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Wijaya M, Surja SS, Adawiyah R, Hariadi A, Setianingrum F, Rozaliyani A, Burhan E, Tugiran M, Sjam R, Denning DW, Wahyuningsih R. Histoplasma antigen detection in unconfirmed pulmonary tuberculosis and cross-reactivity with Aspergillus antigen in patients and in food in Jakarta, Indonesia. Mycoses 2024; 67:e13670. [PMID: 37897135 DOI: 10.1111/myc.13670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 10/23/2023] [Accepted: 10/26/2023] [Indexed: 10/29/2023]
Abstract
PURPOSE H. capsulatum is endemic in Indonesia, but the value of Histoplasma antigen detection has not been studied. PATIENTS AND METHODS Histoplasma galactomannan (GM) ELISA was applied to sera of patients with unproven pulmonary tuberculosis (TB) and patients with a positive Aspergillus GM. Both Histoplasma and Aspergillus GM tests were performed to determine any possible cross-reaction with certain foods. RESULTS Fourteen of 122 (11.5%) sera of patients with newly diagnosed clinical TB were positive for Histoplasma GM. The positivity rate in the serum of patients 5-6 and 12 months after TB diagnosis was 3.8% and 3.5%, respectively. Of 88 positive Aspergillus GM sera, 63 (71.6%) were also positive for Histoplasma GM. All tested foods were positive for Aspergillus GM, while 65% of foods were positive for Histoplasma GM. CONCLUSION Galactomannan is widespread in sera and food in Jakarta, possibly related to food consumption. Histoplasma and Aspergillus antigen detection for the diagnosis will require additional means of confirming the diagnosis; negative tests may be more helpful for ruling out invasive histoplasmosis and aspergillosis.
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Affiliation(s)
- Meiliyana Wijaya
- Study Program of Clinical Parasitology, Department of Parasitology, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
- Department of Parasitology, School of Medicine and Health Sciences, Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia
| | - Sem Samuel Surja
- Department of Parasitology, School of Medicine and Health Sciences, Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia
| | - Robiatul Adawiyah
- Study Program of Clinical Parasitology, Department of Parasitology, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
- Department of Parasitology, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
- Indonesia Pulmonary Mycoses Centre (IPMC), Faculty of Medicine Universitas Indonesia and Persahabatan National Respiratory Referral Hospital, Jakarta, Indonesia
- Master's Programme in Biomedical Sciences, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
- Infectious Diseases and Immunology Research Center (IDIRC), Indonesian Medical Education and Research Institute (IMERI), Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Ariananda Hariadi
- Department of Parasitology, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Findra Setianingrum
- Study Program of Clinical Parasitology, Department of Parasitology, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
- Department of Parasitology, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
- Indonesia Pulmonary Mycoses Centre (IPMC), Faculty of Medicine Universitas Indonesia and Persahabatan National Respiratory Referral Hospital, Jakarta, Indonesia
- Master's Programme in Biomedical Sciences, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Anna Rozaliyani
- Study Program of Clinical Parasitology, Department of Parasitology, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
- Department of Parasitology, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
- Indonesia Pulmonary Mycoses Centre (IPMC), Faculty of Medicine Universitas Indonesia and Persahabatan National Respiratory Referral Hospital, Jakarta, Indonesia
- Master's Programme in Biomedical Sciences, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Erlina Burhan
- Indonesia Pulmonary Mycoses Centre (IPMC), Faculty of Medicine Universitas Indonesia and Persahabatan National Respiratory Referral Hospital, Jakarta, Indonesia
- Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
- Persahabatan National Respiratory Referral Hospital, Jakarta, Indonesia
| | - Mulyati Tugiran
- Study Program of Clinical Parasitology, Department of Parasitology, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
- Department of Parasitology, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
- Indonesia Pulmonary Mycoses Centre (IPMC), Faculty of Medicine Universitas Indonesia and Persahabatan National Respiratory Referral Hospital, Jakarta, Indonesia
- Master's Programme in Biomedical Sciences, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Ridhawati Sjam
- Study Program of Clinical Parasitology, Department of Parasitology, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
- Department of Parasitology, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
- Indonesia Pulmonary Mycoses Centre (IPMC), Faculty of Medicine Universitas Indonesia and Persahabatan National Respiratory Referral Hospital, Jakarta, Indonesia
- Master's Programme in Biomedical Sciences, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - David W Denning
- Manchester Fungal Infection Group, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Retno Wahyuningsih
- Department of Parasitology, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
- Department of Parasitology, Faculty of Medicine, Universitas Kristen Indonesia, Jakarta, Indonesia
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Puerta-Arias JD, Isaza Agudelo JP, Naranjo Preciado TW. Identification and production of novel potential pathogen-specific biomarkers for diagnosis of histoplasmosis. Microbiol Spectr 2023; 11:e0093923. [PMID: 37882565 PMCID: PMC10714873 DOI: 10.1128/spectrum.00939-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 09/08/2023] [Indexed: 10/27/2023] Open
Abstract
IMPORTANCE Histoplasmosis is considered one of the most important mycoses due to the increasing number of individuals susceptible to develop severe clinical forms, particularly those with HIV/AIDS or receiving immunosuppressive biological therapies, the high mortality rates reported when antifungal treatment is not initiated in a timely manner, and the limitations of conventional diagnostic methods. In this context, there is a clear need to improve the capacity of diagnostic tools to specifically detect the fungal pathogen, regardless of the patient's clinical condition or the presence of other co-infections. The proposed novel pathogen-specific biomarkers have the potential to be used in immunodiagnostic platforms and antifungal treatment monitoring in histoplasmosis. In addition, the bioinformatics strategy used in this study could be applied to identify potential diagnostic biomarkers in other models of fungal infection of public health importance.
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Affiliation(s)
- Juan David Puerta-Arias
- Medical and Experimental Mycology Group, Corporación para Investigaciones Biológicas (CIB-UdeA-UPB-UDES), Medellín, Colombia
- School of Health Sciences, Universidad Pontificia Bolivariana, Medellín, Colombia
- Universidad de Santander (UDES), Facultad de Ciencias Médicas y de la Salud, Bucaramanga, Colombia
| | | | - Tonny Williams Naranjo Preciado
- Medical and Experimental Mycology Group, Corporación para Investigaciones Biológicas (CIB-UdeA-UPB-UDES), Medellín, Colombia
- School of Health Sciences, Universidad Pontificia Bolivariana, Medellín, Colombia
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Kuate MPN, Abessolo Abessolo H, Denning DW, Stone NR, Ndip RN. Diagnosing disseminated histoplasmosis in advanced HIV/AIDS disease in Cameroon using a point of care lateral flow assay. Ther Adv Infect Dis 2022; 9:20499361221132133. [PMID: 36277298 PMCID: PMC9583206 DOI: 10.1177/20499361221132133] [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: 04/08/2022] [Accepted: 09/25/2022] [Indexed: 11/25/2022] Open
Abstract
Histoplasmosis is an AIDS-defining opportunistic infection. Disseminated histoplasmosis (DH) can be fatal without early diagnosis and treatment initiation. We present one confirmed and three probable cases of DH in advanced HIV/AIDS disease patients diagnosed using OIDx Histoplasma LFA in Yaoundé, Cameroon. Four women with HIV but unknown CD4 count presented with asthenia, weight loss, productive cough, and fever (39°C) as common symptoms for at least 3 weeks. Two of the patients had skin lesions. These included facial papules, macules, and umbilicated vesicles scattered over the trunk and limbs. These were diffuse lesions which were purulent, itching, and papillomatous lesions with a necrotic centre, and one patient had a right forearm ulcer. We performed the Histoplasma antigen tests using the OIDx Histo LFA, and they were strongly positive in all four patients. Histopathology in skin biopsy allowed identification of the species as Histoplasma capsulatum var capsulatum in one patient. In this same patient, Pseudomonas aeruginosa and Proteus mirabilis were cultured from the forearm ulcer. This patient later commenced antibiotics (Levofloxacin 500 mg) and oral itraconazole (800 mg/day) with immediate improvement. Unfortunately, the other three patients could not access itraconazole, were discharged and lost to follow-up. Early diagnosis and treatment are essential for the management of DH. LFA is a test that can be set up in any setting with limited resource. Access to this can be a major advance in the diagnosis of histoplasmosis in resource-limited settings.
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Affiliation(s)
| | - Hermine Abessolo Abessolo
- Service of Infectious diseases, Central
Hospital Yaoundé, Yaoundé, Cameroon,Department of Microbiology, Haematology,
Parasitology and Infectious Diseases, University of Garoua, Garoua,
Cameroon
| | - David W. Denning
- Faculty of Biology, Medicine and Health, The
University of Manchester, Manchester, UK,The Global Action Fund for Fungal Infections,
Genève, Switzerland
| | - Neil R. Stone
- Hospital for Tropical Diseases, University
College London Hospitals, London, UK
| | - Roland Ndip Ndip
- Department of Microbiology and Parasitology,
University of Buea, Buea, Cameroon
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Ocansey BK, Otoo B, Asamoah I, Ganu V, Berko KP, Oladele O, Opoku-Asare B, Agyei M, George L, Kotey FCN, Kosmidis C, Puplampu P, Opintan JA, Denning DW. Cryptococcal and Histoplasma Antigen Screening among People With HIV in Ghana and Comparative Analysis of OIDx Histoplasma Lateral Flow Assay and IMMY Histoplasma Enzyme Immunoassay. Open Forum Infect Dis 2022; 9:ofac277. [PMID: 35854987 PMCID: PMC9291368 DOI: 10.1093/ofid/ofac277] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 05/31/2022] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Cryptococcal meningitis (CM) and disseminated histoplasmosis (DH) are common in people with HIV (PWH) and diagnosed by detecting cryptococcal antigen (CrAg) and Histoplasma antigen (Histo Ag) respectively. In Ghana, CM and DH are rarely suspected by clinicians due to limited epidemiological data.
Methods
This study was conducted among PWH in Ghana who are unwell. Sociodemographic and clinical data were collected by questionnaire. Serum and/or urine were screened for CrAg and Histo Ag, using IMMY CrAg lateral flow assay (LFA) and IMMY Histoplasma enzyme immunoassay (EIA) kits, respectively, regardless of symptoms. Samples run with IMMY Histoplasma EIA were simultaneously run with OIDx Histoplasma LFA. Laboratory investigations were conducted by the research team while diagnosis incorporating clinical assessment, screening and confirmatory testing results and treatment decisions were made by the clinical team. Treatment and outcome information on CM and DH patients were evaluated.
Results
Overall, 150 participants were recruited. There were 73% (n = 109) females, and the age range was 18–62 years. The prevalence rates of CrAg and Histo Ag were 2.7% (4/150) and 4.7% (5/107), respectively. The OIDx Histoplasma LFA showed a high concordance (98.4%) with the IMMY Histoplasma EIA. All antigen-positive cases by standard tests were diagnosed with CM and DH. Antifungal treatment was given in five patients and follow-up revealed two deaths and three recoveries.
Conclusion
Histoplasmosis among PWH may be more common than previously anticipated and may be more frequent than cryptococcosis in Ghana. The performance of the OIDx Histoplasma LFA should be further explored.
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Affiliation(s)
- Bright K. Ocansey
- University of Manchester, Manchester Academic Health Science Centre Division of Evolution, Infection and Genomics, Faculty of Biology, Medicine and Health, , Manchester, UK
| | - Benjamin Otoo
- University of Ghana Department of Bacteriology, Noguchi Memorial Institute of Medical Research, , Legon, Ghana
| | - Isabella Asamoah
- Korle-Bu Teaching Hospital Fevers Unit, Department of Medicine, , Korle-Bu, Ghana
| | - Vincent Ganu
- Korle-Bu Teaching Hospital Fevers Unit, Department of Medicine, , Korle-Bu, Ghana
| | - Kojo P. Berko
- Korle-Bu Teaching Hospital Fevers Unit, Department of Medicine, , Korle-Bu, Ghana
| | - Oluwakemi Oladele
- Korle-Bu Teaching Hospital Fevers Unit, Department of Medicine, , Korle-Bu, Ghana
| | - Bismark Opoku-Asare
- Korle-Bu Teaching Hospital Fevers Unit, Department of Medicine, , Korle-Bu, Ghana
| | - Martin Agyei
- Komfo Anokye Teaching Hospital Dermatology Unit, Department of Internal Medicine, , Kumasi, Ghana
- Kwame Nkrumah University of Science and Technology Department of Medicine, , Kumasi, Ghana
| | - Lawrence George
- Juaboso Government Hospital Laboratory Department, , Juaboso, Ghana
| | - Fleischer C. N. Kotey
- University of Ghana Medical School Department of Medical Microbiology, , Korle-Bu, Ghana
- FleRhoLife Research Consult , Teshie, Ghana
| | - Chris Kosmidis
- University of Manchester, Manchester Academic Health Science Centre Division of Evolution, Infection and Genomics, Faculty of Biology, Medicine and Health, , Manchester, UK
- National Aspergillosis Centre, Manchester University NHS Foundation Trust , Manchester, UK
| | - Peter Puplampu
- Korle-Bu Teaching Hospital Fevers Unit, Department of Medicine, , Korle-Bu, Ghana
- University of Ghana Medical School Department of Medicine and Therapeutics, , Korle-Bu, Ghana
| | | | - David W. Denning
- University of Manchester, Manchester Academic Health Science Centre Division of Evolution, Infection and Genomics, Faculty of Biology, Medicine and Health, , Manchester, UK
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Freire M, Carvalho V, Spener R, da Silva CR, da Silva Neto JR, Carlos Ferreira L, Nogueira PA. Hemophagocytic Syndrome in a Patient with HIV and Histoplasmosis: A not so Rare Correlation. Clin Med Insights Pathol 2022; 15:2632010X221118059. [PMID: 36051652 PMCID: PMC9425888 DOI: 10.1177/2632010x221118059] [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: 10/29/2021] [Accepted: 07/15/2022] [Indexed: 11/18/2022] Open
Abstract
Hemophagocytic lymphohistiocytosis (HLH) is a disorder that occurs due to unsuitable monocyte activation in a variety of infections. In human immunodeficiency virus (HIV) infections, patients with advanced immunossupression associated with opportunistic infections are at increased risk of developing HLH. We describe a clinical case of a 33-year-old male student diagnosed with HIV who was hospitalized for investigation of asthenia and dyspnea, accompanied by adynamia, decreased motor force in the left leg, dysphagia, and dysfluency. His general condition was regular, he was pale, feverish, and had normal cardiac and pulmonary auscultation. Physical examination revealed ulcerated lesions in the perianal region and hepatosplenomegaly without palpable lymph node enlargement. Laboratory parameters showed pancytopenia, a slight increase in liver function accompanied by high lactate dehydrogenase, and hiperferritinemia. The initial diagnosis was disseminated histoplasmosis, thus amphotericin B deoxycholate was empirically prescribed while waiting on myeloculture and blood cultures for fungi and mycobacteria. Other clinical procedures were blood transfusion, resumption of antiretroviral therapy (ART) and secondary prophylaxis. Myeloculture blood cultures of fungi and mycobacteria were negative. Patient evolved well in relation to the initial complaints and showed partial clinical and laboratory improvement. However, 23 days after hospitalization, he developed a febrile episode accompanied by chills and a convulsive crisis. The patient was transferred to the intensive unit care and developed septic shock and respiratory failure. He died 25 days after the onset of the condition. After the postmortem examination, histopathology revealed countless rounded fungal structures compatible with Histoplasma sp., which were observed in the peripancreatic lymph node, liver, and spleen, in addition to hemophagocytosis in the splenic parenchyma. We thus conclude that when the patient met criteria for HLH, such as fever, hepatosplenomegaly, hiperferritinemia, and pancytopenia, the evolution was fast due to the aggressive and rapidly fatal nature of HLH, despite anti-fungal and corticoid treatment. Therefore, this case report reinforces the need to consider hemophagocytic syndrome in patients with HIV and disseminated histoplasmosis, especially where histoplasmosis is highly endemic, in order for the treatment be started early when there is high clinical suspicion.
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Affiliation(s)
- Monique Freire
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil.,Programa de Pós-graduação em Ciências da Saúde, Universidade Federal do Amazonas, Manaus, Brazil
| | - Viviane Carvalho
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | - Renata Spener
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | - Christiane Rodrigues da Silva
- Programa de Pós-graduação em Biologia da Realação Patogeno Hospedeiro, Instituto Leônidas e Maria Deane, Manaus, Brazil
| | | | - Luiz Carlos Ferreira
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil.,Programa de Pós-graduação em Ciências da Saúde, Universidade Federal do Amazonas, Manaus, Brazil
| | - Paulo Afonso Nogueira
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil.,Programa de Pós-graduação em Biologia da Realação Patogeno Hospedeiro, Instituto Leônidas e Maria Deane, Manaus, Brazil
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Fuloria S, Fuloria N, Subramaniyan V, Darnal H, Meenakshi D, Sekar M, Nordin R, Chakravarthi S, Sathasivam K, Khan S, Wu Y, Kumari U, Sudhakar K, Malviya R, Sharma V. COVID-19-associated mucormycosis and treatments. ASIAN PAC J TROP MED 2021. [DOI: 10.4103/1995-7645.326253] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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