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Leitão TDMJS, Rodrigues NBS, Farias LABG, Henn GADL, Mota RS, Costa RDS, Damasceno LS. Histoplasmosis in non-immunosuppressed patients from an endemic area in Northeastern Brazil. Med Mycol 2024; 62:myae059. [PMID: 38970370 DOI: 10.1093/mmy/myae059] [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: 02/12/2024] [Revised: 04/29/2024] [Accepted: 06/20/2024] [Indexed: 07/08/2024] Open
Abstract
Differently from immunocompromised patients, very little information is available in the literature regarding the clinical presentation, epidemiology, and outcomes of histoplasmosis in non-immunosuppressed individuals living in endemic areas. This retrospective case series study was carried out by reviewing the medical records of non-immunocompromised patients with histoplasmosis, residents in a hyperendemic area in northeastern Brazil, between 2011 and 2022. Thirty HIV-negative patients were identified with histoplasmosis, and 19 cases met the inclusion criteria: three had acute, five subacute and one chronic pulmonary forms; two with mediastinal picture and eight had disseminated disease (two with severe symptoms). The median age of our sample was 32.7 years old [interquartile range: 24-45]. Most of the patients were male (male-to-female ratio = 15:4) and resided in the state capital (n = 9). The majority had a previous history of exposure to well-known risk factors for Histoplasma infection. Pulmonary nodules were observed in all subacute form, two patients (acute and subacute forms) were initially treated empirically for pulmonary tuberculosis; one death was registered in the subacute form. The chronic pulmonary form of histoplasmosis was diagnosed in one patient only after the symptoms persisted despite specific treatment. The primary clinical manifestations of the moderate form of DH were enlarged lymph nodes, with histopathology being the main diagnostic method. The cases were detected as isolated occurrences and not as an outbreak, suggesting that exposure to Histoplasma can be more widespread than presumed. Despite the self-limiting nature of the disease, death can occur even in previously heathy patients.
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Affiliation(s)
- Terezinha do Menino Jesus Silva Leitão
- Universidade Federal do Ceará, Faculdade de Medicina, Departamento de Saúde Comunitária, Postal code 60441-750, Fortaleza, Ceará, Brazil
- Hospital São José de Doenças Infecciosas, Postal code 60455-610, Fortaleza, Ceará, Brazil
| | | | - Luís Arthur Brasil Gadelha Farias
- Universidade Federal do Ceará, Faculdade de Medicina, Departamento de Saúde Comunitária, Postal code 60441-750, Fortaleza, Ceará, Brazil
- Hospital São José de Doenças Infecciosas, Postal code 60455-610, Fortaleza, Ceará, Brazil
| | | | - Rosa Salani Mota
- Universidade Federal do Ceará, Faculdade de Medicina, Departamento de Saúde Comunitária, Postal code 60441-750, Fortaleza, Ceará, Brazil
| | - Rafael de Sousa Costa
- Fundação de Ciência e Pesquisa Maria Ione Xerez Vasconcelos - FUNCIPE, Postal code 60040-430, Fortaleza, Ceará, Brazil
| | - Lisandra Serra Damasceno
- Universidade Federal do Ceará, Faculdade de Medicina, Departamento de Saúde Comunitária, Postal code 60441-750, Fortaleza, Ceará, Brazil
- Hospital São José de Doenças Infecciosas, Postal code 60455-610, Fortaleza, Ceará, Brazil
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Dao A, Kim HY, Halliday CL, Oladele R, Rickerts V, Govender MMed NP, Shin JH, Heim J, Ford NP, Nahrgang SA, Gigante V, Beardsley J, Sati H, Morrissey CO, Alffenaar JW, Alastruey-Izquierdo A. Histoplasmosis: A systematic review to inform the World Health Organization of a fungal priority pathogens list. Med Mycol 2024; 62:myae039. [PMID: 38935903 PMCID: PMC11210611 DOI: 10.1093/mmy/myae039] [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: 09/12/2023] [Revised: 11/30/2023] [Accepted: 04/29/2024] [Indexed: 06/29/2024] Open
Abstract
Histoplasmosis, a significant mycosis primarily prevalent in Africa, North and South America, with emerging reports globally, poses notable health challenges, particularly in immunocompromised individuals such as people living with HIV/AIDS and organ transplant recipients. This systematic review, aimed at informing the World Health Organization's Fungal Priority Pathogens List, critically examines literature from 2011 to 2021 using PubMed and Web of Science, focusing on the incidence, mortality, morbidity, antifungal resistance, preventability, and distribution of Histoplasma. We also found a high prevalence (22%-44%) in people living with HIV, with mortality rates ranging from 21% to 53%. Despite limited data, the prevalence of histoplasmosis seems stable, with lower estimates in Europe. Complications such as central nervous system disease, pulmonary issues, and lymphoedema due to granuloma or sclerosis are noted, though their burden remains uncertain. Antifungal susceptibility varies, particularly against fluconazole (MIC: ≥32 mg/l) and caspofungin (MICs: 4-32 mg/l), while resistance to amphotericin B (MIC: 0.125-0.16 mg/l), itraconazole (MICs: 0.004-0.125 mg/l), and voriconazole (MICs: 0.004-0.125 mg/l) remains low. This review identifies critical knowledge gaps, underlining the need for robust, globally representative surveillance systems to better understand and combat this fungal threat.
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Affiliation(s)
- Aiken Dao
- Sydney Infectious Diseases Institute, The University of Sydney, Westmead, New South Wales, Australia
- Westmead Institute for Medical Research, Westmead, New South Wales, Australia
- Westmead Clinical School, Westmead Hospital, Westmead, New South Wales, Australia
| | - Hannah Yejin Kim
- Sydney Infectious Diseases Institute, The University of Sydney, Westmead, New South Wales, Australia
- Sydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
- Department of Pharmacy, Westmead Hospital, Westmead, New South Wales, Australia
| | - Catriona L Halliday
- Centre for Infectious Diseases and Microbiology Laboratory Services, Institute of Clinical Pathology and Medical Research, New South Wales Health Pathology, Westmead Hospital, Westmead, New South Wales, Australia
| | - Rita Oladele
- Department of Medical Microbiology and Parasitology, College of Medicine, University of Lagos, Lagos, Nigeria
| | | | - Nelesh P Govender MMed
- National Institute for Communicable Diseases, Division of the National Health Laboratory Service, Johannesburg, South Africa
- Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Institute of Infection and Immunity, St George’s University of London, London, UK
- MRC Centre for Medical Mycology, University of Exeter, Exeter, UK
| | - Jong-Hee Shin
- Department of Laboratory Medicine, Chonnam National University School of Medicine, Gwangju, South Korea
| | - Jutta Heim
- Scientific Advisory Committee, Helmholtz Centre for Infection Research, Braunschweig, Germany
| | - Nathan Paul Ford
- Department of HIV, Viral Hepatitis and STIs, World Health Organization, Geneva, Switzerland
- Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Saskia Andrea Nahrgang
- Antimicrobial Resistance Programme, World Health Organization European Office, Copenhagen, Denmark
| | - Valeria Gigante
- AMR Division, World Health Organization, Geneva, Switzerland
| | - Justin Beardsley
- Sydney Infectious Diseases Institute, The University of Sydney, Westmead, New South Wales, Australia
- Westmead Institute for Medical Research, Westmead, New South Wales, Australia
- Westmead Clinical School, Westmead Hospital, Westmead, New South Wales, Australia
| | - Hatim Sati
- AMR Division, World Health Organization, Geneva, Switzerland
| | - C Orla Morrissey
- Department of Infectious Diseases, Alfred Health, Melbourne, Victoria, Australia
- Department of Infectious Diseases, Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Jan-Willem Alffenaar
- Sydney Infectious Diseases Institute, The University of Sydney, Westmead, New South Wales, Australia
- Sydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
- Department of Pharmacy, Westmead Hospital, Westmead, New South Wales, Australia
| | - Ana Alastruey-Izquierdo
- Mycology Reference Laboratory, National Centre for Microbiology, Instituto de Salud Carlos III, Madrid, Spain
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Paixão AG, Almeida MA, Correia RES, Kamiensky BB, Zancopé-Oliveira RM, Lazera MDS, Wanke B, Lamas CDC. Histoplasmosis at a Reference Center for Infectious Diseases in Southeast Brazil: Comparison between HIV-Positive and HIV-Negative Individuals. Trop Med Infect Dis 2023; 8:tropicalmed8050271. [PMID: 37235319 DOI: 10.3390/tropicalmed8050271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 05/02/2023] [Accepted: 05/04/2023] [Indexed: 05/28/2023] Open
Abstract
Objectives: Histoplasmosis is a systemic mycosis, present globally. We aimed to describe cases of histoplasmosis (Hc) and to establish a risk profile associated with Hc in HIV-infected patients (HIV+). Methods: This was a retrospective study of patients with a clinical laboratory diagnosis of Hc. Data were fed into REDCap, and statistical analysis was performed with R. Results: We included 99 records, 65 HIV+ and 34 HIV-. Average age was 39 years. Median time from onset to diagnosis was 8 weeks in HIV- and 22 weeks in HIV+. Disseminated histoplasmosis occurred in 79.4% of HIV+, vs. 36.4% of HIV- patients. Median CD4 count was 70. Co-infection with tuberculosis was present in 20% of HIV+ patients. Blood cultures were positive in 32.3% of HIV+ vs. 11.8% of HIV- (p = 0.025) patients; bone marrow culture was positive in 36.9% vs. 8.8% (p = 0.003). Most HIV+ patients (71.4%) were hospitalized. On univariate analysis, anemia, leukopenia, intensive care, use of vasopressors and mechanical ventilation were associated with death in HIV+ patients. Conclusions: Most of our patients with histoplasmosis were HIV+, presenting advanced AIDS. Diagnosis was late in HIV+ patients, and they frequently presented disseminated Hc, required hospitalization, and died. Early screening for Hc in HIV+ and drug-induced immunosuppressed patients is crucial.
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Affiliation(s)
- Ariane Gomes Paixão
- Instituto Nacional de Infectologia Evandro Chagas, Fiocruz, Rio de Janeiro 21040-900, Brazil
| | - Marcos Abreu Almeida
- Instituto Nacional de Infectologia Evandro Chagas, Fiocruz, Rio de Janeiro 21040-900, Brazil
| | | | | | | | | | - Bodo Wanke
- Instituto Nacional de Infectologia Evandro Chagas, Fiocruz, Rio de Janeiro 21040-900, Brazil
| | - Cristiane da Cruz Lamas
- Instituto Nacional de Infectologia Evandro Chagas, Fiocruz, Rio de Janeiro 21040-900, Brazil
- Instituto Nacional de Cardiologia, Rio de Janeiro 21040-900, Brazil
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Cornell TR, Thomas LF, Cook EAJ, Pinchbeck G, Bettridge J, Gordon L, Kivali V, Kiyong’a A, Fèvre EM, Scantlebury CE. Evidence of Histoplasma capsulatum seropositivity and exploration of risk factors for exposure in Busia county, western Kenya: Analysis of the PAZ dataset. PLoS Negl Trop Dis 2023; 17:e0011295. [PMID: 37172015 PMCID: PMC10180684 DOI: 10.1371/journal.pntd.0011295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 04/07/2023] [Indexed: 05/14/2023] Open
Abstract
BACKGROUND Despite recognition of histoplasmosis as a disease of national public health concern in Kenya, the burden of Histoplasma capsulatum in the general population remains unknown. This study examined the human seroprevalence of anti-Histoplasma antibody and explored associations between seropositivity and demographic and environmental variables, in Busia county, western Kenya. METHODOLOGY Biobanked serum samples and associated data, from a previous cross-sectional survey, were examined. Latex agglutination tests to detect the presence of anti-Histoplasma antibody were performed on serum samples from 670 survey respondents, representing 178 households within 102 sub-locations. Potential epidemiologic risk factors for H. capsulatum exposure were explored using multi-level multivariable logistic regression analysis with household and sub-location included as random effects. PRINCIPAL FINDINGS The apparent sample seroprevalence of anti-Histoplasma antibody was 15.5% (n = 104/670, 95% Confidence Interval (CI) 12.9-18.5%). A multivariable logistic regression model identified increased odds of H. capsulatum seropositivity in respondents reporting rats within the household within the previous 12 months (OR = 2.99 90% CI 1.04-8.55, p = 0.04). Compared to respondents aged 25-34 years, the odds of seropositivity were higher in respondents aged 15-24 years (OR = 2.70 90% CI 1.04-6.97, p = 0.04). CONCLUSIONS The seroprevalence result provides a baseline for sample size approximations for future epidemiologic studies of the burden of H. capsulatum exposure in Busia county. The final model explored theoretically plausible risk factors for H. capsulatum exposure in the region. A number of factors may contribute to the complex epidemiological picture impacting H. capsulatum exposure status at the human-animal-environment interface in western Kenya. Focussed H. capsulatum research is warranted to determine the contextual significance of identified associations, and in representative sample populations.
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Affiliation(s)
- Tessa Rose Cornell
- Institute of Infection, Veterinary and Ecological Sciences (IVES), University of Liverpool, Liverpool, United Kingdom
| | - Lian Francesca Thomas
- Institute of Infection, Veterinary and Ecological Sciences (IVES), University of Liverpool, Liverpool, United Kingdom
- International Livestock Research Institute (ILRI), Nairobi, Kenya
| | | | - Gina Pinchbeck
- Institute of Infection, Veterinary and Ecological Sciences (IVES), University of Liverpool, Liverpool, United Kingdom
| | - Judy Bettridge
- Institute of Infection, Veterinary and Ecological Sciences (IVES), University of Liverpool, Liverpool, United Kingdom
- International Livestock Research Institute (ILRI), Nairobi, Kenya
| | - Lauren Gordon
- Institute of Infection, Veterinary and Ecological Sciences (IVES), University of Liverpool, Liverpool, United Kingdom
| | - Velma Kivali
- International Livestock Research Institute (ILRI), Nairobi, Kenya
| | - Alice Kiyong’a
- International Livestock Research Institute (ILRI), Nairobi, Kenya
| | - Eric Maurice Fèvre
- Institute of Infection, Veterinary and Ecological Sciences (IVES), University of Liverpool, Liverpool, United Kingdom
- International Livestock Research Institute (ILRI), Nairobi, Kenya
| | - Claire Elizabeth Scantlebury
- Institute of Infection, Veterinary and Ecological Sciences (IVES), University of Liverpool, Liverpool, United Kingdom
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Tobón AM, Gómez BL. Pulmonary Histoplasmosis. Mycopathologia 2021; 186:697-705. [PMID: 34498137 DOI: 10.1007/s11046-021-00588-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 08/20/2021] [Indexed: 12/12/2022]
Abstract
Histoplasmosis is one of the most frequent causes of fungal respiratory infection in endemic regions, has a broad spectrum of clinical manifestations and can present in several forms. The extent of disease is determined by the number of conidia inhaled, the immune response of the host and the integrity of the respiratory tract. From an initial and most benign form, acute pulmonary histoplasmosis (an influenza-like illness that is typically asymptomatic or mild in persons without prior immune compromise), histoplasmosis can become a lifethreatening progressive disseminated infection (PDH) that affects mainly immunocompromised patients, with high morbidity and mortality. Chronic pulmonary histoplasmosis is an uncommon manifestation of Histoplasma infection, with features similar to pulmonary tuberculosis, and if it remains undiagnosed or untreated it also can cause significant morbidity. Some rare but serious complications may also occur that are produced by an excessive immune response, such as mediastinal fibrosis, histoplasmoma and broncholithiasis. Histoplasmosis is highly endemic in regions of North, Central and South America as well as being reported in parts of Asia and Africa. The risk of histoplasmosis is greatest in patients with HIV infection, especially those with CD4+ counts of <200 cells/μL. We review clinical manifestations, radiological findings and treatment options according to the clinical form (induction therapy and maintenance therapy), as well as different diagnosis tools and new laboratory tests that have been recently developed and validated and are becoming widely available. These should have an impact in reducing time for diagnosis and starting therapy and in reducing morbidity and mortality, especially in patients with HIV infection, where histoplasmosis is currently estimated to be responsible for 5-15% of AIDS-related deaths.
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Affiliation(s)
- Angela María Tobón
- Instituto Colombiano de Medicina Tropical, Universidad CES, Medellín, Colombia
| | - Beatriz L Gómez
- Translational Microbiology and Emerging Diseases (MICROS), School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia.
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Falci DR, Dalla Lana DF, Pasqualotto AC. The era of histoplasmosis in Brazilian endemic mycoses. LANCET REGIONAL HEALTH. AMERICAS 2021; 3:100037. [PMID: 36777401 PMCID: PMC9903817 DOI: 10.1016/j.lana.2021.100037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 07/28/2021] [Accepted: 08/01/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Diego R. Falci
- Pontificia Universidade Catolica do Rio Grande do Sul, Porto Alegre, Brazil,Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil
| | | | - Alessandro C. Pasqualotto
- Universidade Federal de Ciencias da Saude de Porto Alegre, Porto Alegre, Brazil,Santa Casa de Misericordia de Porto Alegre, Porto Alegre, Brazil,Corresponding author: Prof. Alessandro C. Pasqualotto. Molecular Biology Laboratory, Santa Casa de Misericórdia de Porto Alegre. Av. Independência 155, Hospital Dom Vicente Scherer, Heliponto. Porto Alegre, RS, Brazil. 90035075.
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Benedict K, Kobayashi M, Garg S, Chiller T, Jackson BR. Symptoms in blastomycosis, coccidioidomycosis, and histoplasmosis versus other respiratory illnesses in commercially insured adult outpatients, United States, 2016-2017. Clin Infect Dis 2020; 73:e4336-e4344. [PMID: 33053180 DOI: 10.1093/cid/ciaa1554] [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: 08/10/2020] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Blastomycosis, coccidioidomycosis, and histoplasmosis cause various symptoms and syndromes, which may present similarly to other infections such as bacterial or viral community-acquired pneumonia, influenza, and tuberculosis. METHODS We used the IBM® MarketScan® Research Databases to identify adult outpatients with International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) diagnosis codes during 2016-2017 for blastomycosis; coccidioidomycosis; histoplasmosis; pneumonia (viral, bacterial, Streptococcus pneumoniae, and unspecified pneumonia); influenza; tuberculosis; and other lower and upper respiratory infections. We compared symptoms on and in the 90 days before diagnosis between patients with these diagnosis codes. RESULTS Fever was less common in blastomycosis (2.6%), histoplasmosis (5.3%) and coccidioidomycosis (9.4%) than in influenza (18.5%) or pneumonia (12.6%-16.3%) patients. Fungal diseases resembled bacterial, viral, and unspecified pneumonias for many pulmonary symptoms. However, cough was more common with coccidioidomycosis (31.4%) and less common with histoplasmosis (14.0%) and blastomycosis (13.1%) vs. influenza (20.2%). Although less frequent, solitary pulmonary nodule (5.2%-14.4%), enlarged lymph nodes (3.7%-9.0%), hyperhidrosis (<2%), and erythema nodosum (<2%) were particularly suggestive of fungal diseases. CONCLUSIONS Despite limitations inherent in administrative coding, this analysis of symptom codes across disease types suggests that fungal diseases may be difficult to clinically distinguish from other causes of pneumonia except when certain uncommon symptoms are present. Healthcare providers caring for patients with pneumonia, especially if non-responsive to conventional treatment, should consider fungal diseases as possible etiologies.
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Affiliation(s)
- Kaitlin Benedict
- National Center for Emerging and Zoonotic Infectious Diseases, Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Miwako Kobayashi
- National Center for Immunization and Respiratory Diseases, Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Shikha Garg
- National Center for Immunization and Respiratory Diseases, Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Tom Chiller
- National Center for Emerging and Zoonotic Infectious Diseases, Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Brendan R Jackson
- National Center for Emerging and Zoonotic Infectious Diseases, Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Ramos-E-Silva M, Secchin P, Trope B. The life-threatening eruption in HIV and immunosuppression. Clin Dermatol 2019; 38:52-62. [PMID: 32197749 DOI: 10.1016/j.clindermatol.2019.10.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Immunosuppressed patients frequently have skin diseases of mild to moderate intensity. Diagnosis as well as treatment should be performed early to avoid important complications for these patients. Skin eruptions are among these problems. Life-threatening eruptions in HIV and other types of immunosuppression range from acute retroviral syndrome to drug eruptions; immune reconstitution inflammatory syndrome; infection by virus, protozoan, bacteria, or fungi; inflammatory and immune dermatoses; and neoplasia. All of these are discussed in this group of patients.
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Affiliation(s)
- Marcia Ramos-E-Silva
- The Sector of Dermatology and Post-Graduation Course in Dermatology, University Hospital and School of Medicine, Federal University of Rio de Janeiro, Brazil.
| | - Pedro Secchin
- The Sector of Dermatology and Post-Graduation Course in Dermatology, University Hospital and School of Medicine, Federal University of Rio de Janeiro, Brazil
| | - Beatriz Trope
- The Sector of Dermatology and Post-Graduation Course in Dermatology, University Hospital and School of Medicine, Federal University of Rio de Janeiro, Brazil
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Carreto-Binaghi LE, Morales-Villarreal FR, García-de la Torre G, Vite-Garín T, Ramirez JA, Aliouat EM, Martínez-Orozco JA, Taylor ML. Histoplasma capsulatum and Pneumocystis jirovecii coinfection in hospitalized HIV and non-HIV patients from a tertiary care hospital in Mexico. Int J Infect Dis 2019; 86:65-72. [PMID: 31207386 DOI: 10.1016/j.ijid.2019.06.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 06/10/2019] [Accepted: 06/11/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Histoplasma capsulatum and Pneumocystis jirovecii are respiratory fungal pathogens that principally cause pulmonary disease. Coinfection with both pathogens is scarcely reported. This study detected this coinfection using specific molecular methods for each fungus in the bronchoalveolar lavage (BAL) of patients from a tertiary care hospital. MATERIALS AND METHODS BAL samples from 289 hospitalized patients were screened by PCR with specific markers for H. capsulatum (Hcp100) and P. jirovecii (mtLSUrRNA and mtSSUrRNA). The presence of these pathogens was confirmed by the generated sequences for each marker. The clinical and laboratory data for the patients were analyzed using statistical software. RESULTS The PCR findings separated three groups of patients, where the first was represented by 60 (20.8%) histoplasmosis patients, the second by 45 (15.6%) patients with pneumocystosis, and the last group by 12 (4.2%) patients with coinfection. High similarity among the generated sequences of each species was demonstrated by BLASTn and neighbor-joining algorithms. The estimated prevalence of H. capsulatum and P. jirovecii coinfection was higher in HIV patients.
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Affiliation(s)
- Laura E Carreto-Binaghi
- Laboratorio de Inmunología de Hongos, Unidad de Micología, Departamento de Microbiología-Parasitología, Facultad de Medicina, Universidad Nacional Autónoma de México (UNAM), CDMX, 04510, Mexico; Departamento de Investigación en Microbiología, Instituto Nacional de Enfermedades Respiratorias "Ismael Cosío Villegas" (INER), CDMX, 14080, Mexico.
| | | | | | - Tania Vite-Garín
- Laboratorio de Inmunología de Hongos, Unidad de Micología, Departamento de Microbiología-Parasitología, Facultad de Medicina, Universidad Nacional Autónoma de México (UNAM), CDMX, 04510, Mexico.
| | - Jose-Antonio Ramirez
- Laboratorio de Inmunología de Hongos, Unidad de Micología, Departamento de Microbiología-Parasitología, Facultad de Medicina, Universidad Nacional Autónoma de México (UNAM), CDMX, 04510, Mexico.
| | - El-Moukhtar Aliouat
- Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, U1019 - UMR 8204 - CIIL - Centre d'Infection et d'Immunité de Lille, Lille, France.
| | | | - Maria-Lucia Taylor
- Laboratorio de Inmunología de Hongos, Unidad de Micología, Departamento de Microbiología-Parasitología, Facultad de Medicina, Universidad Nacional Autónoma de México (UNAM), CDMX, 04510, Mexico.
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10
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Leitão TMJS, Oliveira Filho AMP, Sousa Filho JEP, Tavares BM, Mesquita JRL, Farias LABG, Mota RS, Nacher M, Damasceno LS. Accuracy of Buffy Coat in the Diagnosis of Disseminated Histoplasmosis in AIDS-Patients in an Endemic Area of Brazil. J Fungi (Basel) 2019; 5:E47. [PMID: 31181847 PMCID: PMC6616638 DOI: 10.3390/jof5020047] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 05/28/2019] [Accepted: 05/31/2019] [Indexed: 12/24/2022] Open
Abstract
The buffy coat is obtained routinely for disseminated histoplamosis (DH) diagnosis in Ceará, Brazil. The aim of this study is to describe the accuracy of staining smears for Histoplasma in the buffy coat of AIDS-patients with DH. From 2012-2013, all results of stained buffy coat smears and culture for fungi performed at São José Hospital were recorded. In total, 489 buffy coats of 361 patients were studied; 19/361 (5.3%; 95%CI = 2.9-7.6%) had positive direct examination stained smears for Histoplasma and 61/361 (16.9%; 95%CI = 13.0-20.8%) had growth in culture. For those with positive Histoplasma cultures, the CD4 count was significantly lower (139.3 vs. 191.7cells/µL; p = 0.014) than others, and death was 18%. The sensitivity and specificity of stained smears was 25.9% and 100%, respectively. A second test, performed up to 36 days from the first one, increased the sensitivity of stained smears to 32.2%. Stained smears of buffy coat have low accuracy; nonetheless, they are easy to perform and can give a quick diagnosis in low-resource endemic areas. Despite the decrease in mortality, it is not yet to the low levels observed in areas that have better and more efficient methods.
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Affiliation(s)
- Terezinha M J Silva Leitão
- Departamento de Saúde Comunitária, Faculdade de Medicina, Universidade Federal do Ceará, Rodolfo Téofilo, Fortaleza, Ceará 60430-160, Brasil.
- Hospital São José de Doenças Infecciosas, Parquelândia, Fortaleza, Ceará 60455-610, Brasil.
| | - Antonio M P Oliveira Filho
- Departamento de Saúde Comunitária, Faculdade de Medicina, Universidade Federal do Ceará, Rodolfo Téofilo, Fortaleza, Ceará 60430-160, Brasil.
| | - José Evaldo P Sousa Filho
- Departamento de Saúde Comunitária, Faculdade de Medicina, Universidade Federal do Ceará, Rodolfo Téofilo, Fortaleza, Ceará 60430-160, Brasil.
| | - Bruno M Tavares
- Hospital São José de Doenças Infecciosas, Parquelândia, Fortaleza, Ceará 60455-610, Brasil.
| | - Jacó R L Mesquita
- Hospital São José de Doenças Infecciosas, Parquelândia, Fortaleza, Ceará 60455-610, Brasil.
| | - Luís Arthur B G Farias
- Departamento de Saúde Comunitária, Faculdade de Medicina, Universidade Federal do Ceará, Rodolfo Téofilo, Fortaleza, Ceará 60430-160, Brasil.
| | - Rosa S Mota
- Departamento de Saúde Comunitária, Faculdade de Medicina, Universidade Federal do Ceará, Rodolfo Téofilo, Fortaleza, Ceará 60430-160, Brasil.
| | - Mathieu Nacher
- Centre d'Investigation Clinique 1424 Antilles-Guyane, Inserm, Centre Hospitalier de Cayenne, 97 300 Cayenne, France.
| | - Lisandra S Damasceno
- Hospital São José de Doenças Infecciosas, Parquelândia, Fortaleza, Ceará 60455-610, Brasil.
- Faculdade de Medicina, Centro Universitário Unichristus, Cocó, Fortaleza, Ceará 60190-060, Brasil.
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Falci DR, Monteiro AA, Braz Caurio CF, Magalhães TCO, Xavier MO, Basso RP, Melo M, Schwarzbold AV, Ferreira PRA, Vidal JE, Marochi JP, Godoy CSDM, Soares RDBA, Paste A, Bay MB, Pereira-Chiccola VL, Damasceno LS, Leitão TDMJS, Pasqualotto AC. Histoplasmosis, An Underdiagnosed Disease Affecting People Living With HIV/AIDS in Brazil: Results of a Multicenter Prospective Cohort Study Using Both Classical Mycology Tests and Histoplasma Urine Antigen Detection. Open Forum Infect Dis 2019; 6:ofz073. [PMID: 30997365 PMCID: PMC6461557 DOI: 10.1093/ofid/ofz073] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 02/12/2019] [Indexed: 02/01/2023] Open
Abstract
Background Histoplasmosis is highly endemic in the American continent. This condition is associated with a high mortality, particularly in people living with HIV/AIDS (PLWHA). Diagnosis of histoplasmosis is usually late in South America, as Histoplasma antigen detection is rarely available. Here we determined the prevalence, risk factors, and outcome of histoplasmosis in PLWHA in Brazilian hospitals. Methods This was a prospective cohort study (2016-2018) involving 14 tertiary medical centers in Brazil. We included hospitalized PLWHA presenting with fever and additional clinical findings. Patients were investigated at each participant center with classical mycology methods. Also, Histoplasma antigen detection was performed in urine samples (IMMY). Probable/proven histoplasmosis was defined according to European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group/National Institute of Allergy and Infectious Diseases Mycoses Study Group criteria. Results From 616 eligible patients, 570 were included. Histoplasmosis was identified in 21.6% (123/570) of patients. Urine antigen testing increased the diagnostic yield in 53.8%, in comparison with standard mycology methods. Variables independently associated with histoplasmosis were CD4+ count <50 cells/mm3, use of an antiretroviral (protective effect), and sample collection in the Northeast region of Brazil. Dyspnea at presentation was independently associated with death. Histoplasmosis was more frequent than tuberculosis in patients with low CD4+ counts. Overall 30-day mortality was 22.1%, decreasing to 14.3% in patients with antigen-based diagnosis. Conclusions Histoplasmosis is a very frequent condition affecting PLWHA in Brazil, particularly when CD4+ counts are lower than 50 cells/mm3. Antigen detection may detect earlier disease, with a probable impact on outcomes. Access to this diagnostic tool is needed to improve clinical management of PLWHA in endemic countries.
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Affiliation(s)
- Diego R Falci
- Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil
- Universidade La Salle, Canoas, Brazil
| | | | - Cassia Ferreira Braz Caurio
- Universidade Federal de Ciencias da Saude de Porto Alegre, Porto Alegre, Brazil
- Santa Casa de Misericordia de Porto Alegre, Porto Alegre, Brazil
| | | | - Melissa O Xavier
- Hospital Universitario da Universidade Federal do Rio Grande, Rio Grande, Brazil
| | - Rossana P Basso
- Hospital Universitario da Universidade Federal do Rio Grande, Rio Grande, Brazil
| | | | | | | | | | | | | | | | | | - Monica B Bay
- Universidade Federal do Rio Grande do Norte, Natal, Brazil
| | | | | | | | - Alessandro C Pasqualotto
- Universidade Federal de Ciencias da Saude de Porto Alegre, Porto Alegre, Brazil
- Santa Casa de Misericordia de Porto Alegre, Porto Alegre, Brazil
- Correspondence: A. C. Pasqualotto, MD, PhD, MBA, FECMM, Molecular Biology Laboratory at Santa Casa de Misericordia de Porto Alegre, Av Independencia 155, Hospital Dom Vicente Scherer, Heliponto, 90035-075, Porto Alegre, Brazil ()
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