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Bongomin F, Kwizera R, Namusobya M, van Rhijn N, Andia-Biraro I, Kirenga BJ, Meya DB, Denning DW. Re-estimation of the burden of serious fungal diseases in Uganda. Ther Adv Infect Dis 2024; 11:20499361241228345. [PMID: 38328511 PMCID: PMC10848809 DOI: 10.1177/20499361241228345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 01/09/2024] [Indexed: 02/09/2024] Open
Abstract
Background It is of utmost importance to monitor any change in the epidemiology of fungal diseases that may arise from a change in the number of the at-risk population or the availability of local data. Objective We sought to update the 2015 publication on the incidence and prevalence of serious fungal diseases in Uganda. Methods Using the Leading International Fungal Education methodology, we reviewed published data on fungal diseases and drivers of fungal diseases in Uganda. Regional or global data were used where there were no Ugandan data. Results With a population of ~45 million, we estimate the annual burden of serious fungal diseases at 4,099,357 cases (about 9%). We estimated the burden of candidiasis as follows: recurrent Candida vaginitis (656,340 cases), oral candidiasis (29,057 cases), and esophageal candidiasis (74,686 cases) in HIV-infected people. Cryptococcal meningitis annual incidence is estimated at 5553 cases, Pneumocystis pneumonia at 4604 cases in adults and 2100 cases in children. For aspergillosis syndromes, invasive aspergillosis annual incidence (3607 cases), chronic pulmonary aspergillosis (26,765 annual cases and 63,574 5-year-period prevalent cases), and prevalence of allergic bronchopulmonary aspergillosis at 75,931 cases, and severe asthma with fungal sensitization at 100,228 cases. Tinea capitis is common with 3,047,989 prevalent cases. For other mycoses, we estimate the annual incidence of histoplasmosis to be 646 cases and mucormycosis at 9 cases. Conclusion Serious fungal diseases affect nearly 9% of Ugandans every year. Tuberculosis and HIV remain the most important predisposition to acute fungal infection necessitating accelerated preventive, diagnostic, and therapeutic interventions for the management of these diseases.
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Affiliation(s)
- Felix Bongomin
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Gulu University, Gulu, Uganda
- Manchester Fungal Infection Group, Division of Evolution, Infection and Genomics, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Richard Kwizera
- Infectious Diseases Institute, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Martha Namusobya
- Department of Clinical Epidemiology and Biostatistics, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Norman van Rhijn
- Manchester Fungal Infection Group, Division of Evolution, Infection and Genomics, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | | | - Bruce J. Kirenga
- Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - David B. Meya
- Infectious Diseases Institute, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
- Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - David W. Denning
- Manchester Fungal Infection Group, CTF Building, The University of Manchester, Grafton Street, Manchester M13 9NT, UK
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Khairunnisa S, Soeroso NN, Abdullah M, Siahaan L, Eyanoer PC, Daulay ER, Wahyuningsih R, Denning DW. Factors influencing histoplasmosis incidence in multidrug-resistant pulmonary tuberculosis patients: A cross-sectional study in Indonesia. NARRA J 2023; 3:e403. [PMID: 38450334 PMCID: PMC10914037 DOI: 10.52225/narra.v3i3.403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 12/29/2023] [Indexed: 03/08/2024]
Abstract
Histoplasmosis is an infectious disease caused by the dimorphic fungus Histoplasma capsulatum, which in chronic conditions, is generally difficult to distinguish from pulmonary tuberculosis (TB) based on its clinical appearance; therefore, diagnostic errors could occur. Meanwhile, the prevalence of multidrug-resistant pulmonary TB (MDR-TB) in Indonesia remains high. Study determining the incidence of histoplasmosis in MDR-TB is unavailable worldwide. The aim of this study was to determine the risk factors of histoplasmosis incidence in MDR-TB patients in Indonesia. A cross-sectional was conducted at H. Adam Malik General Hospital, Medan, Indonesia and the ELISA platform (semi-quantitative) was used to detect histoplasma antibodies. Factors associated with histoplasmosis incidence among MDR-TB were determined using a Chi-squared test. A total of 50 MDR-TB patients were included this study of which 14 of them (28%) had histoplasmosis. The majority of histoplasmosis occurred in males, in MDR-TB patients with a history of TB treatment and among who had chest x-rays with far-advanced lesions. However, statistical analyses indicated none of those factors (sex, TB treatment history, status of the lung) as well as age group, acid-fast bacillus result, Mycobacterium tuberculosis culture result, having pet, living in damp house, working in the field or plantation, having HIV infection and smoking status were associated with histoplasmosis incidence. This study highlights that the incidence of histoplasmosis is relatively high and therefore further studies are important to be conducted in Indonesia that has a high MDR-TB cases.
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Affiliation(s)
- Selfi Khairunnisa
- Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Sumatera Utara, Prof Chairuddin Panusunan Lubis USU Hospital/H. Adam Malik General Hospital, Medan, Indonesia
| | - Noni N. Soeroso
- Division of Thoracic Oncology, Department of Pulmonology and Respiratory Medicine, Faculty of Medicine Universitas Sumatera Utara, Prof. Chairuddin Panusunan Lubis Universitas Sumatera Utara Hospital, Medan, Indonesia
| | - Muntasir Abdullah
- Division of Pulmonary Infection, Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia
| | - Lambok Siahaan
- Department of Parasitology, Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia
| | - Putri C. Eyanoer
- Department of Community and Preventive Medicine, Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia
| | - Elvita R. Daulay
- Departement of Radiology, Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia
| | - Retno Wahyuningsih
- Department of Parasitology, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - David W. Denning
- Manchester Fungal Infection Group, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
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Kusmiati T, Burhan E, Sugiyono RI, Arlinda D, Naysilla AM, Wibisono BH, El Khair R, Candrawati NW, Sinaga BYM, Djaharrudin I, Lokida D, Kosasih H, Susanto NH, Butar Butar DP, Adawiyah R, Fatril AE, Karyana M, Denning DW, Wahyuningsih R. The seroprevalence of anti-Histoplasma capsulatum IgG antibody among pulmonary tuberculosis patients in seven referral tuberculosis hospitals in Indonesia. PLoS Negl Trop Dis 2023; 17:e0011575. [PMID: 37729126 PMCID: PMC10511117 DOI: 10.1371/journal.pntd.0011575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 08/06/2023] [Indexed: 09/22/2023] Open
Abstract
BACKGROUND Histoplasma capsulatum exposure is rarely suspected in Indonesia. Pulmonary histoplasmosis can occur simultaneously with pulmonary tuberculosis (TB) or as an alternative diagnosis in clinically-diagnosed TB patients with no microbiological evidence of TB. This study aimed to determine the seroprevalence of anti-H. capsulatum IgG antibody among pulmonary TB patients. METHODOLOGY This was a sub-study of 306 participants from a prospective cohort pulmonary TB study conducted at seven TB referral hospitals in Indonesia. The study population was presumptive pulmonary TB adult patients who underwent microbiological TB examinations and were categorized as drug-sensitive (DS), drug-resistant (DR), and clinically-diagnosed TB. Anti-H. capsulatum IgG antibody levels at baseline were measured using MVista Histoplasma Ab enzyme immunoassays. Data were summarized using descriptive statistics. Bivariate and multivariate logistic regression analysis were performed to assess factors associated with anti-H. capsulatum IgG antibody positive result. RESULTS 12.7% (39/306) of pulmonary TB patients were positive for anti-H. capsulatum IgG antibodies (DR-TB patients (15.9%, 18/114), DS-TB (13.0%, 15/115), and clinically-diagnosed TB (7.8%, 6/77)). The median unit value of anti-H. capsulatum IgG antibody for all positive samples was 15.7 (IQR 10.2-28.9) EU. This median unit value was higher in clinically-diagnosed TB patients compared to DS-TB or DR-TB patients (38.1 (IQR 25.6-46.6) EU, 19.7 (IQR 12.3-28.9) EU, and 10.9 (IQR 9.2-15.4), respectively). There were 10 patients (3.3%) with anti-H. capsulatum IgG antibody levels above 30 EU. Factors associated with the anti-H. capsulatum IgG antibody positive result were malignancies (OR 4.88, 95% CI 1.09-21.69, p = 0.037) and cavitary lesions (OR 2.27, 95% CI 1.09-4.70, p = 0.028). CONCLUSIONS Our results provide evidence of exposure to H. capsulatum among pulmonary TB patients in Indonesia. Further studies are needed to provide a comprehensive picture of this fungal disease in other populations and regions to enhance awareness among clinicians and public health officials.
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Affiliation(s)
- Tutik Kusmiati
- Department of Pulmonology, Soetomo Hospital, Surabaya, Indonesia
| | - Erlina Burhan
- Department of Pulmonology, Persahabatan Hospital, Jakarta, Indonesia
| | - Retna Indah Sugiyono
- Indonesia Clinical Research Center (INA-CRC), Health Policy Agency, Ministry of Health, Jakarta, Indonesia
| | - Dona Arlinda
- Indonesia Clinical Research Center (INA-CRC), Health Policy Agency, Ministry of Health, Jakarta, Indonesia
| | - Adhella Menur Naysilla
- Indonesia Clinical Research Center (INA-CRC), Health Policy Agency, Ministry of Health, Jakarta, Indonesia
| | | | - Riat El Khair
- Department of Clinical Pathology and Laboratory Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Sardjito Hospital, Yogyakarta, Indonesia
| | - Ni Wayan Candrawati
- Department of Pulmonology, Faculty of Medicine, Universitas Udayana, Prof. IGNG. Ngoerah General Hospital, Bali, Indonesia
| | | | - Irawaty Djaharrudin
- Department of Pulmonology, Faculty of Medicine, Universitas Hasanuddin, Wahidin Sudirohussodo Hospital, Makassar, Indonesia
| | - Dewi Lokida
- Department of Clinical Pathology, Tangerang District Hospital, Banten, Indonesia
| | - Herman Kosasih
- Indonesia Clinical Research Center (INA-CRC), Health Policy Agency, Ministry of Health, Jakarta, Indonesia
| | - Nugroho Harry Susanto
- Indonesia Clinical Research Center (INA-CRC), Health Policy Agency, Ministry of Health, Jakarta, Indonesia
| | - Deni Pepy Butar Butar
- Indonesia Clinical Research Center (INA-CRC), Health Policy Agency, Ministry of Health, Jakarta, Indonesia
| | - Robiatul Adawiyah
- Department of Parasitology, Universitas Indonesia, Jakarta, Indonesia
| | - Ayu Eka Fatril
- Department of Parasitology, Universitas Indonesia, Jakarta, Indonesia
| | - Muhammad Karyana
- Indonesia Clinical Research Center (INA-CRC), Health Policy Agency, Ministry of Health, Jakarta, Indonesia
| | - David W. Denning
- Manchester Fungal Infection Group, The University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Retno Wahyuningsih
- Department of Parasitology, Universitas Indonesia, Jakarta, Indonesia
- Department of Parasitology, Faculty of Medicine, Universitas Kristen Indonesia, Jakarta, Indonesia
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4
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Sekar P, Nalintya E, Kwizera R, Mukashyaka C, Niyonzima G, Namakula LO, Nerima P, Fieberg A, Dai B, Ellis J, Boulware DR, Meya DB, Bahr NC, Rajasingham R. Prevalence of Histoplasma Antigenuria among Outpatient Cohort with Advanced HIV in Kampala, Uganda. J Fungi (Basel) 2023; 9:757. [PMID: 37504745 PMCID: PMC10381727 DOI: 10.3390/jof9070757] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 07/12/2023] [Accepted: 07/13/2023] [Indexed: 07/29/2023] Open
Abstract
In sub-Saharan Africa, an estimated 25% of people with HIV present with advanced HIV and are at high risk of opportunistic infections. Whereas histoplasmosis has occasionally been seen in Uganda, the understanding of the local risk of acute infection is limited. We sought to determine the prevalence of Histoplasma antigenuria using an enzyme immunoassay (EIA, clarus Histoplasma GM EIA, IMMY; Norman, OK, USA) in a cohort of outpatients with advanced HIV disease in Kampala, Uganda. Among the persons with positive urine Histoplasma antigen tests, we assessed their clinical presentation and outcomes. The EIA was run on stored urine samples as per the manufacturer's instructions. Specimens ≥1 EIA units were considered positive. Among the 388 tested urine samples, 4 (1.2%) were positive for Histoplasma antigen. The histoplasmosis prevalence among participants with a CD4 < 100 cells/mcL was 2.5% (4/158). Three of the four participants with a positive Histoplasma antigen test reported systemic symptoms consistent with histoplasmosis. All four participants had a positive urine lipoarabinomannan test and were treated for tuberculosis. By the four-week follow-up visit, all participants were clinically improved, alive, and in care without antifungal therapy. In advanced HIV, the clinical presentations of tuberculosis and histoplasmosis overlap. The value of histoplasmosis screening and pre-emptive treatment is an area of future research.
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Affiliation(s)
- Preethiya Sekar
- Infectious Diseases Institute, Makerere University, Kampala P.O. Box 22418, Uganda
| | - Elizabeth Nalintya
- Infectious Diseases Institute, Makerere University, Kampala P.O. Box 22418, Uganda
| | - Richard Kwizera
- Infectious Diseases Institute, Makerere University, Kampala P.O. Box 22418, Uganda
| | - Claudine Mukashyaka
- Infectious Diseases Institute, Makerere University, Kampala P.O. Box 22418, Uganda
| | - Godfrey Niyonzima
- Infectious Diseases Institute, Makerere University, Kampala P.O. Box 22418, Uganda
| | | | - Patricia Nerima
- Infectious Diseases Institute, Makerere University, Kampala P.O. Box 22418, Uganda
| | - Ann Fieberg
- Division of Infectious Diseases and International Medicine, Department of Medicine, University of Minnesota, Minneapolis, MN 55455, USA
| | - Biyue Dai
- Division of Infectious Diseases and International Medicine, Department of Medicine, University of Minnesota, Minneapolis, MN 55455, USA
| | - Jayne Ellis
- Clinical Research Department, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - David R Boulware
- Division of Infectious Diseases and International Medicine, Department of Medicine, University of Minnesota, Minneapolis, MN 55455, USA
| | - David B Meya
- Infectious Diseases Institute, Makerere University, Kampala P.O. Box 22418, Uganda
| | - Nathan C Bahr
- Division of Infectious Diseases, University of Kansas, Kansas City, KS 66160, USA
| | - Radha Rajasingham
- Division of Infectious Diseases and International Medicine, Department of Medicine, University of Minnesota, Minneapolis, MN 55455, USA
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5
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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: 1] [Impact Index Per Article: 0.5] [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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Ocansey BK, Kosmidis C, Agyei M, Dorkenoo AM, Ayanlowo OO, Oladele RO, Darre T, Denning DW. Histoplasmosis in Africa: Current perspectives, knowledge gaps, and research priorities. PLoS Negl Trop Dis 2022; 16:e0010111. [PMID: 35202403 PMCID: PMC8870498 DOI: 10.1371/journal.pntd.0010111] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background Histoplasmosis is a chronic granulomatous disease caused by the thermally dimorphic fungus Histoplasma capsulatum. The 2 variants Histoplasma capsulatum var. capsulatum (Hcc) and Histoplasma capsulatum var. duboisii (Hcd) causes infection in humans and commonly termed classical or American histoplasmosis and African histoplasmosis, respectively. Histoplasma capsulatum var. farciminosum (Hcf) affects equines. In recent times, there have been heightened sensitization on fungal infections such as histoplasmosis in Africa, aimed at improving awareness among relevant stakeholders, particularly healthcare workers. This effort is expected to be paralleled with increased detection of both classical and African histoplasmosis, which has remained underdiagnosed over the years. In this narrative review, we describe the current perspectives of histoplasmosis in Africa, identify knowledge gaps, and suggest research priorities. Methods A PubMed, Google Scholar, and Africa Journal Online (AJOL) literature search was conducted for studies on histoplasmosis in Africa between 2000 and 2020. Histoplasmosis essays in medical mycology textbooks were also consulted. This narrative review was prepared from the data gathered. Findings In the past 2 decades, histoplasmosis in general has seen a relative increase in case detection in some Africa countries, probably attributable to the gradually increasing medical mycology advocacy efforts in Africa. Histoplasmosis cases are dominated by African histoplasmosis mostly in Western and Central Africa, while classical histoplasmosis is more common in Southern and Northern Africa. Although both classical and African histoplasmosis are common in Africa, the latter is more restricted to Africa, and cases outside the continent usually have a travel history to the continent. Despite the clinical and laboratory difference between African histoplasmosis and classical histoplasmosis, it is not straightforward to distinguish them. The typical manifestation of African histoplasmosis is the appearance of lesions affecting the skin, bones, and lymph nodes and unusually linked to human immunodeficiency virus (HIV)/AIDS. By contrast, classical histoplasmosis mostly affects the lungs and is often associated with immunosuppression, mainly HIV/AIDS. The present perspectives of histoplasmosis in Africa highlight unclear details on the true burden, strain diversity, infection route and genetic basis of African histoplasmosis, availability of specie-specific diagnostic tools, and compliance with recommended antifungal therapy. These knowledge gaps represent research questions that require scientific exploration. Conclusions Despite a subtle increase in identifying histoplasmosis cases in Africa, it remains underdiagnosed and neglected in some parts of the continent. Increasing awareness and training among healthcare workers, bridging diagnostic and therapeutic gaps, and encouraging more research in Africa are crucial to improve the current perspectives of histoplasmosis in Africa.
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Affiliation(s)
- Bright K. Ocansey
- Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
- * E-mail: ,
| | - Chris Kosmidis
- Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
- National Aspergillosis Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Martin Agyei
- Department of Internal Medicine, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Améyo M. Dorkenoo
- Department of Biology and Basic Sciences, Faculty of Health Sciences, University of Lomé, Lomé, Togo
- Division of Laboratories, Ministry of Health and Public Hygiene, Lomé, Togo
| | - Olusola O. Ayanlowo
- Department of Medicine, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Rita O. Oladele
- Department of Medical Microbiology & Parasitology, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Tchin Darre
- Department of Pathology, University Teaching Hospital of Lomé, Lomé, Togo
| | - David W. Denning
- Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
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7
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Ji C, Liu N, Tu J, Li Z, Han G, Li J, Sheng C. Drug Repurposing of Haloperidol: Discovery of New Benzocyclane Derivatives as Potent Antifungal Agents against Cryptococcosis and Candidiasis. ACS Infect Dis 2020; 6:768-786. [PMID: 31550886 DOI: 10.1021/acsinfecdis.9b00197] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Despite the high morbidity and mortality of invasive fungal infections (IFIs), effective and safe antifungal agents are rather limited. Starting from antifungal lead compound haloperidol that was identified by drug repurposing, a series of novel benzocyclane derivatives were designed, synthesized, and assayed. Several compounds showed improved antifungal potency and broader antifungal spectra. Particularly, compound B10 showed good inhibitory activities against a variety of fungal pathogens and was proven to be an inhibitor of several virulence factors important for drug resistance. In the in vivo cryptococcosis and candidiasis models, compound B10 could effectively reduce the brain fungal burden of Cryptococcus neoformans and synergize with fluconazole to treat resistant Candida albicans infections. Preliminary antifungal mechanism studies revealed that compound B10 regained cell membrane damage and down-regulated the overexpression of ERG11 and MDR1 genes when used in combination with fluconazole. Taken together, haloperidol derivative B10 represents a promising lead compound for the development of a new generation of antifungal agents.
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Affiliation(s)
- Changjin Ji
- School of Pharmacy, East China University of Science & Technology, 130 Meilong Road, Shanghai 200237, People’s Republic of China
- Department of Medicinal Chemistry, School of Pharmacy, Second Military Medical University, 325 Guohe Road, Shanghai 200433, People’s Republic of China
| | - Na Liu
- Department of Medicinal Chemistry, School of Pharmacy, Second Military Medical University, 325 Guohe Road, Shanghai 200433, People’s Republic of China
| | - Jie Tu
- Department of Medicinal Chemistry, School of Pharmacy, Second Military Medical University, 325 Guohe Road, Shanghai 200433, People’s Republic of China
| | - Zhuang Li
- School of Pharmacy, East China University of Science & Technology, 130 Meilong Road, Shanghai 200237, People’s Republic of China
- Department of Medicinal Chemistry, School of Pharmacy, Second Military Medical University, 325 Guohe Road, Shanghai 200433, People’s Republic of China
| | - Guiyan Han
- Department of Medicinal Chemistry, School of Pharmacy, Second Military Medical University, 325 Guohe Road, Shanghai 200433, People’s Republic of China
| | - Jian Li
- School of Pharmacy, East China University of Science & Technology, 130 Meilong Road, Shanghai 200237, People’s Republic of China
| | - Chunquan Sheng
- Department of Medicinal Chemistry, School of Pharmacy, Second Military Medical University, 325 Guohe Road, Shanghai 200433, People’s Republic of China
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Myint T, Leedy N, Villacorta Cari E, Wheat LJ. HIV-Associated Histoplasmosis: Current Perspectives. HIV AIDS-RESEARCH AND PALLIATIVE CARE 2020; 12:113-125. [PMID: 32256121 PMCID: PMC7090190 DOI: 10.2147/hiv.s185631] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Accepted: 02/27/2020] [Indexed: 12/12/2022]
Abstract
Histoplasmosis is an endemic mycosis caused by Histoplasma capsulatum. Infection develops by inhalation of microconidia from environmental sites inhabited by birds and bats. Disseminated disease is the usual presentation due to impaired cellular immunity. Common clinical manifestations include fever, fatigue, malaise, anorexia, weight loss, and respiratory symptoms. Histoplasma antigen detection is the most sensitive method for diagnosis. The sensitivity of the MVista® Quantitative Histoplasma antigen enzyme immunoassay is 95-100% in urine, over 90% in serum and bronchoalveolar lavage (BAL) antigen and 78% in cerebral spinal fluid (CSF). A proven diagnosis can be established by culture or pathology with sensitivities between 70% and 80%. The sensitivity of antibody detection by immunodiffusion or complement fixation was between 60% and 70%. Diagnosis using molecular methods has not been adequately validated for implementation and FDA cleared assays are unavailable. Liposomal amphotericin B should be used for 1-2 weeks followed by itraconazole for at least one year until CD4 counts are above 150 cells/mm3, HIV viral load is below 400 copies/mL and Histoplasma urine antigen is negative. Serum itraconazole level should be monitored to avoid drug toxicity. Antigen should be measured periodically to establish that treatment is effective and to assist in identifying relapse. The incidence of immune reconstitution inflammatory syndrome is low but it must be considered in patients who are thought to be failing antifungal treatment as it does not respond to changing antifungal agents but rather to initiation of corticosteroid therapy. In this review, we discuss pathogenesis, clinical manifestations, diagnosis and treatment based on personal experience and relevant publications.
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Affiliation(s)
- Thein Myint
- Division of Infectious Diseases, Department of Internal Medicine, University of Kentucky, Lexington, KY, USA
| | - Nicole Leedy
- Division of Infectious Diseases, Department of Internal Medicine, University of Kentucky, Lexington, KY, USA
| | - Evelyn Villacorta Cari
- Division of Infectious Diseases, Department of Internal Medicine, University of Kentucky, Lexington, KY, USA
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Ashraf N, Kubat RC, Poplin V, Adenis AA, Denning DW, Wright L, McCotter O, Schwartz IS, Jackson BR, Chiller T, Bahr NC. Re-drawing the Maps for Endemic Mycoses. Mycopathologia 2020; 185:843-865. [PMID: 32040709 PMCID: PMC7416457 DOI: 10.1007/s11046-020-00431-2] [Citation(s) in RCA: 127] [Impact Index Per Article: 31.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Accepted: 01/24/2020] [Indexed: 01/19/2023]
Abstract
Endemic mycoses such as histoplasmosis, coccidioidomycosis, blastomycosis, paracoccidioidomycosis, and talaromycosis are well-known causes of focal and systemic disease within specific geographic areas of known endemicity. However, over the past few decades, there have been increasingly frequent reports of infections due to endemic fungi in areas previously thought to be “non-endemic.” There are numerous potential reasons for this shift such as increased use of immune suppressive medications, improved diagnostic tests, increased disease recognition, and global factors such as migration, increased travel, and climate change. Regardless of the causes, it has become evident that our previous understanding of endemic regions for these fungal diseases needs to evolve. The epidemiology of the newly described Emergomyces is incomplete; our understanding of it continues to evolve. This review will focus on the evidence underlying the established areas of endemicity for these mycoses as well as new data and reports from medical literature that support the re-thinking these geographic boundaries. Updating the endemic fungi maps would inform clinical practice and global surveillance of these diseases.
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Affiliation(s)
- Nida Ashraf
- Division of Infectious Diseases, Department of Internal Medicine, University of Kansas, Kansas City, KS, USA
| | - Ryan C Kubat
- Division of Infectious Diseases, Department of Internal Medicine, University of Kansas, Kansas City, KS, USA
| | - Victoria Poplin
- Department of Internal Medicine, University of Kansas, Kansas City, KS, USA
| | - Antoine A Adenis
- Centre d'Investigation Clinique Antilles-Guyane, Inserm 1424, Centre Hospitalier de Cayenne, Cayenne, French Guiana
| | - David W Denning
- Faculty of Biology, Medicine, and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Laura Wright
- Geographic Research Analysis and Services Program, Division of Toxicology and Human Health Services, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Orion McCotter
- Mycotic Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Ilan S Schwartz
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Brendan R Jackson
- Mycotic Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Tom Chiller
- Mycotic Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Nathan C Bahr
- Division of Infectious Diseases, Department of Internal Medicine, University of Kansas, Kansas City, KS, USA.
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Staffolani S, Riccardi N, Farina C, Lo Cascio G, Gulletta M, Gobbi F, Rodari P, Ursini T, Bertoli G, Ronzoni N, Bisoffi Z, Angheben A. Acute histoplasmosis in travelers: a retrospective study in an Italian referral center for tropical diseases. Pathog Glob Health 2020; 114:40-45. [PMID: 31959091 DOI: 10.1080/20477724.2020.1716517] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Purpose: Histoplasmosis is a fungal infection acquired through inhalation of Histoplasma capsulatum microconidia, mostly present in the Americas. Both immunocompetent and immunocompromised patients can present a wide spectrum of signs/symptoms, ranging from mild disease to a severe, disseminated infection. The aim of this observational study is to describe histoplasmosis cases diagnosed in travelers and their clinical/radiological and therapeutic pattern.Methods: Retrospective study at the Department of Infectious - Tropical Diseases and Microbiology (DITM) of Negrar, Verona, Italy, between January 2005 and December 2015.Results: Twenty-three cases of acute histoplasmosis were diagnosed, 17 of which belong to the same cluster. Seven of the 23 patients (30.4%) were admitted to hospital, four of whom underwent invasive diagnostic procedures. Thirteen patients (56.5%) received oral itraconazole. All patients recovered, although nine (39.1%) had radiological persisting lung nodules at 12 month follow up.Conclusions: Clinical, laboratory and radiological features of histoplasmosis can mimic other conditions, resulting in unnecessary invasive diagnostic procedures. However, a history of travel to endemic areas and of exposure to risk factors (such as visits to caves and presence of bats) should trigger the clinical suspicion of histoplasmosis. Treatment may be indicated in severe or prolonged disease.
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Affiliation(s)
- Silvia Staffolani
- SOD Malattie Infettive Emergenti e Degli Immunodepressi, Azienda Ospedaliero Universitaria, Ospedali Riuniti di Ancona, Ancona, Italy
| | - Niccolò Riccardi
- Department of Infectious - Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Verona, Italy
| | - Claudio Farina
- UOC Microbiologia e Virologia, Azienda Socio-Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Italy
| | - Giuliana Lo Cascio
- Microbiology and Virology Operating Unit, Department of Pathology and Diagnostic, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Maurizio Gulletta
- Department of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili General Hospital, Brescia, Italy
| | - Federico Gobbi
- Department of Infectious - Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Verona, Italy
| | - Paola Rodari
- Department of Infectious - Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Verona, Italy
| | - Tamara Ursini
- Department of Infectious - Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Verona, Italy
| | - Giulia Bertoli
- Department of Infectious - Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Verona, Italy
| | - Niccolò Ronzoni
- Department of Infectious - Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Verona, Italy.,Department of Clinical and Experimental Medicine, School of Infectious Diseases and Tropical Medicine, University of Sassari, Sassari, Italy
| | - Zeno Bisoffi
- Department of Infectious - Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Verona, Italy.,Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Andrea Angheben
- Department of Infectious - Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Verona, Italy
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Bongomin F, Kwizera R, Denning DW. Getting Histoplasmosis on the Map of International Recommendations for Patients with Advanced HIV Disease. J Fungi (Basel) 2019; 5:jof5030080. [PMID: 31480775 PMCID: PMC6787619 DOI: 10.3390/jof5030080] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 08/23/2019] [Accepted: 08/30/2019] [Indexed: 01/10/2023] Open
Abstract
Progressive disseminated histoplasmosis, caused by H. capsulatum, is a life-threatening illness and is an AIDS-defining opportunistic infection. It is neglected, worryingly under-diagnosed, and often misdiagnosed as cancer or tuberculosis with fatal consequences. Globally, over 100,000 cases of disseminated histoplasmosis have been estimated. In 2017, the World Health Organization (WHO) noted that disseminated histoplasmosis is a significant cause of mortality in AIDS patients. Through the rigorous efforts of the Global Action Fund for Fungal Infections (GAFFI) and partners, in 2019, the Histoplasma antigen test was included on the 2nd Edition of the WHO List of Essential Diagnostics. The drugs used in the treatment of histoplasmosis (amphotericin B and itraconazole) are on the WHO Essential Medicine List. The Manaus Declaration on histoplasmosis in the Americas and the Caribbean, where histoplasmosis kills more people with HIV than tuberculosis, advocates for universal access to rapid testing for histoplasmosis and availability of essential drugs for the treatment of histoplasmosis in every country by 2025. Hyperendemic areas are present in the Americas, Caribbean, Southeast Asia, and Latin America. In conclusion, histoplasmosis remains an important clinical and public health problem. To reduce HIV-associated mortality, disseminated histoplasmosis must be addressed through advocacy, increased awareness, and universal access to essential diagnostics and antifungal agents.
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Affiliation(s)
- Felix Bongomin
- Department of Medical Microbiology & Immunology, Faculty of Medicine, Gulu University, P.O. Box 166, Gulu, Uganda.
- Global Action Fund for Fungal Infections, Rue Le Corbusier 12, 1208 Geneva, Switzerland.
| | - Richard Kwizera
- Infectious Diseases Institute, College of Health Sciences, Makerere University, P.O. Box 22418, Kampala, Uganda
- Makerere University Lung Institute, College of Health Sciences, Makerere University, P.O. Box 7749, Kampala, Uganda
| | - David W Denning
- Global Action Fund for Fungal Infections, Rue Le Corbusier 12, 1208 Geneva, Switzerland
- The National Aspergillosis Centre, Wythenshawe Hospital, The University of Manchester, Manchester Academic Health Science Centre, Manchester, M23 9LT, UK
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12
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Caceres DH, Valdes A. Histoplasmosis and Tuberculosis Co-Occurrence in People with Advanced HIV. J Fungi (Basel) 2019; 5:jof5030073. [PMID: 31404979 PMCID: PMC6787747 DOI: 10.3390/jof5030073] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 08/05/2019] [Accepted: 08/07/2019] [Indexed: 12/11/2022] Open
Abstract
Distinguishing between histoplasmosis, tuberculosis (TB), and co-occurrence of disease is a frequent dilemma for clinical staff treating people with advanced Human Immunodeficiency Virus (HIV) infection. This problem is most frequently observed in clinical settings in countries where both diseases are endemic. It is also a challenge outside these endemic countries in HIV clinics that take care of patients coming from countries with endemic histoplasmosis and TB. The gold standard for diagnosis of both of these diseases is based on conventional laboratory tests (culture, histopathology and special stains). These tests have several limitations, such as lack of laboratory infrastructure for handling isolates (biosafety level 3), shortage of laboratory staff who have appropriate training and experience, variable analytical performance of tests and long turn-around time. Recently, novel rapid assays for the diagnosis of histoplasmosis and TB became available. However, this technology is not yet widely used. Mortality in immunocompromised patients, such as people with advanced HIV, is directly linked with the ability to rapidly diagnose opportunistic diseases. The aim of this review is to synthesize the main aspects of epidemiology, clinical characteristics, diagnosis and treatment of histoplasmosis/TB co-occurrence in people with advanced HIV.
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Affiliation(s)
- Diego H Caceres
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
- Studies in Translational Microbiology and Emerging Diseases (MICROS) Research Group, School of Medicine and Health Sciences, Universidad del Rosario, 11011 Bogota, Colombia.
| | - Audrey Valdes
- Service de Maladies Infectieuses et Tropicales, Centre Hospitalier de Cayenne, 97306 Cayenne, French Guiana.
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Almeida MDA, Almeida-Silva F, Guimarães AJ, Almeida-Paes R, Zancopé-Oliveira RM. The occurrence of histoplasmosis in Brazil: A systematic review. Int J Infect Dis 2019; 86:147-156. [PMID: 31330326 DOI: 10.1016/j.ijid.2019.07.009] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 07/09/2019] [Accepted: 07/13/2019] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Histoplasmosis is a systemic disease caused by the dimorphic fungus Histoplasma capsulatum. Diagnosis is often delayed, or it is misdiagnosed as tuberculosis. In Brazil, the infection is common and cases of histoplasmosis have been described in all regions of the country; however, the real problem is underestimated since notification of histoplasmosis is not mandatory. METHODS Human histoplasmosis cases diagnosed in Brazil and published up to December 2018 were identified through a search conducted in the PubMed/MEDLINE, SciELO, and Web of Science databases. Moreover, the isolation of H. capsulatum from animals or environmental sources in Brazil was also evaluated. RESULTS A total of 207 articles fulfilled the inclusion criteria and were evaluated, involving a total of 3530 patients with a diagnosis of histoplasmosis during the period studied. Of these patients, 78.3% were male, giving a male-to-female ratio of approximately 4:1. Histoplasmosis presented a higher frequency in individuals between the fourth and fifth decades of life. Disseminated disease was the most common form of histoplasmosis. Isolation of H. capsulatum on culture media and histopathology using staining methods were the diagnostic methods with the best efficiency. The best results in the identification of the H. capsulatum were achieved for samples from mononuclear phagocyte system components, skin and mucosa, and hematological samples. Regarding predisposing factors for histoplasmosis, HIV infection was the most common underlying condition. The overall mortality rate was 33.1%. CONCLUSIONS This study represents the first available systematic review demonstrating Brazilian cases of histoplasmosis in the literature and highlights that the disease is more widespread in the Brazilian territory than has previously been thought.
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Affiliation(s)
- Marcos de Abreu Almeida
- Laboratório de Micologia, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil
| | - Fernando Almeida-Silva
- Laboratório de Micologia, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil
| | | | - Rodrigo Almeida-Paes
- Laboratório de Micologia, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil
| | - Rosely Maria Zancopé-Oliveira
- Laboratório de Micologia, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil.
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Seroprevalence of Histoplasmosis in Somali, Burmese, and Hmong Refugees Residing in Thailand and Kenya. J Immigr Minor Health 2019; 20:334-338. [PMID: 28474198 DOI: 10.1007/s10903-017-0595-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Histoplasmosis is known to be endemic to the Midwestern United States, but cases have been reported throughout much of the world. Somali, Hmong, and Burmese (ethnically Karen) persons make up some of the largest refugee populations coming the United States in recent years. Yet, information about risk of Histoplasma capsulatum infection amongst these populations is limited. This study used the CDC Migrant Serum Bank to test ~100 samples from each of Somali, Burmese, and Hmong U.S.-bound refugees. Samples were tested by enzyme immunoassay for Histoplasma capsulatum IgG. Overall 1% (2/299) of refugee serum samples were positive for H. capsulatum IgG. One of 99 samples obtained from Hmong refugees was positive, and the other positive sample came from among 100 Burmese refugee samples. H capsulatum IgG positivity was detected at low levels in Hmong and Burmese refugees. No IgG positivity was detected among 100 Somali refugees.
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15
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Bahr NC, Panackal AA, Durkin MM, Smedema ML, Keown W, Davis TE, Raymond-Guillen L, Park YD, Marr KA, Fries BC, Williamson PR, Boulware DR, Wheat LJ. Cryptococcal meningitis is a cause for cross-reactivity in cerebrospinal fluid assays for anti-Histoplasma, anti-Coccidioides and anti-Blastomyces antibodies. Mycoses 2019; 62:268-273. [PMID: 30565753 DOI: 10.1111/myc.12882] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 12/07/2018] [Accepted: 12/12/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND/OBJECTIVES Antibody detection is commonly used for diagnosis of histoplasmosis, and cross-reactions have been recognised due to endemic mycoses but not cryptococcosis. We observed cross-reactions in an anti-Histoplasma antibody enzyme immunoassay (EIA) in the cerebrospinal fluid (CSF) from a patient with cryptococcal meningitis and sought to assess the risk of cross-reactive anti-Histoplasma antibodies in persons with cryptococcal meningitis. METHODS An anti-cryptococcal antibody EIA was developed to measure CSF antibody response in HIV-infected subjects from Kampala, Uganda and previously healthy, HIV-negative subjects at the National Institutes of Health (NIH) with cryptococcal meningitis. Specimens were tested for cross-reactivity in assays for IgG anti-Histoplasma, anti-Blastomyces and anti-Coccidioides antibodies. RESULTS Among 61 subjects with cryptococcal meningitis (44 Kampala cohort, 17 NIH cohort), elevated CSF anti-cryptococcal antibody levels existed in 38% (23/61). Of the 23 CSF specimens containing elevated anti-cryptococcal antibodies, falsely positive results were detected in antibody EIAs for histoplasmosis (8/23, 35%), coccidioidomycosis (6/23, 26%) and blastomycosis (1/23, 4%). Overall, 2% (2/81) of control CSF specimens had elevated anti-cryptococcal antibody detected, both from Indiana. CONCLUSIONS Cryptococcal meningitis may cause false-positive results in the CSF for antibodies against Histoplasma, Blastomyces and Coccidioides. Fungal antigen testing should be performed to aid in differentiating true- and false-positive antibody results in the CSF.
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Affiliation(s)
- Nathan C Bahr
- Division of Infectious Diseases, Department of Medicine, University of Kansas, Kansas City, Kansas
| | - Anil A Panackal
- Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | | | | | - Wesley Keown
- MiraVista Diagnostics, Indianapolis, Indianapolis, Indiana
| | - Thomas E Davis
- Department of Pathology and Laboratory Medicine, Indiana University, Indianapolis, Indiana
| | - Luke Raymond-Guillen
- Division of Infectious Diseases, Department of Medicine, Indiana University, Indianapolis, Indiana
| | - Yoon-Dong Park
- Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Kieren A Marr
- Division of Infectious Disease, Department of Medicine Johns Hopkins, Baltimore, Maryland
| | - Bettina C Fries
- Division of Infectious Disease, Department of Medicine, Stony Brook School of Medicine, Stony Brook, New York
| | - Peter R Williamson
- Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - David R Boulware
- Division of Infectious Disease and International Medicine, Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - L Joseph Wheat
- MiraVista Diagnostics, Indianapolis, Indianapolis, Indiana
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Spec A, Connolly P, Montejano R, Wheat LJ. In vitro activity of isavuconazole against fluconazole-resistant isolates of Histoplasma capsulatum. Med Mycol 2018; 56:834-837. [PMID: 29253204 DOI: 10.1093/mmy/myx130] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2017] [Accepted: 10/24/2017] [Indexed: 11/13/2022] Open
Abstract
No clinical trials for histoplasmosis have been performed with the newer azoles, leaving itraconazole as the azole of choice. In vitro studies suggest that Histoplasma capsulatum from patients that relapse on fluconazole has higher minimum inhibitory concentrations (MICs) to fluconazole and voriconazole but not itraconazole and posaconazole. The newest azole, isavuconazole, shares structural similarity to voriconazole, but to date nobody has explored emergence of resistance. In vitro susceptibilities to isavucoanzole and fluconazole were performed on previously obtained isolates from the patients who relapsed on fluconazole therapy. Susceptibilities were determined by NCCLS method M27A developed for yeasts, as modified for H. capsulatum. The change in the MIC from the primary to the relapse isolate was tested using Wilcoxon Rank-Sum for paired data. Among the primary isolates, the median MICs were 1.0 (range 0.25 to 4.0) μg/ml for fluconazole and ≤0.007 (range ≤0.007 to 0.015) μg/ml for isavuconazole. In the group of relapsed isolates, the median MICs rose to 8.0 (range 0.25 to 64.0) μg/ml for fluconazole and remained unchanged at ≤0.007 (range ≤0.007 to 0.015) μg/ml for isavuconazole (P < .001). Only one isolate exhibited a nonsignificant increase in MIC to isavuconazole. Histoplasma isolates from patients who relapsed on fluconazole did not have an elevation in MICs to isavuconazole. This differs from the results previously seen with voriconazole and suggests that despite a closer structural similarity to voriconazole than itraconazole and posaconazole, isavuconazole has a higher barrier to resistance and may be effective as therapy for histoplasmosis.
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Affiliation(s)
- Andrej Spec
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | | | - Rocio Montejano
- Internal Medicine - HIV Unit, Hospital La Paz-IdiPAZ, Madrid, Spain
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18
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Epidemiology of fungal infections in China. Front Med 2018; 12:58-75. [DOI: 10.1007/s11684-017-0601-0] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2017] [Accepted: 10/23/2017] [Indexed: 01/19/2023]
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Oladele RO, Ayanlowo OO, Richardson MD, Denning DW. Histoplasmosis in Africa: An emerging or a neglected disease? PLoS Negl Trop Dis 2018; 12:e0006046. [PMID: 29346384 PMCID: PMC5773084 DOI: 10.1371/journal.pntd.0006046] [Citation(s) in RCA: 105] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Histoplasmosis in Africa has markedly increased since the advent of the HIV/AIDS epidemic but is under-recognised. Pulmonary histoplasmosis may be misdiagnosed as tuberculosis (TB). In the last six decades (1952-2017), 470 cases of histoplasmosis have been reported. HIV-infected patients accounted for 38% (178) of the cases. West Africa had the highest number of recorded cases with 179; the majority (162 cases) were caused by Histoplasma capsulatum var. dubuosii (Hcd). From the Southern African region, 150 cases have been reported, and the majority (119) were caused by H. capsulatum var. capsulatum (Hcc). There have been 12 histoplasmin skin test surveys with rates of 0% to 35% positivity. Most cases of Hcd presented as localised lesions in immunocompetent persons; however, it was disseminated in AIDS patients. Rapid diagnosis of histoplasmosis in Africa is only currently possible using microscopy; antigen testing and PCR are not available in most of Africa. Treatment requires amphotericin B and itraconazole, both of which are not licensed or available in several parts of Africa.
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Affiliation(s)
- Rita O. Oladele
- Department of Medical Microbiology and Parasitology, Faculty of Basic Medical Sciences, College of Medicine, University of Lagos, Lagos, Nigeria
- Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Olusola O. Ayanlowo
- Department of Medicine, Faculty of Clinical Sciences, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Malcolm D. Richardson
- Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
- Mycology Reference Centre Manchester, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - David W. Denning
- Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
- National Aspergillosis Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, United Kingdom
- Global Action Fund for Fungal Infections, Geneva, Switzerland
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