsunciónParaguay
| | - Ricardo Rabagliati
- Departamento de Enfermedades Infecciosas del Adulto, Escuela de MedicinaPontificia Universidad Católica de ChileSantiagoChile
| | - Tom Chiller
- Centers for Disease Control and Prevention (CDC)AtlantaGeorgiaUSA
| | - Gustavo Giusiano
- Instituto de Medicina RegionalUniversidad Nacional del Nordeste, Consejo Nacional de Investigaciones Científicas y Técnicas de Argentina (CONICET)ResistenciaChacoArgentina
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Almeida-Paes R, Bernardes-Engemann AR, da Silva Motta B, Pizzini CV, de Abreu Almeida M, de Medeiros Muniz M, Dias RAB, Zancopé-Oliveira RM. Immunologic Diagnosis of Endemic Mycoses. J Fungi (Basel) 2022; 8:jof8100993. [PMID: 36294558 PMCID: PMC9605100 DOI: 10.3390/jof8100993] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 09/12/2022] [Accepted: 09/13/2022] [Indexed: 12/02/2022] Open
Abstract
The endemic mycoses blastomycosis, coccidioidomycosis, histoplasmosis, paracoccidioidomycosis, cryptococcosis, sporotrichosis, talaromycosis, adiaspiromycosis, and emergomycosis are mostly caused by geographically limited thermally dimorphic fungi (except for cryptococcosis), and their diagnoses can be challenging. Usual laboratory methods involved in endemic mycoses diagnosis include microscopic examination and culture of biological samples; however, serologic, histopathologic, and molecular techniques have been implemented in the last few years for the diagnosis of these mycoses since the recovery and identification of their etiologic agents is time-consuming and lacks in sensitivity. In this review, we focus on the immunologic diagnostic methods related to antibody and antigen detection since their evidence is presumptive diagnosis, and in some mycoses, such as cryptococcosis, it is definitive diagnosis.
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7
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Beyond Domestic Cats: Environmental Detection of Sporothrix brasiliensis DNA in a Hyperendemic Area of Sporotrichosis in Rio de Janeiro State, Brazil. J Fungi (Basel) 2022; 8:jof8060604. [PMID: 35736087 PMCID: PMC9224889 DOI: 10.3390/jof8060604] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 05/27/2022] [Accepted: 05/30/2022] [Indexed: 02/04/2023] Open
Abstract
In Brazil, sporotrichosis has transitioned from a rural to urban disease, driven by a shift in the initiation of infection from the accidental inoculation of organic matter to the traumatic implantation of the fungus by cats. Since the emergence of zoonotic sporotrichosis caused by Sporothrix brasiliensis, investigations have largely ignored the environmental habitat of the pathogen due to its association with domestic cats. Therefore, we investigated 18 environmental samples collected from rural areas of two cities where zoonotic sporotrichosis is endemic, but where domestic cats are scarce. We utilized traditional culture methods, and samples were also examined with two molecular methods used for the clinical diagnosis of sporotrichosis: a nested-PCR targeting the ITS region and a species-specific PCR targeting the calmodulin gene. No Sporothrix colonies were identified by traditional culture methods. However, the nested-PCR and the species-specific PCR for S. brasiliensis were positive for 18 and 5 samples, respectively. Sequencing revealed that positive results with the nested-PCR were due to non-specific amplification of other Ophiostomatales DNA, rather than Sporothrix spp. Three of the five amplicons from the species-specific PCR were suitable for sequencing and confirmed the presence of S. brasiliensis DNA. Hence, we confirmed that S. brasiliensis, as with other Sporothrix species, has an environmental habitat. Our findings underscore the challenges of nested-PCR for Sporothrix environmental studies and highlight that sequencing must follow PCR protocols to definitively identify Sporothrix spp. in environmental samples.
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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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