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Bourne-Watrin M, Adenis A, Doppelt G, Zappa M, Epelboin L, Nacher M, Bigot J, Drak Alsibai K, Blaizot R, Blanchet D, Demar M, Guillot G, Djossou F, Couppié P. Pulmonary Histoplasmosis in People Living with Human Immunodeficiency Virus in French Guiana: Clinical Epidemiology, Medical Imaging and Prognostic. Mycopathologia 2023; 188:1065-1078. [PMID: 37839020 PMCID: PMC10687118 DOI: 10.1007/s11046-023-00799-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 09/19/2023] [Indexed: 10/17/2023]
Abstract
BACKGROUND Histoplasmosis is mainly described as a disseminated disease in people living with HIV (PLHIV). Compared to historical descriptions in immunocompetent individuals, knowledge is lacking on the detailed clinical and radiological findings and outcomes of pulmonary histoplasmosis (PH). Overlooked or misdiagnosed with other AIDS-defining condition, prognostic of PLHIV may be at risk because of inappropriate care. METHODS A retrospective multicentric study was conducted in PLHIV from French Guiana between January 1988 and October 2019. Proven PH were documented through mycological direct examination, culture, or histology. Patients with concomitant respiratory infections were excluded. RESULTS Among 65 patients, sex ratio M:F was 2.4 with a median age of 39 years [IQR 25-75%: 34-44]. Median CD4 count was 24 cells/mm3 [11-71], with histoplasmosis as the AIDS-defining condition in 88% and concomitant AIDS-defining conditions in 29%. Clinical findings were fever (89%), cough (58%), dyspnea (35%), expectoration (14%), and hemoptysis (5%). Sixty-one X-rays and 24 CT-scans were performed. On X-rays, an interstitial lung disease was mainly found (77%). On CT-scans, a nodular pattern was predominant (83%): mostly miliary disease (63%), but also excavated nodules (35%). Consolidations were present in 46%, associated with miliary disease in 21%. Thoracic lymphadenopathies were found in 58%, mainly hilar and symmetric (33%). Despite antifungal treatment, case-fatality rate at one month was 22%. CONCLUSION When faced with an interstitial lung disease on X-rays or a miliary pattern on CT-scans in advanced PLHIV, physicians in endemic areas, apart from tuberculosis or pneumocystosis, should include histoplasmosis as part of their differential diagnoses.
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Affiliation(s)
- Morgane Bourne-Watrin
- Service de Dermatologie-Vénérologie, Centre Hospitalier de Cayenne, Cayenne, France.
| | - Antoine Adenis
- Centre d'Investigation Clinique Antilles Guyane, Inserm CIC 1424, Centre Hospitalier de Cayenne, Cayenne, France
| | - Gary Doppelt
- Service de Radiologie, Centre Hospitalier de Cayenne, Cayenne, France
| | - Magaly Zappa
- Service de Radiologie, Centre Hospitalier de Cayenne, Cayenne, France
| | - Loïc Epelboin
- Centre d'Investigation Clinique Antilles Guyane, Inserm CIC 1424, Centre Hospitalier de Cayenne, Cayenne, France
- Unité des Maladies Infectieuses et Tropicales, Centre Hospitalier de Cayenne, Cayenne, France
| | - Mathieu Nacher
- Centre d'Investigation Clinique Antilles Guyane, Inserm CIC 1424, Centre Hospitalier de Cayenne, Cayenne, France
| | - Jeanne Bigot
- Service de Parasitologie-Mycologie, Centre Hospitalier Saint Antoine APHP, Paris, France
| | - Kinan Drak Alsibai
- Laboratoire d'Anatomie et Cytologie Pathologique, Centre Hospitalier de Cayenne, Cayenne, France
| | - Romain Blaizot
- Service de Dermatologie-Vénérologie, Centre Hospitalier de Cayenne, Cayenne, France
| | - Denis Blanchet
- Laboratoire de Parasitologie-Mycologie, Centre Hospitalier de Cayenne, Cayenne, France
| | - Magalie Demar
- Laboratoire de Parasitologie-Mycologie, Centre Hospitalier de Cayenne, Cayenne, France
| | - Geneviève Guillot
- Service de Médecine B, Centre Hospitalier de Cayenne, Cayenne, France
| | - Félix Djossou
- Unité des Maladies Infectieuses et Tropicales, Centre Hospitalier de Cayenne, Cayenne, France
| | - Pierre Couppié
- Service de Dermatologie-Vénérologie, Centre Hospitalier de Cayenne, Cayenne, France
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Pullen MF, Alpern JD, Bahr NC. Blastomycosis-Some Progress but Still Much to Learn. J Fungi (Basel) 2022; 8:jof8080824. [PMID: 36012812 PMCID: PMC9410313 DOI: 10.3390/jof8080824] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 08/02/2022] [Accepted: 08/03/2022] [Indexed: 11/16/2022] Open
Abstract
Blastomycosis, caused by Blastomyces spp., is an endemic mycosis capable of causing significant disease throughout the body. Higher rates of infection are seen in the Mississippi and Ohio River valleys, the Great Lakes region of the United States and Canada, much of Africa, and, to a lesser extent, in India and the Middle East. Limited reporting inhibits our true understanding of the geographic distribution of blastomycosis. An estimated 50% of those infected remain asymptomatic. Of those who present with symptomatic disease, pulmonary involvement is most common, while the most common extrapulmonary sites are the skin, bones, genitourinary system, and central nervous system. Itraconazole is the standard therapy for mild-moderate disease. Data for other azoles are limited. Amphotericin is used for severe disease, and corticosteroids are occasionally used in severe disease, but evidence for this practice is limited. Despite increasing incidence and geographic reach in recent years, there are still significant knowledge gaps in our understanding of blastomycosis. Here, we provide an updated review of the epidemiology, clinical presentations, and diagnostic and therapeutic approaches for this infection. We also discuss areas needing further research.
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Affiliation(s)
- Matthew F. Pullen
- Division of Infectious Diseases and International Medicine, Department of Medicine, University of Minnesota, Minneapolis, MN 55455, USA
| | - Jonathan D. Alpern
- Division of Infectious Diseases, HealthPartners, Bloomington, MN 55425, USA
- Department of Medicine, University of Minnesota, Minneapolis, MN 55455, USA
| | - Nathan C. Bahr
- Division of Infectious Diseases, Department of Medicine, University of Kansas Medical Center, Kansas City, KS 66160, USA
- Correspondence:
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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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Singh M, Sharma A, Sankhala K, Bareth H, Suman S. Progressive Disseminated Histoplasmosis Mimicking as Anal Carcinoma - Look at the Mountain, Not at Stone: A Case Report. J Multidiscip Healthc 2021; 14:2749-2754. [PMID: 34629875 PMCID: PMC8493109 DOI: 10.2147/jmdh.s325134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 08/20/2021] [Indexed: 11/23/2022] Open
Abstract
Disseminated histoplasmosis is a systemic disease caused by the dimorphic fungus Histoplasma capsulatum. Here, we are presenting a case of shock who was diagnosed to have primary adrenal insufficiency. This 68-year-old man had bilateral adrenal mass and later presented with chronic fever and ulcerated anal mass in the oncology clinic. The oncologist made a provisional diagnosis of anal carcinoma with adrenal metastasis. He was suspected of having an adrenal crisis and was admitted to the intensive care unit. He also had granulomatous hepatitis and acute kidney injury. The working diagnosis was changed to systemic inflammatory/infective pathology. The biopsy of the anal tissue done to look for the aetiology showed Histoplasma. He was started on oral itraconazole therapy. He improved symptomatically (resolution of fever, improvement in pain) when assessed after seven days. His anal ulcer healed after 21 days of itraconazole therapy.
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Affiliation(s)
- Mahaveer Singh
- Department of Endocrinology, National Institute of Medical Sciences and Research Hospital, Nims University Rajasthan, Jaipur, India
| | - Abhishek Sharma
- Department of General Medicine, National Institute of Medical Sciences and Research Hospital, Nims University Rajasthan, Jaipur, India
| | - Kalpana Sankhala
- Department of Pathology, National Institute of Medical Sciences and Research Hospital, Nims University Rajasthan, Jaipur, India
| | - Hemant Bareth
- Department of Pharmacy Practice, Nims Institute of Pharmacy, Nims University Rajasthan, Jaipur, India
| | - Supriya Suman
- Department of Pharmacy Practice, Nims Institute of Pharmacy, Nims University Rajasthan, Jaipur, India
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A Fragile Balance: Does Neutrophil Extracellular Trap Formation Drive Pulmonary Disease Progression? Cells 2021; 10:cells10081932. [PMID: 34440701 PMCID: PMC8394734 DOI: 10.3390/cells10081932] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 07/22/2021] [Accepted: 07/28/2021] [Indexed: 12/13/2022] Open
Abstract
Neutrophils act as the first line of defense during infection and inflammation. Once activated, they are able to fulfil numerous tasks to fight inflammatory insults while keeping a balanced immune response. Besides well-known functions, such as phagocytosis and degranulation, neutrophils are also able to release "neutrophil extracellular traps" (NETs). In response to most stimuli, the neutrophils release decondensed chromatin in a NADPH oxidase-dependent manner decorated with histones and granule proteins, such as neutrophil elastase, myeloperoxidase, and cathelicidins. Although primarily supposed to prevent microbial dissemination and fight infections, there is increasing evidence that an overwhelming NET response correlates with poor outcome in many diseases. Lung-related diseases especially, such as bacterial pneumonia, cystic fibrosis, chronic obstructive pulmonary disease, aspergillosis, influenza, and COVID-19, are often affected by massive NET formation. Highly vascularized areas as in the lung are susceptible to immunothrombotic events promoted by chromatin fibers. Keeping this fragile equilibrium seems to be the key for an appropriate immune response. Therapies targeting dysregulated NET formation might positively influence many disease progressions. This review highlights recent findings on the pathophysiological influence of NET formation in different bacterial, viral, and non-infectious lung diseases and summarizes medical treatment strategies.
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Saccente M, Krishnan G. Comparison of Blood (1->3)-β-D-Glucan Levels in AIDS-Related Pneumocystis jirovecii Pneumonia and AIDS-Related Progressive Disseminated Histoplasmosis. Clin Infect Dis 2021; 73:1100-1102. [PMID: 33786591 DOI: 10.1093/cid/ciab277] [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: 01/12/2021] [Indexed: 11/13/2022] Open
Abstract
In this retrospective study, (1->3)-β-D-glucan (B-glucan) was an unreliable marker for AIDS-related Pneumocystis jirovecii pneumonia (PCP) because a high percentage of participants with progressive disseminated histoplasmosis and respiratory symptoms had a positive B-glucan result. Where histoplasmosis is common attributing B-glucan positivity to PCP without further testing risks misdiagnosis.
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Affiliation(s)
- Michael Saccente
- Division of Infectious Diseases and Department of Internal Medicine, University of Arkansas for Medical Sciences and the Central Arkansas Veterans Healthcare System, Little Rock, Arkansas, USA
| | - Gayathri Krishnan
- Division of Infectious Diseases and Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
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Martínez-Gamboa A, Niembro-Ortega MD, Torres-González P, Santiago-Cruz J, Velázquez-Zavala NG, Rangel-Cordero A, Crabtree-Ramírez B, Gamboa-Domínguez A, Reyes-Gutiérrez E, Reyes-Terán G, Lozano-Fernandez VH, Ahumada-Topete VH, Martínez-Ayala P, Manríquez-Reyes M, Ramírez-Hinojosa JP, Rodríguez-Zulueta P, Hernández-León C, Ruíz-Quiñones J, Rivera-Martínez NE, Chaparro-Sánchez A, Andrade-Villanueva J, González-Hernández LA, Cruz-Martínez S, Flores-Barrientos O, Gaytán-Martínez JE, Magaña-Aquino M, Cervantes-Sánchez A, Olivas-Martínez A, Araujo-Meléndez J, del Rocío Reyes-Montes M, Duarte-Escalante E, Frías-De León MG, Ramírez JA, Taylor ML, de León-Garduño AP, Sifuentes-Osornio J. Diagnostic accuracy of antigen detection in urine and molecular assays testing in different clinical samples for the diagnosis of progressive disseminated histoplasmosis in patients living with HIV/AIDS: A prospective multicenter study in Mexico. PLoS Negl Trop Dis 2021; 15:e0009215. [PMID: 33684128 PMCID: PMC7971897 DOI: 10.1371/journal.pntd.0009215] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 03/18/2021] [Accepted: 02/06/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The progressive disseminated histoplasmosis (PDH) has been associated with severe disease and high risk of death among people living with HIV (PLWHIV). Therefore, the purpose of this multicenter, prospective, double-blinded study done in ten Mexican hospitals was to determine the diagnostic accuracy of detecting Histoplasma capsulatum antigen in urine using the IMMY ALPHA Histoplasma EIA kit (IAHE), clarus Histoplasma GM Enzyme Immunoassay (cHGEI IMMY) and MiraVista Histoplasma Urine Antigen LFA (MVHUALFA); as well as the Hcp100 and 1281-1283220SCAR nested PCRs in blood, bone-marrow, tissue biopsies and urine. METHODOLOGY/PRINCIPAL FINDINGS We included 415 PLWHIV older than 18 years of age with suspicion of PDH. Using as diagnostic standard recovery of H. capsulatum in blood, bone marrow or tissue cultures, or histopathological exam compatible, detected 108 patients (26%, [95%CI, 21.78-30.22]) with proven-PDH. We analyzed 391 urine samples by the IAHE, cHGEI IMMY and MVHUALFA; the sensitivity/specificity values obtained were 67.3% (95% CI, 57.4-76.2) / 96.2% (95% CI, 93.2-98.0) for IAHE, 91.3% (95% CI, 84.2-96.0) / 90.9% (95% CI, 87.0-94.0) for cHGEI IMMY and 90.4% (95% CI, 83.0-95.3) / 92.3% (95% CI, 88.6-95.1) for MVHUALFA. The Hcp100 nested PCR was performed on 393, 343, 75 and 297, blood, bone marrow, tissue and urine samples respectively; the sensitivity/specificity values obtained were 62.9% (95%CI, 53.3-72.5)/ 89.5% (95%CI, 86.0-93.0), 65.9% (95%CI, 56.0-75.8)/ 89.0% (95%CI, 85.2-92.9), 62.1% (95%CI, 44.4-79.7)/ 82.6% (95%CI, 71.7-93.6) and 34.9% (95%CI, 24.8-46.2)/ 67.3% (95%CI, 60.6-73.5) respectively; and 1281-1283220SCAR nested PCR was performed on 392, 344, 75 and 291, respectively; the sensitivity/specificity values obtained were 65.3% (95% CI, 55.9-74.7)/ 58.8% (95%CI, 53.2-64.5), 70.8% (95%CI, 61.3-80.2)/ 52.9% (95%CI, 46.8-59.1), 71.4% (95%CI, 54.7-88.2)/ 40.4% (95%CI, 26.4-54.5) and 18.1% (95%CI, 10.5-28.1)/ 90.4% (95%CI, 85.5-94.0), respectively. CONCLUSIONS/SIGNIFICANCE The cHGEI IMMY and MVHUALFA tests showed excellent performance for the diagnosis of PDH in PLWHIV. The integration of these tests in clinical laboratories will certainly impact on early diagnosis and treatment.
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Affiliation(s)
- Areli Martínez-Gamboa
- Department of Infectious Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; Tlalpan, Mexico City, Mexico
| | - María Dolores Niembro-Ortega
- Department of Infectious Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; Tlalpan, Mexico City, Mexico
| | - Pedro Torres-González
- Department of Infectious Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; Tlalpan, Mexico City, Mexico
| | - Janeth Santiago-Cruz
- Department of Infectious Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; Tlalpan, Mexico City, Mexico
| | - Nancy Guadalupe Velázquez-Zavala
- Department of Infectious Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; Tlalpan, Mexico City, Mexico
| | - Andrea Rangel-Cordero
- Department of Infectious Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; Tlalpan, Mexico City, Mexico
| | - Brenda Crabtree-Ramírez
- Department of Infectious Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; Tlalpan, Mexico City, Mexico
| | - Armando Gamboa-Domínguez
- Department of Pathology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpan, Mexico City, Mexico
| | - Edgardo Reyes-Gutiérrez
- Department of Pathology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpan, Mexico City, Mexico
| | - Gustavo Reyes-Terán
- Centro de Investigación en Enfermedades Infecciosas, Instituto Nacional de Enfermedades Respiratorias Ismael Cosio Villegas; Tlalpan, Mexico City, Mexico
| | - Víctor Hugo Lozano-Fernandez
- Centro de Investigación en Enfermedades Infecciosas, Instituto Nacional de Enfermedades Respiratorias Ismael Cosio Villegas; Tlalpan, Mexico City, Mexico
| | - Víctor Hugo Ahumada-Topete
- Centro de Investigación en Enfermedades Infecciosas, Instituto Nacional de Enfermedades Respiratorias Ismael Cosio Villegas; Tlalpan, Mexico City, Mexico
| | - Pedro Martínez-Ayala
- HIV Unit, Hospital Civil de Guadalajara “Fray Antonio Alcalde”; Guadalajara, Jalisco, Mexico
| | - Marisol Manríquez-Reyes
- Department of Internal Medicine, Hospital de Alta Especialidad de Veracruz; Veracruz, Veracruz, Mexico
| | | | - Patricia Rodríguez-Zulueta
- Department of Infectious Diseases, Hospital General Dr. Manuel Gea González; Tlalpan, Mexico City, Mexico
| | - Christian Hernández-León
- Area of Infectious Diseases, Department of Internal Medicine, Hospital General de Puebla “Dr. Eduardo Vázquez Navarro”; Puebla, Puebla, Mexico
| | - Jesús Ruíz-Quiñones
- Intensive Care Unit, Department of Internal Medicine, Hospital “Dr. Juan Graham Casasus”; Villahermosa, Tabasco, Mexico
| | - Norma Eréndira Rivera-Martínez
- Adult Infectious Diseases Department, Hospital Regional de Alta Especialidad de Oaxaca, HRAEO; San Bartolo Coyotepec, Oaxaca, Mexico
| | - Alberto Chaparro-Sánchez
- Department of Infectious Diseases, Hospital de Infectología del Centro Médico Nacional “La Raza”, Instituto Mexicano del Seguro Social; Azcapotzalco, Mexico City, Mexico
| | | | | | - Sofia Cruz-Martínez
- Adult Infectious Diseases Department, Hospital Regional de Alta Especialidad de Oaxaca, HRAEO; San Bartolo Coyotepec, Oaxaca, Mexico
| | - Oscar Flores-Barrientos
- Intensive Care Unit, Department of Internal Medicine, Hospital “Dr. Juan Graham Casasus”; Villahermosa, Tabasco, Mexico
| | - Jesús Enrique Gaytán-Martínez
- Department of Infectious Diseases, Hospital de Infectología del Centro Médico Nacional “La Raza”, Instituto Mexicano del Seguro Social; Azcapotzalco, Mexico City, Mexico
| | - Martín Magaña-Aquino
- Department of Internal Medicine, Hospital Central Dr. Ignacio Morones Prieto; San Luis Potosí, San Luis Potosí, Mexico
| | - Axel Cervantes-Sánchez
- Department of Infectious Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; Tlalpan, Mexico City, Mexico
| | - Antonio Olivas-Martínez
- Department of Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; Tlalpan, Mexico City, Mexico
| | - Javier Araujo-Meléndez
- Department of Internal Medicine, Hospital Central Dr. Ignacio Morones Prieto; San Luis Potosí, San Luis Potosí, Mexico
| | - María del Rocío Reyes-Montes
- Mycology Unit, Department of Microbiology and Parasitology, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Esperanza Duarte-Escalante
- Mycology Unit, Department of Microbiology and Parasitology, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | | | - José Antonio Ramírez
- Mycology Unit, Department of Microbiology and Parasitology, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - María Lucia Taylor
- Mycology Unit, Department of Microbiology and Parasitology, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Alfredo Ponce de León-Garduño
- Department of Infectious Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; Tlalpan, Mexico City, Mexico
| | - José Sifuentes-Osornio
- Department of Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; Tlalpan, Mexico City, Mexico
- * E-mail:
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Toscanini MA, Nusblat AD, Cuestas ML. Diagnosis of histoplasmosis: current status and perspectives. Appl Microbiol Biotechnol 2021; 105:1837-1859. [PMID: 33587157 DOI: 10.1007/s00253-021-11170-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 01/29/2021] [Accepted: 02/03/2021] [Indexed: 11/29/2022]
Abstract
Histoplasmosis is a worldwide-distributed systemic mycosis caused by the dimorphic fungus Histoplasma capsulatum. Its clinical manifestations range from subclinical or mild respiratory illness to progressive disseminated histoplasmosis (PDH), a life-threatening disease, whose accurate diagnosis is still challenging and limited in many countries, where this disease is highly endemic. In this regard, Histoplasma antigen testing is now included in the WHO Essential Diagnostics List. The final diagnosis of histoplasmosis is established by culture and/or visualization of the yeast cells by cytology or histopathology using specific stains. However, both procedures have limited sensitivity to detect the disease and cultures are time-consuming. Antibody detection assays are effective for the subacute and chronic clinical forms of histoplasmosis. However, their sensitivity is low in the immunocompromised host. Several molecular "in-house" tests were also developed and showed promising results, but none of these tests are commercially available and their standardization and validation are still pending. Antigen detection assays have high sensitivity in PDH cases and are of great value for the follow-up of patients with histoplasmosis; however, cross-reactivity with other related fungi are common. In addition, this assay is expensive and only performed in few laboratories. Novel protein antigen candidates have been recently identified and produced by DNA-recombinant techniques in order to obtain standardized and specific reagents for the diagnosis of histoplasmosis, as opposed to the unspecific antigens or crude extracts currently used. This review describes the currently available assays, highlighting their strengths and limitations and reports the latest approaches to achieve reliable and rapid diagnostic tests for histoplasmosis. KEY POINTS: • PDH causes thousands of deaths per year globally. • Rapid accurate diagnosis of PDH is unfeasible in many regions. • Fast, accurate, and low-cost diagnostic alternatives are currently under development.
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Affiliation(s)
- María Agustina Toscanini
- Facultad de Farmacia y Bioquímica, CONICET, Instituto de Nanobiotecnología (NANOBIOTEC), Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Alejandro David Nusblat
- Facultad de Farmacia y Bioquímica, CONICET, Instituto de Nanobiotecnología (NANOBIOTEC), Universidad de Buenos Aires, Buenos Aires, Argentina
| | - María Luján Cuestas
- CONICET, Instituto de Investigaciones en Microbiología y Parasitología Médica (IMPaM), Universidad de Buenos Aires, Buenos Aires, Argentina.
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Dimkić I, Fira D, Janakiev T, Kabić J, Stupar M, Nenadić M, Unković N, Grbić ML. The microbiome of bat guano: for what is this knowledge important? Appl Microbiol Biotechnol 2021; 105:1407-1419. [PMID: 33512572 PMCID: PMC7845282 DOI: 10.1007/s00253-021-11143-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 01/15/2021] [Accepted: 01/25/2021] [Indexed: 12/17/2022]
Abstract
Bats as flying mammals are potent vectors and natural reservoir hosts for many infectious viruses, bacteria, and fungi, also detected in their excreta such as guano. Accelerated deforestation, urbanization, and anthropization hastily lead to overpopulation of the bats in urban areas allowing easy interaction with other animals, expansion, and emergence of new zoonotic disease outbreaks potentially harmful to humans. Therefore, getting new insights in the microbiome of bat guano from different places represents an imperative for the future. Furthermore, the use of novel high-throughput sequencing technologies allows better insight in guano microbiome and potentially indicated that some species could be typical guano-dwelling members. Bats are well known as a natural reservoir of many zoonotic viruses such as Ebola, Nipah, Marburg, lyssaviruses, rabies, henipaviruses, and many coronaviruses which caused a high number of outbreaks including ongoing COVID-19 pandemic. Additionally, many bacterial and fungal pathogens were identified as common guano residents. Thus, the presence of multi-drug-resistant bacteria as environmental reservoirs of extended spectrum β-lactamases and carbapenemase-producing strains has been confirmed. Bat guano is the most suitable substrate for fungal reproduction and dissemination, including pathogenic yeasts and keratinophilic and dimorphic human pathogenic fungi known as notorious causative agents of severe endemic mycoses like histoplasmosis and fatal cryptococcosis, especially deadly in immunocompromised individuals. This review provides an overview of bat guano microbiota diversity and the significance of autochthonous and pathogenic taxa for humans and the environment, highlighting better understanding in preventing emerging diseases. KEY POINTS: Bat guano as reservoir and source for spreading of autochthonous and pathogenic microbiota Bat guano vs. novel zoonotic disease outbreaks Destruction of bat natural habitats urgently demands increased human awareness.
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Affiliation(s)
- Ivica Dimkić
- Faculty of Biology, University of Belgrade, Studentski Trg 16, Belgrade, 11000, Serbia.
| | - Djordje Fira
- Faculty of Biology, University of Belgrade, Studentski Trg 16, Belgrade, 11000, Serbia
| | - Tamara Janakiev
- Faculty of Biology, University of Belgrade, Studentski Trg 16, Belgrade, 11000, Serbia
| | - Jovana Kabić
- Faculty of Medicine, University of Belgrade, dr Subotića starijeg 1, Belgrade, 11000, Serbia
| | - Miloš Stupar
- Faculty of Biology, University of Belgrade, Studentski Trg 16, Belgrade, 11000, Serbia
| | - Marija Nenadić
- Institute for Biological Research "Siniša Stanković", Bulevar despota Stefana 142, Belgrade, 11060, Serbia
| | - Nikola Unković
- Faculty of Biology, University of Belgrade, Studentski Trg 16, Belgrade, 11000, Serbia
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10
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Rubio-Carrasquilla M, Santa CD, Rendón JP, Botero-Garcés J, Guimarães AJ, Moreno E, Cano LE. An interferon gamma release assay specific for Histoplasma capsulatum to detect asymptomatic infected individuals: A proof of concept study. Med Mycol 2020; 57:724-732. [PMID: 30534945 DOI: 10.1093/mmy/myy131] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 10/14/2018] [Accepted: 11/07/2018] [Indexed: 12/17/2022] Open
Abstract
Histoplasmosis is the most common endemic mycosis in the Americas. Currently, there is no laboratory test capable to detect subclinical or latent infections by Histoplasma capsulatum (Hc), which might develop as severe infections in immunocompromised individuals. For the first time to our knowledge, we explore the suitability of an interferon gamma release assay (IGRA) to detect latent Hc infection in asymptomatic individuals. A cohort of 126 volunteers was enrolled in the study, 13 of which underwent a Hc infection in the past, and 93 of them showing risk factors for this infection. The remaining 20 participants did not refer any risk factors of Hc infection, but eight of them showed evidences of infection with Mycobacterium tuberculosis. All participants were recruited in Medellin, Colombia, between January 2014 and December 2017. Whole blood samples were cultured with four different Hc crude antigens and phytohemaglutinin as positive control. The interferon (IFN)-γ released by T lymphocytes upon antigen stimulation was quantified by ELISA. A defined cutoff value of 20 pg/ml for the IFN-γ concentration allowed us to distinguish between the group with documented past infections and the group of noninfected individuals with high sensitivity (70-92%) and specificity (85-95%), for the four tested antigens. Positive 82-95% and negative 77-92% predictive values were also very high, comparable to those reported for commercially available IGRAs. The new test constitutes a promising screening method to detect individuals with latent Hc infection, even decades after the primary infection, as evidenced in this study.
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Affiliation(s)
- Marcela Rubio-Carrasquilla
- Grupo de Micología Médica y Experimental, Corporación para Investigaciones Biológicas (CIB), Medellín, Colombia.,Instituto de Biología, Universidad de Antioquia, Medellín, Colombia
| | | | - Juan Pablo Rendón
- Grupo de Micología Médica y Experimental, Corporación para Investigaciones Biológicas (CIB), Medellín, Colombia
| | | | - Allan J Guimarães
- Depto de Microbiologia e Parasitologia, Universidade Federal Fluminense, Niterói-RJ, Brasil
| | - Ernesto Moreno
- Facultad de Ciencias Básicas, Universidad de Medellín, Medellín, Colombia
| | - Luz Elena Cano
- Grupo de Micología Médica y Experimental, Corporación para Investigaciones Biológicas (CIB), Medellín, Colombia.,Escuela de Microbiología, Universidad de Antioquia, Medellín, Colombia
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11
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Ashraf N, Kubat RC, Poplin V, Adenis AA, Denning DW, Wright L, McCotter O, Schwartz IS, Jackson BR, Chiller T, Bahr NC. Re-drawing the Maps for Endemic Mycoses. Mycopathologia 2020; 185:843-865. [PMID: 32040709 PMCID: PMC7416457 DOI: 10.1007/s11046-020-00431-2] [Citation(s) in RCA: 127] [Impact Index Per Article: 31.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Accepted: 01/24/2020] [Indexed: 01/19/2023]
Abstract
Endemic mycoses such as histoplasmosis, coccidioidomycosis, blastomycosis, paracoccidioidomycosis, and talaromycosis are well-known causes of focal and systemic disease within specific geographic areas of known endemicity. However, over the past few decades, there have been increasingly frequent reports of infections due to endemic fungi in areas previously thought to be “non-endemic.” There are numerous potential reasons for this shift such as increased use of immune suppressive medications, improved diagnostic tests, increased disease recognition, and global factors such as migration, increased travel, and climate change. Regardless of the causes, it has become evident that our previous understanding of endemic regions for these fungal diseases needs to evolve. The epidemiology of the newly described Emergomyces is incomplete; our understanding of it continues to evolve. This review will focus on the evidence underlying the established areas of endemicity for these mycoses as well as new data and reports from medical literature that support the re-thinking these geographic boundaries. Updating the endemic fungi maps would inform clinical practice and global surveillance of these diseases.
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Affiliation(s)
- Nida Ashraf
- Division of Infectious Diseases, Department of Internal Medicine, University of Kansas, Kansas City, KS, USA
| | - Ryan C Kubat
- Division of Infectious Diseases, Department of Internal Medicine, University of Kansas, Kansas City, KS, USA
| | - Victoria Poplin
- Department of Internal Medicine, University of Kansas, Kansas City, KS, USA
| | - Antoine A Adenis
- Centre d'Investigation Clinique Antilles-Guyane, Inserm 1424, Centre Hospitalier de Cayenne, Cayenne, French Guiana
| | - David W Denning
- Faculty of Biology, Medicine, and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Laura Wright
- Geographic Research Analysis and Services Program, Division of Toxicology and Human Health Services, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Orion McCotter
- Mycotic Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Ilan S Schwartz
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Brendan R Jackson
- Mycotic Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Tom Chiller
- Mycotic Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Nathan C Bahr
- Division of Infectious Diseases, Department of Internal Medicine, University of Kansas, Kansas City, KS, USA.
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12
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Abstract
Respiratory fungal infection is a severe clinical problem, especially in patients with compromised immune functions. Aspergillus, Cryptococcus, Pneumocystis, and endemic fungi are major pulmonary fungal pathogens that are able to result in life-threatening invasive diseases. Growing data being reported have indicated that multiple cells and molecules orchestrate the host's response to a fungal infection in the lung. Upon fungal challenge, innate myeloid cells including macrophages, dendritic cells (DC), and recruited neutrophils establish the first line of defense through the phagocytosis and secretion of cytokines. Natural killer cells control the fungal expansion in the lung via the direct and indirect killing of invading organisms. Adaptive immune cells including Th1 and Th17 cells confer anti-fungal activity by producing their signature cytokines, interferon-γ, and IL-17. In addition, lung epithelial cells (LEC) also participate in the resistance against fungal infection by internalization, inflammatory cytokine production, or antimicrobial peptide secretion. In the host cells mentioned above, various molecules with distinct functions modulate the immune defense signaling: Pattern recognition receptors (PRRs) such as dectin-1 expressed on the cell surface are involved in fungal recognition; adaptor proteins such as MyD88 and TRAF6 are required for transduction of signals to the nucleus for transcriptional regulation; inflammasomes also play crucial roles in the host's defense against a fungal infection in the lung. Furthermore, transcriptional factors modulate the transcriptions of a series of genes, especially those encoding cytokines and chemokines, which are predominant regulators in the infectious microenvironment, mediating the cellular and molecular immune responses against a fungal infection in the lung.
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Affiliation(s)
- Zhi Li
- The Joint Center for Infection and Immunity, Guangzhou Women and Children's Medical Center, Guangzhou Institute of Pediatrics, Guangzhou, China
- The Joint Center for Infection and Immunity, Institute Pasteur of Shanghai, Chinese Academy of Science, Shanghai, China
| | - Gen Lu
- The Joint Center for Infection and Immunity, Guangzhou Women and Children's Medical Center, Guangzhou Institute of Pediatrics, Guangzhou, China
| | - Guangxun Meng
- The Joint Center for Infection and Immunity, Institute Pasteur of Shanghai, Chinese Academy of Science, Shanghai, China
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13
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Choi J, Nikoomanesh K, Uppal J, Wang S. Progressive disseminated histoplasmosis with concomitant disseminated nontuberculous mycobacterial infection in a patient with AIDS from a nonendemic region (California). BMC Pulm Med 2019; 19:46. [PMID: 30791902 PMCID: PMC6383272 DOI: 10.1186/s12890-019-0808-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 02/08/2019] [Indexed: 01/10/2023] Open
Abstract
Background Opportunistic infections, while well studied in the AIDS population, continue to have variable and surprising presentations. Here, we present a case of disseminated histoplasmosis with disseminated nontuberculous mycobacterial infection in a 50 year old man with long standing AIDS living in a non-endemic area. Case presentation Patient presented with a constellation of symptoms, and imaging of the chest showed a pulmonary mass with cavitation, multiple nodules, and ground glass opacities. Further investigations revealed granulomatous lung nodules and fungemia consistent with Histoplasma capsulatum, and coinfection with disseminated nontuberculous mycobateria in a nonendemic area. Conclusions Immunocompromised patients risk co-inhabitation by multiple infectious organisms. Some of these organisms may preside in the host for years prior to reactivation. Clinicians in non endemic areas should therefore be careful to not overlook specific organisms based on a lack of a recent travel history. Physicians in nonendemic areas should become more familiar with the clinical findings and diagnostic approach of infectious such as Histoplasmosis, to ensure earlier recognition and treatment in immunocompromised individuals.
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Affiliation(s)
- Julian Choi
- Department of Pulmonary and Critical Care Medicine, Arrowhead Regional Medical Center, Colton, USA
| | - Kia Nikoomanesh
- Department of Internal Medicine, Arrowhead Regional Medical Center, Colton, USA.
| | - Jusleen Uppal
- Department of Internal Medicine, Arrowhead Regional Medical Center, Colton, USA
| | - Sharon Wang
- Department of Infectious Disease, Arrowhead Regional Medical Center, Colton, USA
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14
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Chroboczek T, Dufour J, Renaux A, Aznar C, Demar M, Couppie P, Adenis A. Histoplasmosis: An oral malignancy-like clinical picture. Med Mycol Case Rep 2018; 19:45-48. [PMID: 29379706 PMCID: PMC5775070 DOI: 10.1016/j.mmcr.2017.11.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 09/12/2017] [Accepted: 11/24/2017] [Indexed: 12/27/2022] Open
Abstract
HIV-associated histoplasmosis is mainly misdiagnosed for granulomatous diseases, such as tuberculosis. Nonetheless, malignancy-like lesions have been reported sporadically in HIV-infected patients. Although the main reported lesions are erosive or ulcerated, here a rare case of oral tumor is reported. This case raises the awareness of this presentation, and the importance of accurate identification in the laboratory. Performing systematic specific stains for fungal elements and culture on tissue samples ensures accurate differential diagnosis.
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Affiliation(s)
| | - Julie Dufour
- Service de Dermatologie Vénérologie, CH de Cayenne, Cayenne, France
| | - Alain Renaux
- Service d'Oto-Rhino-Laryngologie, CH de Cayenne, Cayenne, France
| | - Christine Aznar
- Laboratoire Hospitalo-Universitaire de Parasitologie-Mycologie, CH de Cayenne, Cayenne, France.,Ecosystèmes Amazoniens et Pathologies Tropicales, EA3593, Université de Guyane, Cayenne, France
| | - Magalie Demar
- Laboratoire Hospitalo-Universitaire de Parasitologie-Mycologie, CH de Cayenne, Cayenne, France.,Ecosystèmes Amazoniens et Pathologies Tropicales, EA3593, Université de Guyane, Cayenne, France
| | - Pierre Couppie
- Service de Dermatologie Vénérologie, CH de Cayenne, Cayenne, France.,Ecosystèmes Amazoniens et Pathologies Tropicales, EA3593, Université de Guyane, Cayenne, France
| | - Antoine Adenis
- Ecosystèmes Amazoniens et Pathologies Tropicales, EA3593, Université de Guyane, Cayenne, France.,Centre d'Investigation Clinique Antilles-Guyane, Inserm CIC1424, CH de Cayenne, Cayenne, France
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15
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Oladele RO, Ayanlowo OO, Richardson MD, Denning DW. Histoplasmosis in Africa: An emerging or a neglected disease? PLoS Negl Trop Dis 2018; 12:e0006046. [PMID: 29346384 PMCID: PMC5773084 DOI: 10.1371/journal.pntd.0006046] [Citation(s) in RCA: 105] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Histoplasmosis in Africa has markedly increased since the advent of the HIV/AIDS epidemic but is under-recognised. Pulmonary histoplasmosis may be misdiagnosed as tuberculosis (TB). In the last six decades (1952-2017), 470 cases of histoplasmosis have been reported. HIV-infected patients accounted for 38% (178) of the cases. West Africa had the highest number of recorded cases with 179; the majority (162 cases) were caused by Histoplasma capsulatum var. dubuosii (Hcd). From the Southern African region, 150 cases have been reported, and the majority (119) were caused by H. capsulatum var. capsulatum (Hcc). There have been 12 histoplasmin skin test surveys with rates of 0% to 35% positivity. Most cases of Hcd presented as localised lesions in immunocompetent persons; however, it was disseminated in AIDS patients. Rapid diagnosis of histoplasmosis in Africa is only currently possible using microscopy; antigen testing and PCR are not available in most of Africa. Treatment requires amphotericin B and itraconazole, both of which are not licensed or available in several parts of Africa.
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Affiliation(s)
- Rita O. Oladele
- Department of Medical Microbiology and Parasitology, Faculty of Basic Medical Sciences, College of Medicine, University of Lagos, Lagos, Nigeria
- Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Olusola O. Ayanlowo
- Department of Medicine, Faculty of Clinical Sciences, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Malcolm D. Richardson
- Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
- Mycology Reference Centre Manchester, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - David W. Denning
- Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
- National Aspergillosis Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, United Kingdom
- Global Action Fund for Fungal Infections, Geneva, Switzerland
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16
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Abstract
A review of pulmonary infections of all types with diagnostic and morphological features.
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17
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Limper AH, Adenis A, Le T, Harrison TS. Fungal infections in HIV/AIDS. THE LANCET. INFECTIOUS DISEASES 2017; 17:e334-e343. [PMID: 28774701 DOI: 10.1016/s1473-3099(17)30303-1] [Citation(s) in RCA: 264] [Impact Index Per Article: 37.7] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 03/13/2017] [Accepted: 03/14/2017] [Indexed: 01/25/2023]
Abstract
Fungi are major contributors to the opportunistic infections that affect patients with HIV/AIDS. Systemic infections are mainly with Pneumocystis jirovecii (pneumocystosis), Cryptococcus neoformans (cryptococcosis), Histoplasma capsulatum (histoplasmosis), and Talaromyces (Penicillium) marneffei (talaromycosis). The incidence of systemic fungal infections has decreased in people with HIV in high-income countries because of the widespread availability of antiretroviral drugs and early testing for HIV. However, in many areas with high HIV prevalence, patients present to care with advanced HIV infection and with a low CD4 cell count or re-present with persistent low CD4 cell counts because of poor adherence, resistance to antiretroviral drugs, or both. Affordable, rapid point-of-care diagnostic tests (as have been developed for cryptococcosis) are urgently needed for pneumocystosis, talaromycosis, and histoplasmosis. Additionally, antifungal drugs, including amphotericin B, liposomal amphotericin B, and flucytosine, need to be much more widely available. Such measures, together with continued international efforts in education and training in the management of fungal disease, have the potential to improve patient outcomes substantially.
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Affiliation(s)
| | - Antoine Adenis
- Inserm CIC 1424, Centre d'Investigation Clinique Antilles Guyane, Centre Hospitalier de Cayenne, Cayenne, France; Equipe EA 3593, Ecosystèmes Amazoniens et Pathologie Tropicale, Université de Guyane, Cayenne, France
| | - Thuy Le
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, Ho Chi Minh City, Vietnam; Hawaii Centre for AIDS, University of Hawaii at Manoa, Honolulu, HI, USA
| | - Thomas S Harrison
- Institute of Infection and Immunity, St George's, University of London, London, UK.
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18
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Feline cutaneous histoplasmosis: The first case report from Thailand. Med Mycol Case Rep 2017; 18:28-30. [PMID: 28794961 PMCID: PMC5547237 DOI: 10.1016/j.mmcr.2017.07.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 07/16/2017] [Accepted: 07/24/2017] [Indexed: 11/29/2022] Open
Abstract
A 2-year-old, neutered female domestic shorthaired cat presented with a history of multiple papules and nodules on pinnae, nodules on the nose, and chronic wound at the lateral surface of left radial area for four months. Skin biopsy demonstrated moderate numbers of small, oval-to-round, single-walled yeasts inside the macrophages. In addition, PCR confirmed the sequence of Histoplasma capsulatum. This is the first case report of feline cutaneous histoplasmosis in Thailand.
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19
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Hendren N, Yek C, Mull J, Cutrell JB. Disseminated histoplasmosis presenting as multiple oral ulcers. BMJ Case Rep 2017; 2017:bcr-2017-220364. [PMID: 28710196 DOI: 10.1136/bcr-2017-220364] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 61-year-old female with a history of advanced HIV disease and chronic hepatitis B was presented with an 8-week history of painful oral ulcers. She appeared systemically well but examination revealed multiple well-demarcated clean-based ulcers on the tongue and hard palate. Biopsy of one of the lesions showed numerous histiocytes containing intracellular yeast forms consistent with Histoplasma capsulatum var. capsulatum Fungal blood cultures subsequently grew H. capsulatum var. capsulatum, confirming a diagnosis of disseminated histoplasmosis. She was treated with intravenous amphotericin B for 2 weeks followed by a prolonged course of oral itraconazole, with which her ulcers resolved completely and have not recurred. This case exemplifies how oral ulcers may be a manifestation of an underlying systemic disease and demonstrates the utility of biopsy in establishing a diagnosis.
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Affiliation(s)
- Nicholas Hendren
- Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Christina Yek
- Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Jason Mull
- Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - James B Cutrell
- Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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20
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Disseminated pulmonary histoplasmosis with multiple cutaneous lesions: Case report and literature review. REVISTA MÉDICA DEL HOSPITAL GENERAL DE MÉXICO 2017. [DOI: 10.1016/j.hgmx.2016.05.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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21
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Lee PP, Lau YL. Cellular and Molecular Defects Underlying Invasive Fungal Infections-Revelations from Endemic Mycoses. Front Immunol 2017; 8:735. [PMID: 28702025 PMCID: PMC5487386 DOI: 10.3389/fimmu.2017.00735] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 06/09/2017] [Indexed: 01/29/2023] Open
Abstract
The global burden of fungal diseases has been increasing, as a result of the expanding number of susceptible individuals including people living with human immunodeficiency virus (HIV), hematopoietic stem cell or organ transplant recipients, patients with malignancies or immunological conditions receiving immunosuppressive treatment, premature neonates, and the elderly. Opportunistic fungal pathogens such as Aspergillus, Candida, Cryptococcus, Rhizopus, and Pneumocystis jiroveci are distributed worldwide and constitute the majority of invasive fungal infections (IFIs). Dimorphic fungi such as Histoplasma capsulatum, Coccidioides spp., Paracoccidioides spp., Blastomyces dermatiditis, Sporothrix schenckii, Talaromyces (Penicillium) marneffei, and Emmonsia spp. are geographically restricted to their respective habitats and cause endemic mycoses. Disseminated histoplasmosis, coccidioidomycosis, and T. marneffei infection are recognized as acquired immunodeficiency syndrome (AIDS)-defining conditions, while the rest also cause high rate of morbidities and mortalities in patients with HIV infection and other immunocompromised conditions. In the past decade, a growing number of monogenic immunodeficiency disorders causing increased susceptibility to fungal infections have been discovered. In particular, defects of the IL-12/IFN-γ pathway and T-helper 17-mediated response are associated with increased susceptibility to endemic mycoses. In this review, we put together the various forms of endemic mycoses on the map and take a journey around the world to examine how cellular and molecular defects of the immune system predispose to invasive endemic fungal infections, including primary immunodeficiencies, individuals with autoantibodies against interferon-γ, and those receiving biologic response modifiers. Though rare, these conditions provide importance insights to host defense mechanisms against endemic fungi, which can only be appreciated in unique climatic and geographical regions.
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Affiliation(s)
- Pamela P Lee
- LKS Faculty of Medicine, Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | - Yu-Lung Lau
- LKS Faculty of Medicine, Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China.,Shenzhen Primary Immunodeficiencies Diagnostic and Therapeutic Laboratory, The University of Hong Kong-Shenzhen Hospital (HKU-SZH), Shenzhen, China
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22
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Duong TN, Waldman SE. Importance of a Travel History in Evaluation of Respiratory Infections. CURRENT EMERGENCY AND HOSPITAL MEDICINE REPORTS 2016; 4:141-152. [PMID: 32226655 PMCID: PMC7100244 DOI: 10.1007/s40138-016-0109-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
PURPOSE OF REVIEW International travel has increased at a fast pace and will continue to rapidly rise. Concomitantly, with this increase in travel is the increase in post travel-related diseases, such as respiratory illnesses. Identifying the cause of the posttravel respiratory illness is a complex challenge for many healthcare professionals because similar presentations occur for both infectious and noninfectious causes. Not only is diagnosis important but also transmission prevention. In the last two decades, there have been several severe infectious respiratory syndromes that have spread through international travel causing epidemics in many countries. RECENT FINDINGS A detailed travel history with the chronology of symptoms paired with the patient's medical risk factors and exposures along with some basic knowledge of infectious respiratory illnesses will help facilitate clinical decision making. This framework will help create a broad, but appropriate differential diagnosis to guide clinical workup, prevent delays in diagnosis, and implement the appropriate precautions to prevent transmission if appropriate. SUMMARY The foundation to diagnosing a travel-related respiratory illness lies within integrating the patient's travel history, comorbid conditions, clinical presentation, exposures, and mode of transmission. A timely and accurate diagnosis benefits not only the patient but also the surrounding community to prevent further individual transmission, epidemics, and pandemics.
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Affiliation(s)
- Theresa N. Duong
- Division of Hospital Medicine, Department of Internal Medicine, University of California, Davis Medical Center, Sacramento, CA USA
| | - Sarah E. Waldman
- Division of Infectious Diseases, Department of Internal Medicine, University of California, Davis Medical Center, Sacramento, CA USA
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23
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Kochar PS, Lath CO, Klein AP, Ulmer JL. Multimodality imaging in cranial blastomycosis, a great mimicker: Case-based illustration with review of clinical and imaging findings. Indian J Radiol Imaging 2016; 26:120-5. [PMID: 27081235 PMCID: PMC4813061 DOI: 10.4103/0971-3026.178360] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
We describe the clinical, laboratory, and imaging data of three patients who are proven cases of blastomycosis with cranial involvement. In this review, we discuss the imaging features of cranial blastomycosis with relevant clinical case examples including computed tomography (CT), magnetic resonance imaging (MRI), and advanced MR imaging techniques like magnetic resonance spectroscopy (MRS) and MR perfusion. Literature is reviewed for modern-day diagnosis and treatment of this fatal intracranial infection, if not diagnosed promptly and managed effectively.
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Affiliation(s)
- Puneet S Kochar
- Department of Radiology, Division of Neuroradiology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Chinar O Lath
- Department of Radiology, Division of Neuroradiology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Andrew P Klein
- Department of Radiology, Division of Neuroradiology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - John L Ulmer
- Department of Radiology, Division of Neuroradiology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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Klein IP, Martins MAT, Martins MD, Carrard VC. Diagnosis of HIV infection on the basis of histoplasmosis-related oral ulceration. SPECIAL CARE IN DENTISTRY 2015; 36:99-103. [PMID: 26597996 DOI: 10.1111/scd.12147] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Histoplasmosis is an endemic systemic mycosis caused by the dimorphic fungus Histoplasma capsulatum. In immunocompromised patients, histoplasmosis generally occurs as an opportunistic disease, with dissemination to various organs. Cutaneous involvement is observed in 38% to 85% of cases, with oral mucosal involvement in 30% to 60% of cases. This article describes the case study of a 32-year-old woman who presented an extensive tongue ulcer due to histoplasmosis and had the HIV infection diagnosis based on laboratory tests requested by the dentist.
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Affiliation(s)
- Isadora Peres Klein
- Master's degree student, Department of Conservative Dentistry, School of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Marco Antonio Trevizani Martins
- Assistant professor, Department of Conservative Dentistry, School of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Manoela Domingues Martins
- Assistant professor, Department of Conservative Dentistry, School of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Vinicius Coelho Carrard
- Assistant professor, Department of Conservative Dentistry, School of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
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Caceres DH, Zuluaga A, Arango-Bustamante K, de Bedout C, Tobón ÁM, Restrepo Á, Gómez BL, Cano LE, González Á. Implementation of a Training Course Increased the Diagnosis of Histoplasmosis in Colombia. Am J Trop Med Hyg 2015; 93:662-7. [PMID: 26123961 PMCID: PMC4559714 DOI: 10.4269/ajtmh.15-0108] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Accepted: 05/02/2015] [Indexed: 11/07/2022] Open
Abstract
Histoplasmosis causes a significant mortality, especially persons living with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) from developing countries where access to both appropriate diagnostic methods and antiretroviral therapy are limited. A total of 81 physicians assigned to 17 Colombian departments (states) received training in the clinical, epidemiological, and diagnostic aspects of histoplasmosis. Once this training was received and during the period of October 2009-November 2012, these physicians sent biological samples for immunodiagnostic, mycological, and molecular tests from their patients with suspicion of histoplasmosis. A total of 1,536 samples from 768 patients were evaluated. Of the 768 patients studied, 463 (60%) were HIV positive, 214 (28%) HIV negative, and in 91 (12%) this diagnosis was unknown, and 538 (70%) were males. The 1,536 specimens studied comprised 722 sera, 439 blood samples, and 241 urines, which were tested by immunodiffusion (ID), culture, and antigenuria, respectively; in addition, 134 specimens were tested by performing a molecular assay. Histoplasmosis was diagnosed in 133 patients (17%). After the training, we observed more diagnoses from 27 to 44 cases per year. In this study, a significantly increased number of histoplasmosis cases reported by year were observed after implementing an educational training program.
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Affiliation(s)
- Diego H Caceres
- Medical and Experimental Mycology Group, Corporación para Investigaciones Biológicas (CIB), Medellín, Colombia; School of Medicine and Health Sciences, Universidad del Rosario, Bogota, Colombia; School of Microbiology, Universidad de Antioquia, Medellín, Colombia; Basic and Applied Microbiology Research Group (MICROBA), School of Microbiology, Universidad de Antioquia, Medellín, Colombia
| | - Alejandra Zuluaga
- Medical and Experimental Mycology Group, Corporación para Investigaciones Biológicas (CIB), Medellín, Colombia; School of Medicine and Health Sciences, Universidad del Rosario, Bogota, Colombia; School of Microbiology, Universidad de Antioquia, Medellín, Colombia; Basic and Applied Microbiology Research Group (MICROBA), School of Microbiology, Universidad de Antioquia, Medellín, Colombia
| | - Karen Arango-Bustamante
- Medical and Experimental Mycology Group, Corporación para Investigaciones Biológicas (CIB), Medellín, Colombia; School of Medicine and Health Sciences, Universidad del Rosario, Bogota, Colombia; School of Microbiology, Universidad de Antioquia, Medellín, Colombia; Basic and Applied Microbiology Research Group (MICROBA), School of Microbiology, Universidad de Antioquia, Medellín, Colombia
| | - Catalina de Bedout
- Medical and Experimental Mycology Group, Corporación para Investigaciones Biológicas (CIB), Medellín, Colombia; School of Medicine and Health Sciences, Universidad del Rosario, Bogota, Colombia; School of Microbiology, Universidad de Antioquia, Medellín, Colombia; Basic and Applied Microbiology Research Group (MICROBA), School of Microbiology, Universidad de Antioquia, Medellín, Colombia
| | - Ángela Maria Tobón
- Medical and Experimental Mycology Group, Corporación para Investigaciones Biológicas (CIB), Medellín, Colombia; School of Medicine and Health Sciences, Universidad del Rosario, Bogota, Colombia; School of Microbiology, Universidad de Antioquia, Medellín, Colombia; Basic and Applied Microbiology Research Group (MICROBA), School of Microbiology, Universidad de Antioquia, Medellín, Colombia
| | - Ángela Restrepo
- Medical and Experimental Mycology Group, Corporación para Investigaciones Biológicas (CIB), Medellín, Colombia; School of Medicine and Health Sciences, Universidad del Rosario, Bogota, Colombia; School of Microbiology, Universidad de Antioquia, Medellín, Colombia; Basic and Applied Microbiology Research Group (MICROBA), School of Microbiology, Universidad de Antioquia, Medellín, Colombia
| | - 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; School of Microbiology, Universidad de Antioquia, Medellín, Colombia; Basic and Applied Microbiology Research Group (MICROBA), School of Microbiology, Universidad de Antioquia, Medellín, Colombia
| | - Luz Elena Cano
- Medical and Experimental Mycology Group, Corporación para Investigaciones Biológicas (CIB), Medellín, Colombia; School of Medicine and Health Sciences, Universidad del Rosario, Bogota, Colombia; School of Microbiology, Universidad de Antioquia, Medellín, Colombia; Basic and Applied Microbiology Research Group (MICROBA), School of Microbiology, Universidad de Antioquia, Medellín, Colombia
| | - Ángel González
- Medical and Experimental Mycology Group, Corporación para Investigaciones Biológicas (CIB), Medellín, Colombia; School of Medicine and Health Sciences, Universidad del Rosario, Bogota, Colombia; School of Microbiology, Universidad de Antioquia, Medellín, Colombia; Basic and Applied Microbiology Research Group (MICROBA), School of Microbiology, Universidad de Antioquia, Medellín, Colombia
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Sifuentes-Osornio J, Torres-Gonzalez P, Ponce-de-Leon A. Diagnosis and Treatment of Non-European Fungal Infections. CURRENT FUNGAL INFECTION REPORTS 2014. [DOI: 10.1007/s12281-014-0202-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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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: 37] [Impact Index Per Article: 3.7] [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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Mehta AK, Langston AA. Use of posaconazole in the treatment of invasive fungal infections. Expert Rev Hematol 2014; 2:619-30. [DOI: 10.1586/ehm.09.46] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Perforation of the nasal septum as the first sign of histoplasmosis associated with AIDS and review of published literature. Mycopathologia 2013; 176:145-50. [PMID: 23661050 DOI: 10.1007/s11046-013-9662-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2012] [Accepted: 04/27/2013] [Indexed: 10/26/2022]
Abstract
Disseminated histoplasmosis in South America is associated with AIDS in 70-90 % of cases. It is visceral and cutaneous, compromising the oral, pharynx, and laryngeal mucous membranes. The involvement of the nasal mucosa is unusual. Two patients with perforation of the nasal septum as the only sign of their disease were clinically and histopathologically diagnosed as leishmaniasis. The revision of the biopsies and the culture of nasal discharge secretions showed that the pathogens seen were not amastigotes but Histoplasma capsulatum. Other mycotic lesions were not detected, nor there was history of cutaneous leishmaniasis. The leishmanin skin test, available only for the male patient, was negative. The PCR and immunofluorescence antibody titers for Leishmania were negative in both patients. They were HIV positive; in the male, his CD4+ T cell count was 60/mm(3) and in the female 133/mm(3). The nasal ulcer was the only manifestation of histoplasmosis and the first of AIDS in both patients. The male patient recovered with amphotericin B and itraconazole treatment. The female has improved with itraconazole. Both patients received antiretroviral treatment. Nasal mucous membrane ulcers should include histoplasmosis among the differential diagnosis. In conclusion, two patients had perforation of their nasal septum as the only manifestation of histoplasmosis, a diagnosis confirmed by nasal mucosa biopsy and by culture of H. capsulatum, findings which demonstrated that both patients had AIDS.
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Denis B, Lortholary O. [Pulmonary fungal infection in patients with AIDS]. Rev Mal Respir 2013; 30:682-95. [PMID: 24182654 DOI: 10.1016/j.rmr.2013.02.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2011] [Accepted: 02/07/2013] [Indexed: 01/15/2023]
Abstract
Fungal infections are the most common opportunistic infections (OI) occurring during the course of HIV infection, though their incidence has decreased dramatically with the introduction of highly active antiretroviral therapy (cART). Most cases occur in untreated patients, noncompliant patients or patients whose multiple antiretroviral regimens have failed and they are a good marker of the severity of cellular immunodepression. Pneumocystis jiroveci pneumonia is the second most frequent OI in France and cryptococcosis remains a major problem in the Southern Hemisphere. With the increase in travel, imported endemic fungal infection can occur and may mimic other infections, notably tuberculosis. Fungal infections often have a pulmonary presentation but an exhaustive search for dissemination should be made in patients infected with HIV, at least those at an advanced stage of immune deficiency. Introduction of cART in combination with anti-fungal treatment depends on the risk of AIDS progression and on the risk of cumulative toxicity and the immune reconstitution inflammatory syndrome (IRIS) if introduced too early. Fungal infections in HIV infected patients remain a problem in the cART era. IRIS can complicate the management and requires an optimised treatment regime.
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Affiliation(s)
- B Denis
- Service des maladies infectieuses et tropicales, centre d'infectiologie Necker-Pasteur, université Paris Descartes, hôpital Necker-Enfants-Malades, 149, rue de Sèvres, 75743 Paris cedex 15, France
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Histoplasmosis y sida: factores de riesgo clínicos y de laboratorio asociados al pronóstico de la enfermedad. INFECTIO 2012. [DOI: 10.1016/s0123-9392(12)70026-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Singh V, Gupta P, Khatana S, Bhagol A, Gupta A. A nonhealing ulcer of mandibular alveolar ridge. Oral Surg Oral Med Oral Pathol Oral Radiol 2012. [PMID: 23182373 DOI: 10.1016/j.oooo.2012.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Virendra Singh
- Department of Oral and Maxillofacial Pathology, Government Dental College, Pt. B. D. Sharma University of Health Sciences, Rohtak, Haryana, India.
| | - Pranav Gupta
- Department of Oral and Maxillofacial Pathology, Government Dental College, Pt. B. D. Sharma University of Health Sciences, Rohtak, Haryana, India
| | - Shruti Khatana
- Department of Oral and Maxillofacial Pathology, Government Dental College, Pt. B. D. Sharma University of Health Sciences, Rohtak, Haryana, India
| | - Amrish Bhagol
- Department of Oral and Maxillofacial Pathology, Government Dental College, Pt. B. D. Sharma University of Health Sciences, Rohtak, Haryana, India
| | - Ambika Gupta
- Department of Oral Diagnosis and Radiology, Government Dental College, Pt. B. D. Sharma University of Health Sciences, Rohtak, Haryana, India
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Lortholary O, Charlier C, Lebeaux D, Lecuit M, Consigny PH. Fungal Infections in Immunocompromised Travelers. Clin Infect Dis 2012; 56:861-9. [DOI: 10.1093/cid/cis935] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
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Abstract
Diarrhea is a common problem in patients with immunocompromising conditions. The etiologic spectrum differs from patients with diarrhea who have a normal immune system. This article reviews the most important causes of diarrhea in immunocompromised patients, ranging from infectious causes to noninfectious causes of diarrhea in the setting of HIV infection as a model for other conditions of immunosuppression. It also deals with diarrhea in specific situations, eg, after hematopoietic stem cell or solid organ transplantation, diarrhea induced by immunosuppressive drugs, and diarrhea in congenital immunodeficiency syndromes.
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Affiliation(s)
- Elisabeth Krones
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
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37
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Scott AD, Dhir A. Case of the month #175: intracranial blastomycosis. Can Assoc Radiol J 2012; 63:73-6. [PMID: 22281398 DOI: 10.1016/j.carj.2010.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2010] [Accepted: 06/09/2010] [Indexed: 11/26/2022] Open
Affiliation(s)
- Andrew D Scott
- Department of Medical Imaging, Royal University Hospital, Saskatoon, Saskatchewan, Canada.
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Infektionskrankheiten. DIE ÄRZTLICHE BEGUTACHTUNG 2012. [PMCID: PMC7418528 DOI: 10.1007/978-3-642-21081-5_27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Virale Infektionen zählen immer noch weltweit, besonders in den Entwicklungsländern, zu den häufigsten Todesursachen. Durch internationale systematische Impfkampagnen der WHO ist die Welt Pocken-frei geworden. Die Inzidenz der Infektionen, die durch eine Immunprophylaxe verhindert werden können, wurde drastisch gesenkt (Poliomyelitis, Tollwut). In den 1980er Jahren trat eine neue Tierseuche beim Rind auf, die bovine spongyforme Enzephalopathie (BSE), die mit der neuen Variante der Creutzfeldt-Jakob-Krankheit (vCJK) in Zusammenhang steht (Nahrungskette). Im selben Zeitraum begann die explosionsartige weltweite Verbreitung eines neuen Retrovirus, des HIV. Trotz intensiver Aufklärungskampagnen und neuen therapeutischen Möglichkeiten (HAART, hoch aktive antiretrovirale Therapie) ist es bis zur Jahrtausendwende nicht gelungen, die weitere Ausbreitung der HIV-Infektion zu verhindern. Seit 2007 ist eine allmähliche Eindämmung der Infektion zu erkennen, die Neuinfektionen sind weltweit rückläufig. Durch den breiteren Einsatz der HAART sind Lebensqualität und Lebenserwartung enorm gestiegen, die Sterberate der AIDS-Infizierten ist seit 2005 um mehr als 50 % zurückgegangen.
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Husain N, Kumar P. Pathology of tropical diseases. Neuroimaging Clin N Am 2011; 21:757-75, vii. [PMID: 22032498 DOI: 10.1016/j.nic.2011.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Tropical diseases affecting the central nervous system include infections, infestations, and nutritional deficiency disorders. This article discusses the commonly encountered diseases. The infections include bacterial, mycobacterial, fungal, parasitic, and viral infections with varied clinical manifestations. Imaging sensitivity and specificity for the prediction of the cause of infections has improved with application of advanced techniques. Microbial demonstration and histology remain the gold standard for diagnosis. Understanding the basis of imaging changes is mandatory for better evaluation of images. Nutritional disorders present with generalized and nonspecific imaging manifestations. The pathology of commonly encountered vitamin deficiencies is also discussed.
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Affiliation(s)
- Nuzhat Husain
- Department of Pathology, Dr Ram Manohar Lohia Institute of Medical Sciences, Gomti Nagar, Lucknow, Uttar Pradesh, India.
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Islam A, Mody CH. Management of fungal lung disease in the immunocompromised. Ther Adv Respir Dis 2011; 5:305-24. [PMID: 21807757 DOI: 10.1177/1753465811398720] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Pulmonary mycoses are among the most feared infections encountered in immunocompromised patients. The problem is amplified by the increasing numbers of chronically immunocompromised patients that have substantially increased both the prevalence and clinical severity of infections caused by fungi. Moreover, fungal infections in this patient population pose challenges in diagnosis and management. Fortunately, recent advances in diagnostics and antifungal therapy, and their direct application to specific diseases, provide important new approaches to this complex and often seriously ill patient population. In this article we review the commonly occurring pulmonary fungal infections in the immunocompromised population with a particular focus on their management.
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Affiliation(s)
- Anowara Islam
- Snyder Institute for Infection, Inflammation and Immunity, University of Calgary, Alberta, Canada
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Colombo AL, Tobón A, Restrepo A, Queiroz-Telles F, Nucci M. Epidemiology of endemic systemic fungal infections in Latin America. Med Mycol 2011; 49:785-98. [PMID: 21539506 DOI: 10.3109/13693786.2011.577821] [Citation(s) in RCA: 137] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Although endemic mycoses are a frequent health problem in Latin American countries, clinical and epidemiological data remain scarce and fragmentary. These mycoses have a significant impact on public health, and early diagnosis and appropriate treatment remain important. The target population for endemic disease in Latin America is mostly represented by low-income rural workers with limited access to a public or private health system. Unfortunately, diagnostic tools are not widely available in medical centers in Latin America; consequently, by the time patients are diagnosed with fungal infection, many are already severely ill. Among immunocompromised patients, endemic mycoses usually behave as opportunistic infections causing disseminated rather than localized disease. This paper reviews the epidemiology of the most clinically significant endemic mycoses in Latin America: paracoccidioidomycosis, histoplasmosis, and coccidioidomycosis. The burdens of disease, typically affected populations, and clinical outcomes also are discussed.
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Affiliation(s)
- Arnaldo Lopes Colombo
- Division of Infectious Diseases, Department of Medicine, Federal University of São Paulo, São Paulo, Brazil.
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Navascués A, Rodríguez I, Repáraz J, Salvo S, Gil-Setas A, Martínez Peñuela JM. [Imported histoplasmosis in Navarra: presentation of four cases]. Rev Iberoam Micol 2011; 28:194-7. [PMID: 21539930 DOI: 10.1016/j.riam.2011.03.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2010] [Revised: 03/04/2011] [Accepted: 03/15/2011] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE Histoplasmosis is a fungal infection caused by the dimorphic fungi Histoplasma capsulatum. Its incidence in Spain has increased in recent years, mainly due to the increased presence of immigrants from Latin America and increased travel to the continent for tourism and cooperation. Our aim was to review the clinical characteristics of cases of histoplasmosis diagnosed in our hospital during the last six years. CASE REPORTS We diagnosed 4 cases from 4 patients from South America, 3 of whom were HIV positive and 1 diagnosed with dermatomyositis was treated with immunosuppressive drugs. The laboratory diagnosis was carried out by histological and microbiological study, by culture and specific PCR directly on the sample. DISCUSSION As it is an imported infection there needs to be a high level of suspicion and a detailed history taken to get a diagnosis. This infection requires a differential diagnosis between febrile syndrome in immunosuppressed patients, both HIV positive and immunosuppressive therapy, which originate from endemic areas, or who have a history of staying in them.
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Affiliation(s)
- Ana Navascués
- Servicio de Microbiología, Complejo Hospitalario de Navarra, Pamplona, España.
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Fever and Productive Cough in a Patient with AIDS. Clin Infect Dis 2011. [DOI: 10.1093/cid/ciq171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Karp CL, Mahanty S. Approach to the Patient with HIV and Coinfecting Tropical Infectious Diseases. TROPICAL INFECTIOUS DISEASES: PRINCIPLES, PATHOGENS AND PRACTICE 2011. [PMCID: PMC7150329 DOI: 10.1016/b978-0-7020-3935-5.00139-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Buitrago MJ, Bernal-Martínez L, Castelli MV, Rodríguez-Tudela JL, Cuenca-Estrella M. Histoplasmosis and paracoccidioidomycosis in a non-endemic area: a review of cases and diagnosis. J Travel Med 2011; 18:26-33. [PMID: 21199139 DOI: 10.1111/j.1708-8305.2010.00477.x] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Histoplasmosis and paracoccidioidomycosis (PCM) have increased in Spain in recent years, due firstly to the migration from endemic regions and secondly to travelers returning from these regions. In non-endemic areas, diagnosis of both diseases is hampered by the lack of experience, long silent periods, and the resemblance to other diseases such as tuberculosis and sarcoidosis. METHODS A total of 39 cases of imported histoplasmosis and 6 cases of PCM diagnosed in the Spanish Mycology Reference Laboratory since 2006 were analyzed. Microbiological diagnosis was performed using classical methods and also a specific real-time polymerase chain reaction (RT-PCR) assay for each microorganism. RESULTS We had 9 cases of probable histoplasmosis in travelers and 30 cases in immigrants, 29 of whom were defined as proven. Paracoccidioidomycosis (PCM) cases were either immigrants or people who had lived for a long period of time in endemic regions, all of whom were classified as proven cases. Cultures showed a good sensitivity in detecting Histoplasma capsulatum in immigrants with proven histoplasmosis (73%); however, growth was very slow. The fungus was never recovered in traveler patients. Paracoccidioides brasiliensis was isolated in a culture only in one case of the proven PCM. Serological methods were not very reliable in immunocompromised patients with histoplasmosis (40%). A PCR-based technique for histoplasmosis detected 55.5% of the cases in travelers (probable cases) and 89% of the cases in immigrants (proven). The PCR method for PCM detected 100% of the cases. CONCLUSIONS These kinds of mycoses are increasingly frequent in non-endemic areas, and newer and faster techniques should be used to reach an early diagnosis. The RT-PCR techniques developed appear to be sensitive, specific, and fast and could be helpful to detect those mycoses. However, it is also essential that physicians perform differential diagnosis in individuals coming from endemic areas.
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Affiliation(s)
- Maria J Buitrago
- Servicio de Micología, Instituto de Salud Carlos III, Carretera Majadahonda-Pozuelo Km 2, Majadahonda, Madrid, Spain.
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Abstract
AbstractThe activity of fungicide agents containing a quinazolinone ring was described using the quantitative structure-activity relationship (QSAR) model by applying it to data taken from literature. The title compounds exhibit two important types of activity against certain fungal pathogens, i.e. activity against yeast and activity against filamentous fungi. A correlation between both antifungal activities (e.g. FA(yst) and FA(ff)) and physicochemical parameters such as the logarithm of the n-octanol/water partition coefficient (log P), the polarizability (P), the global minimum energy (TE), the energy difference between the frontier molecular orbital (DELH) and the molar refractivity (MR), was established using multiple linear regression. The molecular descriptors of the antifungal agents were obtained by quantum chemical calculations combined with molecular modeling calculations. Statistical analysis shows that the antifungal activity depends mainly on the calculated partition coefficients, log P, of the compounds. Bi-parametric models reveal that antifungal activity relates linearly to log P and P.
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