1
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Andreani M, Frola CE, Cáceres DH, Bozzano C, Diaz L, Cattani ME, Rodriguez-Tudela JL, Rolón MJ, Guelfand L. Rapid CD4 cell count determination and Cryptococcus and Histoplasma antigen detection in people living with HIV: Implementation of a package of care strategy in a pilot study, Argentina. IJID REGIONS 2024; 12:100403. [PMID: 39188885 PMCID: PMC11345679 DOI: 10.1016/j.ijregi.2024.100403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Revised: 07/03/2024] [Accepted: 07/04/2024] [Indexed: 08/28/2024]
Abstract
Objectives Despite advancements in HIV diagnosis and treatment, advanced HIV disease (AHD) is still a significant concern worldwide, especially in countries with a high percentage of undiagnosed cases and late-stage diagnoses. Methods A prospective pilot study was conducted in Buenos Aires, Argentina to assess the feasibility of implementing a package for people living with HIV, integrating a point-of-care clusters of differentiation (CD4) test, followed by rapid Cryptococcus and Histoplasma antigen (Ag) detection. Results A total of 105 people living with HIV were enrolled, during June 2021 to October 2021. The VISITECT CD4 Advanced Disease Lateral Flow Assay (CD4-LFA) (Accubio) classified 98 (93%) patients with AHD. Compared with flow cytometry, the CD4-LFA performed with a high sensitivity (100%) but low specificity (19%) and limited accuracy (47%). In the 98 patients classified with AHD using the CD4-LFA, 16 tested positive for any of the rapid Ag used, including 12 patients positive for the Histoplasma Ag test and four positive for Cryptococcus Ag; all four patients with positive Cryptococcus Ag in sera and were diagnosed with meningitis. In the 30-day follow-up, one death was recorded. Conclusions The CD4-LFA correctly classified all patients with CD4 ≤200 cells/µL by flow cytometry, but a high frequency of patients misclassified with AHD was recorded. We also observed a high prevalence of opportunistic fungal infections, as previously observed in the hospital where this pilot study was conducted; however, in contrast with those previous reports, mortality was lower. The study underscores the importance of scaling up comprehensive care strategies and collaborating with governmental and non-governmental partners to enhance access to essential diagnostic tools and treatments for people living with HIV. Further research with larger sample sizes is needed to validate these findings.
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Affiliation(s)
- Mariana Andreani
- División Laboratorio de Análisis Clínicos, Sección Microbiología, Hospital General de Agudos “Dr. Juan A. Fernández”, 1425, Buenos Aires, Argentina
| | - Claudia E. Frola
- División Infectología, Hospital General de Agudos “Dr. Juan A. Fernández”, 1425, Buenos Aires, Argentina
| | - 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, Oklahoma, 73069, USA
| | - Claudia Bozzano
- División Laboratorio de Análisis Clínicos, Sección Microbiología, Hospital General de Agudos “Dr. Juan A. Fernández”, 1425, Buenos Aires, Argentina
| | - Liliana Diaz
- División Laboratorio de Análisis Clínicos, Sección Microbiología, Hospital General de Agudos “Dr. Juan A. Fernández”, 1425, Buenos Aires, Argentina
| | - Maria E. Cattani
- División Laboratorio de Análisis Clínicos, Sección Microbiología, Hospital General de Agudos “Dr. Juan A. Fernández”, 1425, Buenos Aires, Argentina
| | | | - Maria J. Rolón
- División Infectología, Hospital General de Agudos “Dr. Juan A. Fernández”, 1425, Buenos Aires, Argentina
| | - Liliana Guelfand
- División Laboratorio de Análisis Clínicos, Sección Microbiología, Hospital General de Agudos “Dr. Juan A. Fernández”, 1425, Buenos Aires, Argentina
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2
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Denning DW. Global incidence and mortality of severe fungal disease. THE LANCET. INFECTIOUS DISEASES 2024; 24:e428-e438. [PMID: 38224705 DOI: 10.1016/s1473-3099(23)00692-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 11/05/2023] [Accepted: 11/06/2023] [Indexed: 01/17/2024]
Abstract
Current estimates of fungal disease incidence and mortality are imprecise. Population at risk denominators were used to estimate annual incidence for 2019-21. Extensive literature searches from 2010 to 2023 were combined with over 85 papers on individual country and global disease burden. Crude and attributable mortality were estimated using a combination of untreated mortality, the proportion of patients who are treated, and percentage survival in treated patients. Awareness, guidelines, and accessibility of diagnostics and therapies informed the ratio of treated to untreated cases. Estimates do not include influenza or COVID-19 outbreaks. Data from more than 120 countries were included. Annually, over 2 113 000 people develop invasive aspergillosis in the context of chronic obstructive pulmonary disease, intensive care, lung cancer, or haematological malignancy, with a crude annual mortality of 1 801 000 (85·2%). The annual incidence of chronic pulmonary aspergillosis is 1 837 272, with 340 000 (18·5%) deaths. About 1 565 000 people have a Candida bloodstream infection or invasive candidiasis each year, with 995 000 deaths (63·6%). Pneumocystis pneumonia affects 505 000 people, with 214 000 deaths (42·4%). Cryptococcal meningitis affects 194 000 people, with 147 000 deaths (75·8%). Other major life-threatening fungal infections affect about 300 000 people, causing 161 000 deaths (53·7%). Fungal asthma affects approximately 11·5 million people and might contribute to 46 000 asthma deaths annually. These updated estimates suggest an annual incidence of 6·5 million invasive fungal infections and 3·8 million deaths, of which about 2·5 million (68%; range 35-90) were directly attributable.
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Affiliation(s)
- David W Denning
- Manchester Fungal Infection Group, University of Manchester, Core Technology Facility, Manchester, UK; Global Action For Fungal Infections, Geneva, Switzerland.
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3
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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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4
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Trubin P, Azar MM. A fast-track to fungal diagnosis: the potential of molecular diagnostics for fungi at the point of care. Expert Rev Mol Diagn 2024; 24:143-146. [PMID: 37991006 DOI: 10.1080/14737159.2023.2287504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 11/21/2021] [Indexed: 11/23/2023]
Affiliation(s)
- Paul Trubin
- Section of Infectious Diseases, Department of Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Marwan M Azar
- Section of Infectious Diseases, Department of Medicine, Yale School of Medicine, New Haven, CT, USA
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5
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Beardsley J. Pathogens of importance in lung disease-Implications of the WHO fungal priority pathogen list. Respirology 2024; 29:21-23. [PMID: 37956991 PMCID: PMC10952795 DOI: 10.1111/resp.14623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 10/25/2023] [Indexed: 11/21/2023]
Affiliation(s)
- Justin Beardsley
- University of Sydney Infectious Disease InstituteSydneyNew South WalesAustralia
- Westmead Institute for Medical ResearchSydneyNew South WalesAustralia
- Department of Infectious DiseasesWestmead Hospital, NSW HealthSydneyNew South WalesAustralia
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6
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Cipolat MM, Rodrigues DR, Brenol CV, Pasqualotto AC, Falci DR. Incidence of histoplasmosis in patients receiving TNF-alpha inhibitors: A systematic review and meta-analysis. Medicine (Baltimore) 2023; 102:e36450. [PMID: 38065857 PMCID: PMC10713183 DOI: 10.1097/md.0000000000036450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 11/13/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Immunobiological drugs such as TNF-α inhibitors are valuable in rescue therapy for autoimmune diseases such as rheumatoid arthritis and inflammatory bowel disease (IBD), but they increase the risk of infectious complications. Histoplasmosis is a significant concern in patients living in endemic regions, however, few studies have assessed the incidence of Histoplasma infection during therapy, and classic estimates may underestimate the risk. This study aimed to produce an updated risk estimate of histoplasmosis in patients on TNF-α blocking therapy. METHODS This is a systematic review and meta-analysis of studies that contain parameters for calculating the risk of histoplasmosis in people who use TNF-α inhibitors, to produce a risk estimate. RESULTS We identified 11 studies with the necessary parameters for inclusion in the meta-analysis, most of which were from North America. The incidence rate of histoplasmosis found was 33.52 cases per 100,000 patients treated with TNF-ɑ inhibitors (95% CI 12.28-91.46). Considering only studies evaluating monoclonal antibodies, the calculated incidence was 54.88/100,000 patients treated (95%CI 23.45-128.34). In subgroup analysis, the incidence was much higher in patients with IBD compared to rheumatic diseases. There was significant heterogeneity among the studies. CONCLUSION The risk of histoplasmosis during TNF-α inhibitory therapy may be considerably higher than that found in classical estimates, especially in patients with IBD. There is a lack of studies evaluating histoplasmosis in large endemic areas, such as Central and South America.
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Affiliation(s)
- Murillo M. Cipolat
- Graduate Program in Medical Sciences (PPGCM), Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Débora R.R. Rodrigues
- Graduate Program in Medical Sciences (PPGCM), Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Claiton V. Brenol
- Graduate Program in Medical Sciences (PPGCM), Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Alessandro C. Pasqualotto
- Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, Brazil
- Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil
| | - Diego R. Falci
- Graduate Program in Medical Sciences (PPGCM), Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
- Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil
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7
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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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8
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Edwards RJ, Todd S, Edwards J, Samaroo-Francis W, Lyons N, Boyce G, Denning DW. The incidence of histoplasmosis and cryptococcal antigenemia among patients attending a large HIV clinic in Trinidad. Diagn Microbiol Infect Dis 2023; 106:115952. [PMID: 37267742 DOI: 10.1016/j.diagmicrobio.2023.115952] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 03/11/2023] [Accepted: 04/11/2023] [Indexed: 06/04/2023]
Abstract
Our aim was to determine the incidence disseminated histoplasmosis and cryptococcal antigenemia among 280 patients with a CD4<350 cells/mm3 attending a large HIV clinic in Trinidad over the period November 2021-June 2022. Sera were screened for cryptococcal antigen (CrAg) using the Immy CrAg Immunoassay (EIA) and the Immy CrAg lateral flow assay (LFA). Urine was screened for Histoplasma antigen using the Immy EIA and the Optimum Imaging Diagnostics (OIDx) LFA. For the purposes of analysis, it was assumed, that all patients with positive urine Histoplasma antigen tests by both EIA and LFA and those with a single positive urine Histoplasma antigen test and clinical features of disseminated histoplasmosis were true positives. The incidence of probable disseminated histoplasmosis and cryptococcal antigenemia were 6.4% (18/280) and 2.5% (7/280) respectively. The sensitivity and specificity of the Immy Histoplasma EIA were 100% (95% CI, 81.5%-100%) and 98.5% (95% CI, 96.1% - 99.6%) respectively as compared to the OIDx Histoplasma LFA of 88.9% (95% CI, 65.3% - 98.6%) and 93.9% (95% CI, 90.3% - 96.5%) respectively, with substantial agreement between the 2 test kits (Kappa value = 0.763; 95% CI 0.685, 0.841). Testing for disseminated histoplasmosis in HIV patients is important in endemic areas.
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Affiliation(s)
- Robert Jeffrey Edwards
- Medical Research Foundation of Trinidad and Tobago, Port of Spain, Trinidad; Department of Paraclinical Sciences, University of the West Indies, St Augustine Trinidad.
| | - Selena Todd
- Medical Research Foundation of Trinidad and Tobago, Port of Spain, Trinidad
| | - Jonathan Edwards
- Medical Research Foundation of Trinidad and Tobago, Port of Spain, Trinidad
| | | | - Nyla Lyons
- Medical Research Foundation of Trinidad and Tobago, Port of Spain, Trinidad
| | - Gregory Boyce
- Medical Research Foundation of Trinidad and Tobago, Port of Spain, Trinidad
| | - David W Denning
- Manchester Fungal Infection Group, The University of Manchester and Manchester Academic Health Science Centre, Manchester, UK
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9
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Pasqualotto AC, Queiroz-Telles F, Chebabo A, Leitao TMJS, Falci DR, Xavier MO, Bay MB, Sprinz E, Dalla Lana D, Vincentini AP, Damasceno LS, Schwarzbold AV, Ferreira PA, Godoy CM, Vidal JE, Basso R, Driemeyer C, Aquino VR, Severo CB, Ferreira MS, Bastos C, Prohaska F, Melo M, Cavassin FB, Lacerda M, Soares R, Zancope-Oliveira R, Teixeira M, Perez F, Caceres DH, Rodriguez-Tudela JL, Chiller T, Colombo AL. The "Histoplasmosis Porto Alegre manifesto"-Addressing disseminated histoplasmosis in AIDS. PLoS Negl Trop Dis 2023; 17:e0010960. [PMID: 36602963 DOI: 10.1371/journal.pntd.0010960] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Affiliation(s)
| | | | - Alberto Chebabo
- Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Diego R Falci
- Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | | | - Monica B Bay
- Universidade Federal do Rio Grande do Norte, Natal, Brazil
| | - Eduardo Sprinz
- Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | | | | | | | | | | | | | | | - Rossana Basso
- Universidade Federal de Rio Grande, Rio Grande, Brazil
| | | | | | | | | | | | | | | | | | - Marcus Lacerda
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | - Renata Soares
- Pontifícia Universidade Católica de Goiás, Goiânia, Brazil
| | | | | | - Freddy Perez
- Panamerican Health Organization, Washington, DC, United States of America
| | | | | | - Tom Chiller
- Center for Disease Control and Prevention, Atlanta, Georgia, United States of America
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10
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Caceres DH, Echeverri Tirado LC, Bonifaz A, Adenis A, Gomez BL, Flores CLB, Canteros CE, Santos DW, Arathoon E, Soto ER, Queiroz‐Telles F, Schwartz IS, Zurita J, Damasceno LS, Garcia N, Fernandez NB, Chincha O, Araujo P, Rabagliati R, Chiller T, Giusiano G. Current situation of endemic mycosis in the Americas and the Caribbean: Proceedings of the first international meeting on endemic mycoses of the Americas (IMEMA). Mycoses 2022; 65:1179-1187. [PMID: 35971917 PMCID: PMC9804294 DOI: 10.1111/myc.13510] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 07/18/2022] [Accepted: 07/24/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND The Americas are home to biologically and clinically diverse endemic fungi, including Blastomyces, Coccidioides, Emergomyces, Histoplasma, Paracoccidioides and Sporothrix. In endemic areas with high risk of infection, these fungal pathogens represent an important public health problem. OBJECTIVES This report aims to summarise the main findings of the regional analysis carried out on the status of the endemic mycoses of the Americas, done at the first International Meeting on Endemic Mycoses of the Americas (IMEMA). METHODS A regional analysis for the Americas was done, the 27 territories were grouped into nine regions. A SWOT analysis was done. RESULTS All territories reported availability of microscopy. Seventy percent of territories reported antibody testing, 67% of territories reported availability of Histoplasma antigen testing. None of the territories reported the use of (1-3)-β-d-glucan. Fifty two percent of territories reported the availability of PCR testing in reference centres (mostly for histoplasmosis). Most of the territories reported access to medications such as trimethoprim-sulfamethoxazole, itraconazole, voriconazole and amphotericin B (AMB) deoxycholate. Many countries had limited access to liposomal formulation of AMB and newer azoles, such as posaconazole and isavuconazole. Surveillance of these fungal diseases was minimal. CONCLUSIONS A consensus emerged among meeting participants, this group concluded that endemic mycoses are neglected diseases, and due to their severity and lack of resources, the improvement of diagnosis, treatment and surveillance is needed.
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Affiliation(s)
- Diego H. Caceres
- Centers for Disease Control and Prevention (CDC)AtlantaGeorgiaUSA,Center of Expertise in Mycology Radboudumc/CWZNijmegenThe Netherlands,Studies in Translational Microbiology and Emerging Diseases (MICROS) Research Group, School of Medicine and Health SciencesUniversidad del RosarioBogotaColombia
| | - Laura C. Echeverri Tirado
- Medical Mycology Group, School of Medicine, Microbiology and Parasitology DepartmentUniversidad de AntioquiaMedellínAntioquiaColombia
| | | | - Antoine Adenis
- Centre d'Investigation Clinique Antilles Guyane Inserm 1424CayenneFrance,Centre Hospitalier de CayenneCayenneFrance
| | - Beatriz L. Gomez
- Studies in Translational Microbiology and Emerging Diseases (MICROS) Research Group, School of Medicine and Health SciencesUniversidad del RosarioBogotaColombia
| | | | - Cristina E. Canteros
- Departamento de Micología, Instituto Nacional de Enfermedades Infecciosas (INEI)Administración Nacional de Laboratorios e Institutos de Salud (ANLIS) "Dr. Carlos G. Malbrán"Buenos AiresArgentina
| | - Daniel Wagner Santos
- Department of Infectious Diseases and Infection ControlUniversidade Federal do Maranhão, UFMASão LuísMaranhãoBrazil,Instituto D'Or de Pesquisa e Ensino, IDOR, Hospital UDISão LuisMaranhãoBrazil
| | | | - Elia Ramirez Soto
- Centro Nacional de Enfermedades Tropicales (CENETROP)Santa CruzBolivia
| | | | - Ilan S. Schwartz
- Department of Medicine, Division of Infectious DiseasesUniversity of AlbertaEdmontonAlbertaCanada
| | - Jeannete Zurita
- Facultad de MedicinaPontificia Universidad Católica del EcuadorQuitoEcuador,Unidad de Investigaciones en Biomedicina, Zurita & Zurita LaboratoriosQuitoEcuador
| | - Lisandra Serra Damasceno
- Faculdade de MedicinaUniversidade Federal do CearáFortalezaCEBrazil,Hospital São José de Doenças Infecciosas, Secretaria de SaúdeCearáBrazil
| | - Nataly Garcia
- Sociedad Venezolana de MicrobiologíaCaracasVenezuela
| | - Norma B. Fernandez
- Sección Micologia, Division InfectologíaHospital de Clinicas “José de San Martín” Universidad de Buenos AiresBuenos AiresArgentina
| | - Omayra Chincha
- Universidad Peruana Cayetano Heredia (UPCH), Hospital Cayetano HerediaLimaPeru
| | - Patricia Araujo
- Departamento de Bacteriología y MicologíaLaboratorio Central de Salud Pública, Ministerio de Salud Pública y Bienestar SocialAsunciónParaguay
| | - Ricardo Rabagliati
- Departamento de Enfermedades Infecciosas del Adulto, Escuela de MedicinaPontificia Universidad Católica de ChileSantiagoChile
| | - Tom Chiller
- Centers for Disease Control and Prevention (CDC)AtlantaGeorgiaUSA
| | - Gustavo Giusiano
- Instituto de Medicina RegionalUniversidad Nacional del Nordeste, Consejo Nacional de Investigaciones Científicas y Técnicas de Argentina (CONICET)ResistenciaChacoArgentina
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Oladele RO, Osaigbovo II, Akanmu AS, Adekanmbi OA, Ekeng BE, Mohammed Y, Alex-Wele MA, Okolo MO, Ayanbeku ST, Unigwe US, Akase IE, Dan-Jumbo A, Isralski D, Denning DW, Pasqualotto AC, Chiller T. Prevalence of Histoplasmosis among Persons with Advanced HIV Disease, Nigeria. Emerg Infect Dis 2022; 28:2261-2269. [PMID: 36286009 PMCID: PMC9622240 DOI: 10.3201/eid2811.220542] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/29/2023] Open
Abstract
We sought to determine the prevalence of probable disseminated histoplasmosis among advanced HIV disease (AHD) patients in Nigeria. We conducted a cross-sectional study in 10 sites across 5 of 6 geopolitical zones in Nigeria. We identified patients with urinary samples containing CD4 cell counts <200 cells/mm3 or World Health Organization stage 3 or 4 disease who also had >2 clinical features of disseminated histoplasmosis, and we tested them for Histoplasma antigen using a Histoplasma enzyme immune assay. Of 988 participants we recruited, 76 (7.7%) were antigen-positive. The 76 Histoplasma antigen-positive participants had significantly lower (p = 0.03) CD4 counts; 9 (11.8%) were also co-infected with tuberculosis. Most antigen-positive participants (50/76; 65.8%; p = 0.015) had previously received antiretroviral treatment; 26/76 (34.2%) had not. Because histoplasmosis is often a hidden disease among AHD patients in Nigeria, Histoplasma antigen testing should be required in the AHD package of care.
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