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Colović N, Ljubičić J, Kostić D, Barać A, Jurišić V. Disseminated cerebral cryptococcosis after silent West Nile virus infection in a patient with polycythemia vera: A case report and review of the literature. SAGE Open Med Case Rep 2024; 12:2050313X241262145. [PMID: 38895656 PMCID: PMC11185029 DOI: 10.1177/2050313x241262145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 05/29/2024] [Indexed: 06/21/2024] Open
Abstract
Although disseminated cryptococcosis can occur occasionally, it is most commonly seen in immunodeficient patients. In 2005, a 43-year-old man was diagnosed with polycythemia vera. Following in 2018, he experienced an unknown-cause fever and headache. To establish the source of the symptoms, a magnetic resonance imaging scan of the brain was performed, which indicated meningeal and gyral-leptomeningeal thickening and several localized T2 hyperintense lesions measuring up to 10 × 14 mm in diameter. Cryptococcus neoformans was then cultivated from cerebrospinal fluid. Serum IgM antibodies against West Nile Virus were positive. After 8 weeks of treatment with amphotericin B and fluconazole, the overall condition improved, and the cerebrospinal fluid control culture became negative. The symptoms returned shortly after discontinuing antifungal therapy, necessitating the reintroduction of fluconazole. Currently, the patient is stable and responding positively to ruxolitinib. Here, it is demonstrated how a patient with polycythemia vera due to immunological weakness might develop disseminated cryptococcosis of the brain after West Nile virus infection.
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Affiliation(s)
- Nataša Colović
- Faculty of Medicine, University of Belgrade, Beograd, Serbia
- Clinic for Hematology, University Clinical Center of Serbia, Belgrade, Serbia
| | - Jelena Ljubičić
- General Hospital Kraljevo, Service of Hematology, Kraljevo, Serbia
| | - Dejan Kostić
- Institute of Radiology, Military Medical Academy, Belgrade, Serbia
- Faculty of Medicine of the Military Medical Academy, University of Defense, Belgrade, Serbia
| | - Aleksandra Barać
- Faculty of Medicine, University of Belgrade, Beograd, Serbia
- Clinic for Infectious and Tropical Diseases, University Clinical Center of Serbia, Belgrade, Serbia
| | - Vladimir Jurišić
- University of Kragujevac, Faculty of Medical Sciences, Kragujevac, Serbia
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Castellanos Reynosa ME, Caal ME, Mercado D, Medina N, Pérez JC, Emeto TI, Arathoon E. Clinical characteristics, diagnosis, treatment and outcomes of patients living with HIV and co-infected with tuberculosis and histoplasmosis: a 5-y retrospective case series. Trans R Soc Trop Med Hyg 2024; 118:391-398. [PMID: 38279781 PMCID: PMC11149374 DOI: 10.1093/trstmh/trad104] [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: 10/02/2023] [Revised: 12/18/2023] [Accepted: 01/01/2024] [Indexed: 01/28/2024] Open
Abstract
BACKGROUND In Latin America, tuberculosis (TB) and histoplasmosis are two of the most frequent opportunistic infections affecting people living with human immunodeficiency virus (HIV). However, there are limited data on the clinical characteristics and outcomes of patients with concurrent TB and histoplasmosis infections. METHODS This was a retrospective observational study to describe the clinical, epidemiological and laboratory characteristics and outcomes of 21 patients living with HIV (PLHIV) who were diagnosed with concurrent histoplasmosis and TB between 2017 and 2021 in Guatemala City, Guatemala. RESULTS Most patients were male and were newly diagnosed with HIV. All patients had advanced HIV disease (AHD). They presented with a median CD4 count of 20 cells/µl. The most common symptoms reported by the patients were fever, weight loss, cough and diarrhoea. Twelve patients died within 6 months of baseline evaluation, for a mortality rate of 57.1%. CONCLUSIONS PLHIV with concurrent TB and histoplasmosis infections are characterised by AHD, predominantly presenting with disseminated forms of these infections and with unspecific symptoms and signs. This evidence calls for early HIV and opportunistic infection screening and insights into the challenges and opportunities for the efficient diagnostic and therapeutic management of patients with AHD with concurrent histoplasmosis and TB infections.
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Affiliation(s)
- María Eugenia Castellanos Reynosa
- Public Health and Tropical Medicine, College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
| | | | - Danicela Mercado
- Clínica Familiar Luis Ángel García, Hospital General San Juan de Dios, Guatemala City, Guatemala
| | - Narda Medina
- Asociación de Salud Integral, Guatemala City, Guatemala
| | | | - Theophilus I Emeto
- Public Health and Tropical Medicine, College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
| | - Eduardo Arathoon
- Asociación de Salud Integral, Guatemala City, Guatemala
- Clínica Familiar Luis Ángel García, Hospital General San Juan de Dios, Guatemala City, Guatemala
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Aguilar G, Lopez G, Sued O, Medina N, Caceres DH, Pereira J, Jordan A, Lezcano V, Vicenti C, Benitez G, Samudio T, Perez F. Implementation of a rapid diagnostic assay package for cryptococcosis, histoplasmosis and tuberculosis in people living with HIV in Paraguay. BMC Infect Dis 2024; 24:406. [PMID: 38627642 PMCID: PMC11020460 DOI: 10.1186/s12879-024-09257-5] [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: 02/08/2024] [Accepted: 03/26/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Opportunistic infections (OIs) are common causes of mortality among people living with HIV (PLHIV). We determined prevalence and 30-day mortality due to histoplasmosis, cryptococcosis, and TB in PLHIV with advanced HIV disease (AHD). METHODS PLHIV 18 years and older, with a CD4 + T-cell count of less than 350 cells/mm3 newly diagnosed with HIV infection or re-engaged in care after being without ART for more than 90 days (Group A). The second group included symptomatic PLHIV regardless of ART status or CD4 + T-cell count (Group B); all followed for 30 days. Detection of Histoplasma Ag (HisAg) in urine was done by enzyme immunoassay (EIA), Cryptococcus antigen (CrAg) was detected in serum and cerebrospinal fluid (CSF) specimens by lateral flow assay (LFA), and lipoarabinomannan (LAM) detection in urine was by LFA (TB LAM) and in sputum by GeneXpert for diagnosis of Mycobacterium infections. RESULTS From August 2021 to June 2022, 491 PLHIV were enrolled; 482 (98%) had a CD4 + T-cell result, and 381 patients (79%) were classified with AHD according to CD4 + T-cell count (< 200 CD4/mm3). Frequency of an OI was 38% (n = 145/381). Antigen test positivity rate was 16% (72/467) for TB-LAM, 9% (43/464) for HisAg, and 11% (51/484) for CrAg. Twenty-one of 34 (62%) patients receiving CSF CrAg tests were positive, confirming meningitis. Significant differences in 30-day mortality were observed in patients with an OI (16%) vs. no OI (7%) (p = 0.002). Mortality was highest in patients with histoplasmosis (25%), co-infection (22%), cryptococcosis (18% overall; 19% for cryptococcal meningitis), and TB (10%). CONCLUSIONS TB and fungal OIs, including co-infection, were common in PLHIV in Paraguay and had high associated mortality. Laboratories and health facilities need access to CD4 + T-cell testing and rapid diagnostic assays.
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Affiliation(s)
- Gloria Aguilar
- National HIV Program, Asunción, Paraguay
- Facultad de Ciencias de la Salud, Universidad Sudamericana, Amambay, Paraguay
| | | | - Omar Sued
- Communicable Diseases Prevention, Control, and Elimination and Environmental Determinants of Health Department, Pan American Health Organization, 525 23rd St. NW, 20037, Washington, DC, USA
| | - Narda Medina
- Mycotic Diseases Branch, Division of Foodborne, Waterborne, and Environmental Diseases (DFWED), ASRT, Inc., Centers for Disease Control and Prevention, 30333, Atlanta, GA, USA
| | - Diego H Caceres
- IMMY, Inc., 73069, Norman, OK, USA
- Studies in Translational Microbiology and Emerging Diseases (MICROS) Research Group, School of Medicine and Health Sciences, Universidad del Rosario, Bogota, Colombia
| | - Jose Pereira
- Centro de Especialidades Dermatológicas, Ministerio de Salud Pública y Bienestar Social, San Lorenzo, Paraguay
| | - Alexander Jordan
- Mycotic Diseases Branch-Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | | | | | | | | | - Freddy Perez
- Communicable Diseases Prevention, Control, and Elimination and Environmental Determinants of Health Department, Pan American Health Organization, 525 23rd St. NW, 20037, Washington, DC, USA.
- Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil.
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Laboccetta CR, Toscanini MA, Garrido AV, Posse GB, Capece P, Valdez RM, Chacón YA, Maglio DG, Nusblat AD, Cuestas ML. Evaluation of the Histoplasma capsulatum 100-kilodalton antigen dot blot for the rapid diagnosis of progressive histoplasmosis in HIV/AIDS patients. Diagn Microbiol Infect Dis 2023; 107:116060. [PMID: 37738785 DOI: 10.1016/j.diagmicrobio.2023.116060] [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: 05/29/2023] [Revised: 08/07/2023] [Accepted: 08/11/2023] [Indexed: 09/24/2023]
Abstract
Among people living with HIV (PLHIV), progressive disseminated histoplasmosis (PDH) represents an important cause of mortality. Since antigen detection allows a rapid diagnosis and the instauration of a specific treatment this study aimed to evaluate the analytical performance of the Hcp100 dot blot, an in-house assay that detects the Histoplasma capsulatum 100-kilodalton antigen in urine and compare it with 2 commercially available assays the Histoplasma Urine Antigen Lateral Flow Assay (MVD-LFA) (MiraVista® Diagnostics) and the Clarus Histoplasma Galactomannan EIA (Clarus HGM) (IMMY). Urine specimens from 23 PLHIV with PDH, 13 patients with other infectious diseases, and 20 healthy individuals were tested. The Hcp100 dot blot showed higher sensitivity (87.0%), specificity (97.0%) and accuracy (92.9%) than the MVD-LFA (73.9%, 78.8%, and 76.8%, respectively) and the Clarus HGM (78.3%, 90.9%, and 85.7%, respectively). The Hcp100 dot blot had high analytical performance and would be a valuable screening tool for diagnosing PDH among PLHIV.
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Affiliation(s)
- Carolina Rodríguez Laboccetta
- Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica, Instituto de Nanobiotecnología (NANOBIOTEC), Buenos Aires, Argentina; Universidad de Buenos Aires, CONICET, Instituto de Investigaciones en Microbiología y Parasitología Médica (IMPaM), Buenos Aires, Argentina
| | - María A Toscanini
- Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica, Instituto de Nanobiotecnología (NANOBIOTEC), Buenos Aires, Argentina; Universidad de Buenos Aires, CONICET, Instituto de Investigaciones en Microbiología y Parasitología Médica (IMPaM), Buenos Aires, Argentina
| | - Agustín Videla Garrido
- Universidad de Buenos Aires, CONICET, Instituto de Investigaciones en Microbiología y Parasitología Médica (IMPaM), Buenos Aires, Argentina
| | - Gladys B Posse
- Laboratorio de Micología, Hospital Nacional Profesor Alejandro Posadas, Buenos Aires, Argentina
| | - Paula Capece
- Laboratorio de Micología, Hospital Nacional Profesor Alejandro Posadas, Buenos Aires, Argentina
| | - Ruth M Valdez
- Laboratorio de Micología, Hospital Señor del Milagro de Salta, Salta, Argentina
| | - Yone A Chacón
- Laboratorio de Micología, Hospital Señor del Milagro de Salta, Salta, Argentina
| | - Daniel González Maglio
- Facultad de Farmacia y Bioquímica, Cátedra de Inmunología, Universidad de Buenos Aires, Buenos Aires, Argentina; Instituto de Estudios de la Inmunidad Humoral (IDEHU), CONICET-Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Alejandro D Nusblat
- Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica, Instituto de Nanobiotecnología (NANOBIOTEC), Buenos Aires, Argentina
| | - María L Cuestas
- Universidad de Buenos Aires, CONICET, Instituto de Investigaciones en Microbiología y Parasitología Médica (IMPaM), Buenos Aires, Argentina.
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Smith DJ, Gold JAW, Benedict K, Wu K, Lyman M, Jordan A, Medina N, Lockhart SR, Sexton DJ, Chow NA, Jackson BR, Litvintseva AP, Toda M, Chiller T. Public Health Research Priorities for Fungal Diseases: A Multidisciplinary Approach to Save Lives. J Fungi (Basel) 2023; 9:820. [PMID: 37623591 PMCID: PMC10455901 DOI: 10.3390/jof9080820] [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: 07/07/2023] [Revised: 07/31/2023] [Accepted: 08/01/2023] [Indexed: 08/26/2023] Open
Abstract
Fungal infections can cause severe disease and death and impose a substantial economic burden on healthcare systems. Public health research requires a multidisciplinary approach and is essential to help save lives and prevent disability from fungal diseases. In this manuscript, we outline the main public health research priorities for fungal diseases, including the measurement of the fungal disease burden and distribution and the need for improved diagnostics, therapeutics, and vaccines. Characterizing the public health, economic, health system, and individual burden caused by fungal diseases can provide critical insights to promote better prevention and treatment. The development and validation of fungal diagnostic tests that are rapid, accurate, and cost-effective can improve testing practices. Understanding best practices for antifungal prophylaxis can optimize prevention in at-risk populations, while research on antifungal resistance can improve patient outcomes. Investment in vaccines may eliminate certain fungal diseases or lower incidence and mortality. Public health research priorities and approaches may vary by fungal pathogen.
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Affiliation(s)
- Dallas J. Smith
- Mycotic Diseases Branch, Division of Foodborne, Waterborne and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA; (J.A.W.G.); (K.B.); (K.W.); (M.L.); (A.J.); (N.M.); (S.R.L.); (D.J.S.); (N.A.C.); (B.R.J.); (A.P.L.); (M.T.)
| | | | | | | | | | | | | | | | | | | | | | | | | | - Tom Chiller
- Mycotic Diseases Branch, Division of Foodborne, Waterborne and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA; (J.A.W.G.); (K.B.); (K.W.); (M.L.); (A.J.); (N.M.); (S.R.L.); (D.J.S.); (N.A.C.); (B.R.J.); (A.P.L.); (M.T.)
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Cáceres DH, Gómez BL, Tobón ÁM, Restrepo Á, Chiller T, Lindsley MD, Meis JF, Verweij PE. Tackling Histoplasmosis Infection in People Living with HIV from Latin America: From Diagnostic Strategy to Public Health Solutions. J Fungi (Basel) 2023; 9:jof9050558. [PMID: 37233269 DOI: 10.3390/jof9050558] [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: 04/09/2023] [Revised: 05/04/2023] [Accepted: 05/05/2023] [Indexed: 05/27/2023] Open
Abstract
Histoplasmosis, caused by the thermally dimorphic fungus Histoplasma spp., is a disease with a broad clinical spectrum, presenting from asymptomatic/flu-like symptoms to progressive disseminated disease in people with immunosuppression. In recent years, the concept of histoplasmosis as a disease restricted to the American continent has changed, as now histoplasmosis is reported in many regions around the world. In Latin America, histoplasmosis represents a threat, especially in people with advanced HIV disease (AHD). Diagnosis of histoplasmosis in people living with HIV (PLHIV) is challenging due to the low index of suspicion of the disease, non-specificity of signs and symptoms, and limited access to specific laboratory testing, while the diagnostic delay is significantly associated with mortality. In the last decade, novel diagnostic tests have been developed for the rapid detection of histoplasmosis, such as commercial kits for antigen detection. Furthermore, advocacy groups were created that presented histoplasmosis as a public health problem, with emphasis on patients at risk of progressive disseminated disease. This review aims to discuss the impact of histoplasmosis associated with AHD in Latin America and the strategies employed to tackle histoplasmosis, from the implementation of laboratory testing to disease advocacy and public health interventions.
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Affiliation(s)
- Diego H Cáceres
- Center of Expertise in Mycology Radboudumc/Canisius Wilhelmina Hospital, 6532 SZ Nijmegen, The Netherlands
- Studies in Translational Microbiology and Emerging Diseases (MICROS) Research Group, School of Medicine and Health Sciences, Universidad del Rosario, Bogota 111221, Colombia
- IMMY, Norman, OK 73069, USA
| | - Beatriz L Gómez
- Studies in Translational Microbiology and Emerging Diseases (MICROS) Research Group, School of Medicine and Health Sciences, Universidad del Rosario, Bogota 111221, Colombia
| | - Ángela M Tobón
- Instituto Colombiano de Medicina Tropical, Universidad CES, Medellín 055450, Colombia
| | - Ángela Restrepo
- COLCIENCIAS Emeritus Researcher, Ministerio de Ciencias, Tecnología e Innovación, Bogota 111321, Colombia
| | - Tom Chiller
- Mycotic Diseases Branch, Centers for Disease Control and Prevention (CDC), Atlanta, GA 30329, USA
| | - Mark D Lindsley
- Mycotic Diseases Branch, Centers for Disease Control and Prevention (CDC), Atlanta, GA 30329, USA
| | - Jacques F Meis
- Center of Expertise in Mycology Radboudumc/Canisius Wilhelmina Hospital, 6532 SZ Nijmegen, The Netherlands
- Department I of Internal Medicine, Excellence Center for Medical Mycology, University Hospital Cologne, 50931 Cologne, Germany
| | - Paul E Verweij
- Center of Expertise in Mycology Radboudumc/Canisius Wilhelmina Hospital, 6532 SZ Nijmegen, The Netherlands
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Izco S, Garcia-Basteiro AL, Denning DW, Boulware DR, Penn-Nicholson A, Letang E. Management of advanced HIV disease in Africa. Lancet HIV 2023:S2352-3018(23)00078-4. [PMID: 37105215 DOI: 10.1016/s2352-3018(23)00078-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 03/25/2023] [Accepted: 03/29/2023] [Indexed: 04/29/2023]
Affiliation(s)
- Santiago Izco
- National Program of STD/HIV/AIDS, Tuberculosis and Viral Hepatitis, Ministry of Health and Social Welfare, Malabo 399, Equatorial Guinea.
| | - Alberto L Garcia-Basteiro
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique; Barcelona Institute for Global Health, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain; Biomédica en Red de Enfermedades Infecciosas, Barcelona, Spain
| | | | - David R Boulware
- Department of Medicine, University of Minnesota Microbiology Research Facility, Minneapolis, MN, USA
| | | | - Emilio Letang
- Universitat de Barcelona, Faculty of Medicine, Barcelona, Spain
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Lakoh S, Kamudumuli PS, Penney ROS, Haumba SM, Jarvis JN, Hassan AJ, Moudoute NLE, Ocansey BK, Izco S, Kipkerich S, Sacarlal J, Awopeju AT, Govender NP, Munyanji CIM, Guyguy K, Orefuwa E, Denning DW. Diagnostic capacity for invasive fungal infections in advanced HIV disease in Africa: a continent-wide survey. THE LANCET. INFECTIOUS DISEASES 2022; 23:598-608. [PMID: 36565714 DOI: 10.1016/s1473-3099(22)00656-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 09/26/2022] [Accepted: 09/26/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Fungal infections are common causes of death and morbidity in those with advanced HIV infection. Data on access to diagnostic tests in Africa are scarce. We aimed to evaluate the diagnostic capacity for invasive fungal infections in advanced HIV disease in Africa. METHODS We did a continent-wide survey by collecting data from 48 of 49 target countries across Africa with a population of more than 1 million; for Lesotho, only information on the provision of cryptococcal antigen testing was obtained. This survey covered 99·65% of the African population. We did the survey in six stages: first, questionnaire development, adaptation, and improvement; second, questionnaire completion by in-country respondents; third, questionnaire review and data analysis followed by video conference calls with respondents; fourth, external validation from public or private sources; fifth, country validation by video conference with senior figures in the Ministry of Health; and sixth, through five regional webinars led by the Africa Centres for Disease Control and Prevention with individual country profiles exchanged by email. Data was compiled and visualised using the Quantum Geographic Information System software and Natural Earth vectors to design maps showing access. FINDINGS Data were collected between Oct 1, 2020, and Oct 31, 2022 in the 48 target countries. We found that cryptococcal antigen testing is frequently accessible to 358·39 million (25·5%) people in 14 African countries. Over 1031·49 million (73·3%) of 1·4 billion African people have access to a lumbar puncture. India ink microscopy is frequently accessible to 471·03 million (33·5%) people in 23 African countries. About 1041·62 million (74·0%) and 1105·11 million (78·5%) people in Africa do not have access to histoplasmosis and Pneumocystis pneumonia diagnostics in either private or public facilities, respectively. Fungal culture is available in 41 countries covering a population of 1·289 billion (94%) people in Africa. MRI is routinely accessible to 453·59 million (32·2%) people in Africa and occasionally to 390·58 million (27·8%) people. There was a moderate correlation between antiretroviral therapy usage and external expenditure on HIV care (R2=0·42) but almost none between external expenditure and AIDS death rate (R2=0·18), when analysed for 40 African countries. INTERPRETATION This survey highlights the enormous challenges in the diagnosis of HIV-associated Pneumocystis pneumonia, cryptococcal disease, histoplasmosis, and other fungal infections in Africa. Urgent political and global health leadership could improve the diagnosis of fungal infections in Africa, reducing avoidable deaths. FUNDING Global Action For Fungal Infections.
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Affiliation(s)
- Sulaiman Lakoh
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | | | | | - Samson M Haumba
- Center for Global Health Practice and Impact, Georgetown University, Mbabane, Eswatini
| | - Joseph N Jarvis
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK; Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | | | | | - Bright K Ocansey
- Department of Medical Microbiology, University of Ghana Medical School, Accra, Ghana; Manchester Fungal Infection Group, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Santiago Izco
- Office of HIV/AIDS, Tuberculosis and Hepatitis, Ministry of Health and Social Welfare, Malabo, Equatorial Guinea
| | - Stephen Kipkerich
- National Public Health Reference Laboratories, Ministry of Health, Nairobi, Kenya
| | - Jahit Sacarlal
- Department of Microbiology, Faculty of Medicine, Universidade Eduardo Mondlane, Maputo, Mozambique
| | - Abimbola T Awopeju
- Department of Medical Microbiology and Parasitology, University of Port Harcourt, Port Harcourt, Nigeria
| | - Nelesh P Govender
- National Institute for Communicable Diseases, a Division of the National Health Laboratory Service, School of Pathology, University of the Witwatersrand, Johannesburg, South Africa; Division of Medical Microbiology, University of Cape Town, Cape Town, 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
| | | | - Kamwiziku Guyguy
- Department of Microbiology, Kinshasa University Hospital, University of Kinshasa, Kinshasa, DR Congo
| | - Emma Orefuwa
- Global Action For Fungal Infections, Geneva, Switzerland
| | - David W Denning
- Global Action For Fungal Infections, Geneva, Switzerland; Manchester Fungal Infection Group, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.
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Diagnostic Mycology Laboratories Should Have a Central Role for the Management of Fungal Disease. J Fungi (Basel) 2022; 8:jof8121285. [PMID: 36547618 PMCID: PMC9787327 DOI: 10.3390/jof8121285] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 12/03/2022] [Accepted: 12/06/2022] [Indexed: 12/13/2022] Open
Abstract
The absence of awareness of fungal diseases as part of the differential diagnosis in at-risk populations has severe consequences. Here, we show how the active role of laboratories can improve patients’ survival. Recently, major advances have been made in non-culture-based assays for fungal diseases, improving accuracy and turnaround time. Furthermore, with the introduction of proficiency control systems, laboratories are an easily monitored environment with good analytical accuracy. Diagnostic packages for opportunistic infections can overcome many deficiencies caused by the absence of awareness. In Guatemala, to make diagnosis accessible, we set up a diagnostic laboratory hub (DLH) providing screening for cryptococcosis, histoplasmosis and tuberculosis to a network of 13 healthcare facilities attending people living with HIV (PLWHIV). In two years, we screened 2127 newly HIV-diagnosed patients. The frequency of opportunistic infections was 21%, rising to 30.3% in patients with advanced HIV disease (<200 CD4); 8.1% of these patients had more than one infection. With the implementation of this diagnostic package, mortality decreased by 7%, a key goal of many public health interventions. Screening for serious infection in high-risk populations can partially overcome training or experiential deficiencies among clinicians for life-threatening fungal diseases.
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Rajasingham R, Govender NP, Jordan A, Loyse A, Shroufi A, Denning DW, Meya DB, Chiller TM, Boulware DR. The global burden of HIV-associated cryptococcal infection in adults in 2020: a modelling analysis. THE LANCET. INFECTIOUS DISEASES 2022; 22:1748-1755. [PMID: 36049486 PMCID: PMC9701154 DOI: 10.1016/s1473-3099(22)00499-6] [Citation(s) in RCA: 199] [Impact Index Per Article: 99.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 06/17/2022] [Accepted: 07/07/2022] [Indexed: 10/15/2022]
Abstract
BACKGROUND Cryptococcal meningitis is the most common cause of meningitis in adults living with HIV in sub-Saharan Africa. The estimates of national, regional, and global burden of cryptococcal meningitis are essential to guide prevention strategies and determine needs for diagnostic tests and treatments. We present a 2020 estimate of the global burden of HIV-associated cryptococcal infection (antigenaemia), cryptococcal meningitis, and cryptococcal-associated deaths. METHODS We defined advanced HIV disease as adults with a CD4 count of less than 200 cells/μL, as this group is at highest risk for cryptococcosis. We used UNAIDS estimates (2019-20) and population-based HIV impact assessment surveys (2016-18) to estimate the number of adults with CD4 counts of less than 200 cells/μL at risk for cryptococcosis, by country and region. Secondly, we summarised cryptococcal antigenaemia prevalence in those with a CD4 count of less than 200 cells/μL by reviewing published literature. Thereafter, we calculated the number of cryptococcal antigen (CrAg)-positive people in each country and region by multiplying the number with advanced HIV disease at risk for cryptococcal infection by the cryptococcal antigenaemia prevalence of the respective country or region. We estimated progression from cryptococcal antigenaemia to meningitis or death based on estimates from the published literature. FINDINGS We estimated that there were 4·3 million (IQR 3·0-4·8) adults with HIV and CD4 counts of less than 200 cells/μL globally in 2020. We calculated a mean global cryptococcal antigenaemia prevalence of 4·4% (95% CI 1·6-7·4) among HIV-positive people with CD4 counts of less than 200 cells/μL, corresponding to 179 000 cases (IQR 133 000-219 000) of cryptococcal antigenaemia globally in 2020. Annually, we estimated that there are 152 000 cases (111 000-185 000) of cryptococcal meningitis, resulting in 112 000 cryptococcal-related deaths (79 000-134 000). Globally, cryptococcal disease accounts for 19% (13-24) of AIDS-related mortality. INTERPRETATION Despite a reduction in the estimated absolute global burden of HIV-associated cryptococcal meningitis compared with 2014, likely to be due to antiretroviral therapy expansion, cryptococcal disease still accounts for 19% of AIDS-related deaths, similar to 2014 estimates. To end cryptococcal meningitis deaths by 2030, cryptococcal diagnostics, meningitis treatments, and implementation of preventive screening are urgently needed. FUNDING None.
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Affiliation(s)
- Radha Rajasingham
- Division of Infectious Diseases and International Medicine, Department of Medicine, University of Minnesota, Minneapolis, MN, USA.
| | - Nelesh P Govender
- National Institute for Communicable Diseases, National Health Laboratory Service and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Alexander Jordan
- Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Angela Loyse
- Centre for Global Health, Institute for Infection and Immunity, St George's University of London, London, UK
| | | | - David W Denning
- Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK; Global Action Fund for Fungal Infections, Geneva, Switzerland
| | - David B Meya
- Division of Infectious Diseases and International Medicine, Department of Medicine, University of Minnesota, Minneapolis, MN, USA; Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Tom M Chiller
- Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - David R Boulware
- Division of Infectious Diseases and International Medicine, Department of Medicine, University of Minnesota, Minneapolis, MN, USA
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11
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Validation of a Lateral Flow Assay for Rapid Diagnosis of Histoplasmosis in Advanced HIV Disease, Buenos Aires, Argentina. Appl Microbiol 2022. [DOI: 10.3390/applmicrobiol2040072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Histoplasmosis is a major cause of mortality in individuals with advanced human immunodeficiency virus (HIV) disease (AHD). We evaluated in patients with AHD a lateral flow assay (LFA) developed by MiraVista® Diagnostics (MVD LFA). Histoplasmosis was defined based on the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG) case definitions. We also compared the results of this LFA with those obtained using a commercial enzyme immunoassay (EIA) developed by IMMY, Clarus Histoplasma GM EIA, IMMY (HGM EIA). A retrospective observational study was conducted at Hospital Juan A. Fernández, located in Buenos Aires, Argentina. The study included 48 urine specimens from patients aged >18 years with AHD. Urine specimens included 17 patients with disseminated histoplasmosis and 31 specimens from patients without evidence of histoplasmosis. Specimens were tested using the MVD LFA and the HGM EIA. The MVD LFA and the HGM EIA had similar analytical performance, with a sensitivity of 94%, specificity of 100%, positive predictive value of 100%, negative predictive value of 97%, and an accuracy of 98%. Comparison of the MVD LFA with the HGM EIA demonstrated a Kappa agreement index of 0.906. The LFA evaluated in this study had high analytical performance; it provided rapid diagnosis of histoplasmosis with minimal requirements for laboratory training, equipment, and laboratory infrastructure.
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12
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Establishing the proportion of severe/moderately severe vs mild cases of progressive disseminated histoplasmosis in patients with HIV. PLoS Negl Trop Dis 2022; 16:e0010856. [DOI: 10.1371/journal.pntd.0010856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 11/16/2022] [Accepted: 09/29/2022] [Indexed: 11/06/2022] Open
Abstract
Background
Progressive disseminated histoplasmosis remains a major but neglected cause of death among patients with advanced HIV. Recently, aiming to reduce avoidable deaths, the Pan American Health Organization issued the first diagnosis and treatment guidelines for HIV-associated histoplasmosis. But what proportion of progressive disseminated histoplasmosis in HIV-infected patients is severe is currently not known. Because this proportion influences treatment needs, we aimed to estimate this in a cohort of 416 patients in French Guiana.
Methods
We used the definition in the recent PAHO/WHO guidelines for severity. We used regression modelling to predict the impact of CD4 count on the proportion of severe cases. In a territory where treatment cost is not a limiting factor and where histoplasmosis is well known, we assumed that clinicians’ initial treatment reflected their perception about the severity of the case and therefore, the needs for different treatments.
Results
Using these definitions, since the beginning, there were 274 (65.9%) severe/moderately severe cases and 142 (34.1%) mild cases. In practice 186 cases were treated with deoxycholate or liposomal amphotericin B (44.7%) and 230 (55.3%) cases treated with itraconazole as first line treatment. The Kappa concordance measure between the guideline definition and the actual treatment given was 0.22. There was a 9% risk difference for death within 30 days of antifungal treatment initiation between severe/moderately severe and mild cases. Over threequarters (77%) of early deaths were attributed to severe/moderately severe cases.
Conclusions
This is the only rigorous estimate of the proportion of severe/moderately severe cases of progressive disseminated histoplasmosis in symptomatic HIV patients on the largest published cohort. These numbers may help defend budget needs for rapid diagnostic tests and liposomal amphotericin B.
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Epidemiology and Mortality of Cryptococcal Disease in Guatemala: Two-Year Results of a Cryptococcal Antigen Screening Program. Microorganisms 2022; 10:microorganisms10071388. [PMID: 35889106 PMCID: PMC9323764 DOI: 10.3390/microorganisms10071388] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 07/01/2022] [Accepted: 07/07/2022] [Indexed: 12/10/2022] Open
Abstract
Cryptococcal disease is an important opportunistic infection among people living with HIV. The cryptococcal antigen (CrAg) can be detected before the clinical onset of meningitis and its screening is recommended. Here, we evaluated CrAg frequency, and describe the epidemiological characteristics and mortality at 180 days in a cohort of HIV patients from Guatemala. A total of 3457 patients were screened with a CrAg lateral flow assay in serum between January 2017 and December 2018. CrAg positivity was 11.5% in patients with ≤100 CD4/mm3, 8.7% in patients with <200 CD4/mm3, and 6.3% in patients with <350 CD4/mm3. In Latin America, we estimated 9.2% CrAg positivity (IC95% 7.9−10.7%) in patients with ≤100 CD4/mm3. Among patients newly diagnosed with HIV, we estimated 4416 incident cases per year in Latin America in those with <200 CD4/mm3 and 5289 in those with <350 CD4/mm3. In addition, we calculated the burden in people not on ARV or without viral suppression and found 28,672 cases. CrAg screening should be considered in patients who have a CD4 cell count < 350 cells/mm3. Cryptococcal meningitis was associated with 30.8% mortality in Guatemala. Global access to diagnosis as well as to liposomal amphotericin B and flucytosine is a priority.
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14
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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: 16] [Impact Index Per Article: 8.0] [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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15
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Pulmonary and Extrapulmonary Manifestations of Fungal Infections Misdiagnosed as Tuberculosis: The Need for Prompt Diagnosis and Management. J Fungi (Basel) 2022; 8:jof8050460. [PMID: 35628715 PMCID: PMC9143176 DOI: 10.3390/jof8050460] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 04/26/2022] [Accepted: 04/27/2022] [Indexed: 01/15/2023] Open
Abstract
Fungal infections commonly present with myriad symptoms that mimic other clinical entities, notable amongst which is tuberculosis. Besides histoplasmosis and chronic pulmonary aspergillosis, which can mimic TB, this review has identified several other fungal infections which also do. A total of 80 individual cases misdiagnosed as TB are highlighted: aspergillosis (n = 18, 22.5%), histoplasmosis (n = 16, 20%), blastomycosis (n = 14, 17.5%), cryptococcosis (n = 11, 13.8%), talaromycosis (n = 7, 8.8%), coccidioidomycosis (n = 5, 6.3%), mucormycosis (n = 4, 5%), sporotrichosis (n = 3, 3.8%), phaeohyphomycosis (n = 1, 1.3%) and chromoblastomycosis (n = 1, 1.3%). Case series from India and Pakistan reported over 100 cases of chronic and allergic bronchopulmonary aspergillosis had received anti-TB therapy before the correct diagnosis was made. Forty-five cases (56.3%) had favorable outcomes, and 25 (33.8%) died, outcome was unclear in the remainder. Seventeen (21.3%) cases were infected with human immunodeficiency virus (HIV). Diagnostic modalities were histopathology (n = 46, 57.5%), culture (n = 42, 52.5%), serology (n = 18, 22.5%), cytology (n = 2, 2.5%), gene sequencing (n = 5, 6.3%) and microscopy (n = 10, 12.5%) including Gram stain, India ink preparation, bone marrow smear and KOH mount. We conclude that the above fungal infections should always be considered or ruled out whenever a patient presents with symptoms suggestive of tuberculosis which is unconfirmed thereby reducing prolonged hospital stay and mortalities associated with a delayed or incorrect diagnosis of fungal infections.
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16
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Agudelo Higuita NI, Varela Bustillo D, Denning DW. Burden of serious fungal infections in Honduras. Mycoses 2022; 65:429-439. [PMID: 35165955 DOI: 10.1111/myc.13432] [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: 01/14/2022] [Accepted: 02/09/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND The burden of serious fungal infections in Honduras is unknown. The diagnosis of fungal diseases relies on almost exclusively on microscopy and culture limiting an accurate estimate of the burden of disease. OBJECTIVES The primary objective of the study was to estimate the burden of serious fungal infections in Honduras using previously described methods. METHODS National and international demographic data on population, HIV, tuberculosis, asthma, COPD and cancer were obtained. A thorough literature search was done for all epidemiological studies and case series of serious fungal diseases. Using these risk populations and whatever incidence and prevalence could be found that was most pertinent to Honduras, a burden estimate was derived. RESULTS The estimated number of serious fungal infection was estimated to be between 178,772 and 179,624 with nearly 2300 cases of these representing opportunistic infections in people living with HIV. The incidence of histoplasmosis and cryptococcosis in people living with HIV is high and estimated to be 4.3 and 4.6 cases per 100,000 population respectively. Approximately 12,247-13,099 cases of aspergillosis and 164,227 of other serious fungal infections were estimated to occur each year. CONCLUSION An accurate estimate of the burden of serious fungal infections in Honduras is unknown but based on our results, likely significant. Serious fungal infections represent an important public health problem in Honduras affecting approximately 1.8% of the population. There is a clear need for better access to diagnostic tools and antifungals to conduct research to better understand the impact of fungal diseases in Honduras.
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Affiliation(s)
- Nelson Iván Agudelo Higuita
- Department of Medicine, Section of Infectious Diseases, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Diana Varela Bustillo
- Department of Medicine, Infectious Diseases Service, Hospital Escuela, Tegucigalpa, Honduras
| | - David W Denning
- Manchester Fungal Infection Group, Core Technology Facility, The University of Manchester and the Manchester Academic Health Science Centre, Manchester, UK
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17
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Medina N, Rodriguez-Tudela JL, Aguirre L, Salazar LR, Gamboa O, Bonilla O, Pérez JC, Arathoon E, Denning DW, Alastruey-Izquierdo A. Incidence of Histoplasmosis in a Cohort of People with HIV: From Estimations to Reality. Microorganisms 2021; 9:microorganisms9122596. [PMID: 34946197 PMCID: PMC8703839 DOI: 10.3390/microorganisms9122596] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 12/06/2021] [Accepted: 12/11/2021] [Indexed: 11/24/2022] Open
Abstract
Among people with HIV, histoplasmosis represents an important cause of mortality. Previous studies provided estimates of the disease incidence. Here, we compared those estimates with the results obtained from a screening program implemented in Guatemala, which included histoplasmosis detection for people with HIV. To compare the results of this program with previous estimations, a literature search was performed and reports concerning histoplasmosis incidence were analyzed. The screening program enrolled 6366 patients. The overall histoplasmosis incidence in the screening program was 7.4%, which was almost double that estimated in previous studies. From 2017 to 2019, the screening program showed an upward trend in histoplasmosis cases from 6.5% to 8.8%. Histoplasmosis overall mortality among those who were newly HIV diagnosed showed a decrease at 180 days from 32.8% in 2017 to 21.2% in 2019. The screening approach using rapid diagnostic assays detects histoplasmosis cases more quickly, allowing a specific treatment to be administered, which decreases the mortality of the disease. Therefore, the use of these new techniques, especially in endemic areas of histoplasmosis, must be implemented.
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Affiliation(s)
- Narda Medina
- Asociación de Salud Integral, Guatemala City 01001, Guatemala; (N.M.); (L.A.); (L.R.S.); (O.G.); (E.A.)
| | | | - Luis Aguirre
- Asociación de Salud Integral, Guatemala City 01001, Guatemala; (N.M.); (L.A.); (L.R.S.); (O.G.); (E.A.)
| | - Luis R. Salazar
- Asociación de Salud Integral, Guatemala City 01001, Guatemala; (N.M.); (L.A.); (L.R.S.); (O.G.); (E.A.)
| | - Osmar Gamboa
- Asociación de Salud Integral, Guatemala City 01001, Guatemala; (N.M.); (L.A.); (L.R.S.); (O.G.); (E.A.)
| | - Oscar Bonilla
- Clínica Familiar “Luis Ángel García”, Hospital General San Juan de Dios, Guatemala City 01001, Guatemala; (O.B.); (J.C.P.)
| | - Juan C. Pérez
- Clínica Familiar “Luis Ángel García”, Hospital General San Juan de Dios, Guatemala City 01001, Guatemala; (O.B.); (J.C.P.)
| | - Eduardo Arathoon
- Asociación de Salud Integral, Guatemala City 01001, Guatemala; (N.M.); (L.A.); (L.R.S.); (O.G.); (E.A.)
- Clínica Familiar “Luis Ángel García”, Hospital General San Juan de Dios, Guatemala City 01001, Guatemala; (O.B.); (J.C.P.)
| | - David W. Denning
- Global Action Fund for Fungal Infections, 01564 Geneva, Switzerland; (J.L.R.-T.); (D.W.D.)
- The National Aspergillosis Centre, University Hospital of South Manchester, Manchester M23 9LT, UK
- Manchester Academic Health Science Centre, School of Medicine, The University of Manchester, Manchester M23 9LT, UK
| | - Ana Alastruey-Izquierdo
- Global Action Fund for Fungal Infections, 01564 Geneva, Switzerland; (J.L.R.-T.); (D.W.D.)
- Mycology Reference Laboratory, National Centre for Microbiology, Instituto de Salud Carlos III, 28222 Madrid, Spain
- Correspondence:
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18
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Edwards RJ, Boyce G, Alastruey-Izquierdo A, Denning DW. Updated estimated incidence and prevalence of serious fungal infections in Trinidad and Tobago. IJID REGIONS 2021; 1:34-40. [PMID: 35757825 PMCID: PMC9216327 DOI: 10.1016/j.ijregi.2021.09.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 09/20/2021] [Accepted: 09/21/2021] [Indexed: 11/05/2022]
Abstract
There is an extensive burden of serious fungal infections in Trinidad and Tobago Serious fungal infections among PLHIV include PCP, histoplasmosis, and cryptococcosis Increased availability of diagnostics and drugs is needed to reduce mortality A national surveillance system for fungal infections should be implemented
Objective : To estimate the incidence and prevalence of serious fungal infections in Trinidad and Tobago (T&T), with a population of 1 394 973 million. Methods : The medical literature was searched to obtain published data on the incidence and prevalence of fungal infections in the Caribbean. If data were unavailable, estimations were performed using the frequencies of fungal infection in populations at risk. Asthma and pulmonary tuberculosis rates were used to derive the prevalence of allergic bronchopulmonary aspergillosis (ABPA), severe asthma with fungal sensitization (SAFS), and chronic pulmonary aspergillosis (CPA). Results : The estimated annual burden of fungal infections was 46 156 persons (3.3% of the population), including 21 455 women with recurrent vulvovaginal candidiasis, 118 persons with invasive aspergillosis, 3637 adults with ABPA, 4800 with SAFS, and 178 with CPA. Annually, we estimated 70 cases of candidemia and 14 647 cases of tinea capitis in children. Of the 11 000 persons living with HIV/AIDS, it was estimated that there were 40 cases of cryptococcal meningitis, 88 cases of disseminated histoplasmosis, and 124 cases of Pneumocystis pneumonia. Conclusion : There seems to be an extensive burden of fungal infections in T&T. Hence, targeted interventions are required to improve clinical and laboratory diagnosis and a national surveillance system should be implemented.
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19
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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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20
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Medina N, Alastruey-Izquierdo A, Bonilla O, Ortíz B, Gamboa O, Salazar LR, Mercado D, Pérez JC, Denning DW, Arathoon E, Rodriguez-Tudela JL. Impact of the COVID-19 pandemic on HIV care in Guatemala. Int J Infect Dis 2021; 108:422-427. [PMID: 34119676 PMCID: PMC8191308 DOI: 10.1016/j.ijid.2021.06.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 06/03/2021] [Accepted: 06/05/2021] [Indexed: 11/29/2022] Open
Abstract
Objectives To describe the impact of the coronavirus disease 2019 (COVID-19) pandemic on the diagnosis of human immunodeficiency virus (HIV) and deaths from opportunistic infections in Guatemala. Methods A retrospective study was conducted to investigate the impact of the COVID-19 pandemic on people with HIV at a referral clinic (Clinica Familiar Luis Angel García, CFLAG), as well as the disruption of services at a diagnostic laboratory hub (DLH) which provides diagnosis for opportunistic infections to a network of 13 HIV healthcare facilities. Comparative analysis was undertaken using the months March–August from two different time periods: (i) pre-COVID-19 (2017–2019); and (ii) during the COVID-19 period (2020). Results During the COVID-19 period, 7360 HIV tests were performed at Clinica Familiar Luis Angel García, compared with an average of 16,218 tests in the pre-COVID-19 period; a reduction of 54.7% [95% confidence interval (CI) 53.8–55.4%],Deaths from opportunistic infections at 90 days were 10.7% higher in 2020 compared with 2019 (27.3% vs 16.6%; P = 0.05). Clinical samples sent to the DLH for diagnosis of opportunistic infections decreased by 43.7% in 2020 (95% CI 41.0–46.2%). Conclusion The COVID-19 pandemic is having a substantial impact on HIV care in Guatemala. Diagnostic services for HIV have been severely affected and deaths from opportunistic infections have increased. The lessons learnt must guide the introduction of strategies to reduce the impact of the pandemic.
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Affiliation(s)
- Narda Medina
- Asociación de Salud Integral, Guatemala, Guatemala; Mycology Reference Laboratory, National Centre for Microbiology, Instituto de Salud Carlos III, Madrid, Spain
| | - Ana Alastruey-Izquierdo
- Mycology Reference Laboratory, National Centre for Microbiology, Instituto de Salud Carlos III, Madrid, Spain
| | - Oscar Bonilla
- Clínica Familiar Luis Ángel García/Hospital General San Juan de Dios, Guatemala, Guatemala
| | - Brenan Ortíz
- Clínica Familiar Luis Ángel García/Hospital General San Juan de Dios, Guatemala, Guatemala
| | - Osmar Gamboa
- Asociación de Salud Integral, Guatemala, Guatemala
| | | | - Danicela Mercado
- Clínica Familiar Luis Ángel García/Hospital General San Juan de Dios, Guatemala, Guatemala
| | - Juan C Pérez
- Clínica Familiar Luis Ángel García/Hospital General San Juan de Dios, Guatemala, Guatemala
| | - David W Denning
- Manchester Fungal Infection Group, The University of Manchester and Manchester Academic Health Science Centre, Manchester, UK; The National Aspergillosis Centre, University Hospital of South Manchester and The University of Manchester, Manchester M23 9LT, UK
| | - Eduardo Arathoon
- Asociación de Salud Integral, Guatemala, Guatemala; Clínica Familiar Luis Ángel García/Hospital General San Juan de Dios, Guatemala, Guatemala
| | - Juan Luis Rodriguez-Tudela
- The National Aspergillosis Centre, University Hospital of South Manchester and The University of Manchester, Manchester M23 9LT, UK.
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21
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Caceres DH, Arauz AB, Flores C, Santiago E, Montoya S, Saenz C, Torres-Meneses FA, Peralta H, Zuniga-Moya JC, Lainez Arteaga IZ, Garcia A, Abdo J, Verweij PE, Chiller TM, Forno D. Implementation of rapid diagnostics assays for detection of histoplasmosis and cryptococcosis in central american people living with HIV. Mycoses 2021; 64:1396-1401. [PMID: 33966300 PMCID: PMC8596515 DOI: 10.1111/myc.13303] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 04/29/2021] [Accepted: 04/30/2021] [Indexed: 01/07/2023]
Abstract
Objectives Histoplasmosis and cryptococcosis are important public health problems in people living with HIV (PLHIV) in Central America. Conventional laboratory assays, based on microscopy and culture, are not optimal for the diagnosis of either disease. However, antigen (Ag) assays are rapid and highly accurate for the diagnosis of these infections. Methods Laboratory surveillance of PLHIV was carried out in four hospitals in Panama, Honduras and Nicaragua, between 2015 and 2019. Detection of Histoplasma antigens in urine was performed by enzyme immunoassay (EIA), and Cryptococcus antigen detection in sera and cerebrospinal fluid specimens was performed by lateral flow assay (LFA). Results A total of 4,453 PLHIV with clinical suspicion of histoplasmosis (n = 1,343) or cryptococcosis (n = 3,110; 2,721 sera and 389 CSF) were tested. Of 1,343 patients suspected of having histoplasmosis, 269 (20%) were Histoplasma Ag positive. Of 3,110 patients tested using the Cryptococcus Ag assay, 329 (11%) were positive. Honduras reported the highest positivity rates (32% for Histoplasma Ag, and 16% for Cryptococcus Ag); Panama reported the largest number of patients testing positive using the Histoplasma Ag assay (n = 201); and Nicaragua reported the largest number of patients testing positive using the Cryptococcus Ag assay (n = 170). Conclusion Here, we show how the implementation of rapid diagnostics assays impacted case detection and was useful for the care of people with advanced HIV. Rapid and accurate diagnosis could reduce mortality associated with histoplasmosis and cryptococcosis in PLHIV.
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Affiliation(s)
- Diego H Caceres
- Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA.,Department of Medical Microbiology, Radboud University Medical Center and Radboudumc-CWZ Center of Expertise for Mycology, Nijmegen, The Netherlands
| | | | | | | | | | - Carlos Saenz
- Centro Nacional de Diagnóstico y Referencia, Managua, Nicaragua
| | | | | | | | | | - Arturo Garcia
- LLC. HIV-TB Co-infection Surveillance Strategies for Program Planning in the Central American Region under PEPFAR, Formerly with University Research Co., Guatemala City, Guatemala
| | - Jose Abdo
- LLC. HIV-TB Co-infection Surveillance Strategies for Program Planning in the Central American Region under PEPFAR, Formerly with University Research Co., Guatemala City, Guatemala
| | - Paul E Verweij
- Department of Medical Microbiology, Radboud University Medical Center and Radboudumc-CWZ Center of Expertise for Mycology, Nijmegen, The Netherlands
| | - Tom M Chiller
- Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Diana Forno
- Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
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