1
|
Villareal K, Price A, Pasqualotto AC, Bahr NC. The Current and Future States of Diagnostic Tests for Histoplasmosis with a Focus on People with HIV and Disseminated Histoplasmosis. J Fungi (Basel) 2023; 9:793. [PMID: 37623564 PMCID: PMC10456117 DOI: 10.3390/jof9080793] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 07/21/2023] [Accepted: 07/24/2023] [Indexed: 08/26/2023] Open
Abstract
Histoplasmosis is caused by Histoplasma capsulatum and, although endemic in large parts of the world, is often underrecognized in many locations. In addition to underrecognition, inadequate availability of diagnostic tests is a major contributor to poor outcomes in disseminated disease in people with HIV. For those with advanced HIV and disseminated disease, antibody testing is less useful. Culture and histopathology can be useful in this situation, but each has limitations, including variable sensitivity by site and, in the case of culture, the need for a biosafety level three laboratory and a long period of growth. Antigen testing has proven useful for disseminated histoplasmosis due to the excellent sensitivity of urine. Yet, turnaround is slower than ideal due to use in a limited number of centers. The development of lateral flow assays has the potential to make for true rapid point-of-care assays for histoplasmosis, but in order to meet that promise, the tests must be widely available and affordable.
Collapse
Affiliation(s)
- Kenneth Villareal
- Division of Infectious Diseases, Department of Medicine, University of Kansas Medical Center, Kansas City, KS 66160, USA; (K.V.); (A.P.)
| | - Austin Price
- Division of Infectious Diseases, Department of Medicine, University of Kansas Medical Center, Kansas City, KS 66160, USA; (K.V.); (A.P.)
| | - Alessandro C. Pasqualotto
- Department of Clinical Medicine and Post-Graduation Program in Pathology, Universidade Federal de Ciências da Saúde, Porto Alegre 90050-170, Brazil;
| | - Nathan C. Bahr
- Division of Infectious Diseases, Department of Medicine, University of Kansas Medical Center, Kansas City, KS 66160, USA; (K.V.); (A.P.)
| |
Collapse
|
2
|
Wilmes D, Hagen F, Verissimo C, Alanio A, Rickerts V, Buitrago MJ. A multicentre external quality assessment: A first step to standardise PCR protocols for the diagnosis of histoplasmosis and coccidioidomycosis. Mycoses 2023. [PMID: 37169736 DOI: 10.1111/myc.13603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 04/25/2023] [Accepted: 04/27/2023] [Indexed: 05/13/2023]
Abstract
BACKGROUND In-house real-time PCR (qPCR) is increasingly used to diagnose the so-called endemic mycoses as commercial assays are not widely available. OBJECTIVES To compare the performance of different molecular diagnostic assays for detecting Histoplasma capsulatum and Coccidioides spp. in five European reference laboratories. METHODS Two blinded external quality assessment (EQA) panels were sent to each laboratory that performed the analysis with their in-house assays. Both panels included a range of concentrations of H. capsulatum (n = 7) and Coccidioides spp. (n = 6), negative control and DNA from other fungi. Four laboratories used specific qPCRs, and one laboratory a broad-range fungal conventional PCR (cPCR) and a specific cPCR for H. capsulatum with subsequent sequencing. RESULTS qPCR assays were the most sensitive for the detection of H. capsulatum DNA. The lowest amount of H. capsulatum DNA detected was 1-4 fg, 0.1 pg and 10 pg for qPCRs, specific cPCR and broad-range cPCR, respectively. False positive results occurred with high concentrations of Blastomyces dermatitidis DNA in two laboratories and with Emergomyces spp. in one laboratory. For the Coccidioides panel, the lowest amount of DNA detected was 1-16 fg by qPCRs and 10 pg with the broad-range cPCR. One laboratory reported a false positive result by qPCR with high load of Uncinocarpus DNA. CONCLUSION All five laboratories were able to correctly detect H. capsulatum and Coccidioides spp. DNA and qPCRs had a better performance than specific cPCR and broad-range cPCR. EQAs may help standardise in-house molecular tests for the so-called endemic mycoses improving patient management.
Collapse
Affiliation(s)
- Dunja Wilmes
- FG16, Unit for Mycotic and Parasitic Agents and Mycobacteria, Robert Koch Institute, Berlin, Germany
| | - Ferry Hagen
- Westerdijk Fungal Biodiversity Institute (WI-KNAW), Utrecht, The Netherlands
- Institute for Biodiversity and Ecosystem Dynamics, University of Amsterdam, Amsterdam, The Netherlands
- Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Cristina Verissimo
- Department of Infectious Diseases, Reference Laboratory for Parasites and Fungal infections, Instituto Nacional de Saúde Dr. Ricardo Jorge, Lisbon, Portugal
| | - Alexandre Alanio
- Mycology Department, Translational Mycology Research Group, National Reference Center for Invasive Mycoses and Antifungals, Institut Pasteur, Université Paris Cité, Paris, France
- Laboratoire de Parasitologie-Mycologie, AP-HP, Hôpital Saint-Louis, Paris, France
| | - Volker Rickerts
- FG16, Unit for Mycotic and Parasitic Agents and Mycobacteria, Robert Koch Institute, Berlin, Germany
- Konsiliarlabor für Kryptokokkose und Seltene Systemmykosen, Robert Koch Institute, Berlin, Germany
| | - Maria José Buitrago
- Reference Mycology Laboratory, National Centre for Microbiology, Instituto de Salud Carlos III, Madrid, Spain
- CIBERINFEC, ISCIII-CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain
| |
Collapse
|
3
|
Ramírez JA, Reyes-Montes MDR, Rodríguez-Arellanes G, Pérez-Torres A, Taylor ML. Central Nervous System Histoplasmosis: An Updated Insight. Pathogens 2023; 12:pathogens12050681. [PMID: 37242351 DOI: 10.3390/pathogens12050681] [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: 03/02/2023] [Revised: 04/06/2023] [Accepted: 04/14/2023] [Indexed: 05/28/2023] Open
Abstract
Histoplasmosis is one of the systemic mycoses that can involve the Central Nervous System (CNS), and it is caused by the dimorphic ascomycete species of the Histoplasma capsulatum complex. Once in the CNS, this pathogen causes life-threatening injuries that are associated with clinical manifestations of meningitis, focal lesions (abscesses, histoplasmomas), and spinal cord injuries. The present review provides updated data and highlights a particular vision regarding this mycosis and its causative agent, as well as its epidemiology, clinical forms, pathogenesis, diagnosis, and therapy, focusing on the CNS.
Collapse
Affiliation(s)
- José Antonio Ramírez
- Unidad de Micología, Departamento de Microbiología-Parasitología, Facultad de Medicina, Universidad Nacional Autónoma de México (UNAM), CDMX, Mexico City 04510, Mexico
| | - María Del Rocío Reyes-Montes
- Unidad de Micología, Departamento de Microbiología-Parasitología, Facultad de Medicina, Universidad Nacional Autónoma de México (UNAM), CDMX, Mexico City 04510, Mexico
| | - Gabriela Rodríguez-Arellanes
- Unidad de Micología, Departamento de Microbiología-Parasitología, Facultad de Medicina, Universidad Nacional Autónoma de México (UNAM), CDMX, Mexico City 04510, Mexico
| | - Armando Pérez-Torres
- Departamento de Biología Celular y Tisular, Facultad de Medicina, Universidad Nacional Autónoma de México (UNAM), CDMX, Mexico City 04510, Mexico
| | - Maria Lucia Taylor
- Unidad de Micología, Departamento de Microbiología-Parasitología, Facultad de Medicina, Universidad Nacional Autónoma de México (UNAM), CDMX, Mexico City 04510, Mexico
| |
Collapse
|
4
|
Molecular Diagnosis of Endemic Mycoses. J Fungi (Basel) 2022; 9:jof9010059. [PMID: 36675880 PMCID: PMC9866865 DOI: 10.3390/jof9010059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 12/22/2022] [Accepted: 12/24/2022] [Indexed: 01/03/2023] Open
Abstract
Diagnosis of endemic mycoses is still challenging. The moderated availability of reliable diagnostic methods, the lack of clinical suspicion out of endemic areas and the limitations of conventional techniques result in a late diagnosis that, in turn, delays the implementation of the correct antifungal therapy. In recent years, molecular methods have emerged as promising tools for the rapid diagnosis of endemic mycoses. However, the absence of a consensus among laboratories and the reduced availability of commercial tests compromises the diagnostic effectiveness of these methods. In this review, we summarize the advantages and limitations of molecular methods for the diagnosis of endemic mycoses.
Collapse
|
5
|
Earp E, Gordon PM, Tan A, Page I, Thum CK, Mackenzie AI, Johnson E, Biswas A. Disseminated Mucocutaneous Histoplasmosis Diagnosed in the United Kingdom, Presumably as a Result of Recrudescence Decades After Primary Infection Following Immunosuppressive Treatment of Its Mimic, Sarcoidosis: A Multidisciplinary Cautionary Tale. Am J Dermatopathol 2022; 44:984-988. [PMID: 36197058 DOI: 10.1097/dad.0000000000002235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
ABSTRACT Histoplasmosis is a dimorphic fungal infection, which is rare outside endemic pockets in North, Central, and South America, Asia, and Africa. Herein, we describe a woman in her 80s living in the Scottish Borders region of the United Kingdom with a recent diagnosis of granulomatous rosacea, who on receiving escalating immunosuppression for suspected sarcoidosis, and long-standing rheumatoid arthritis developed a striking eruption involving her eyelids along with painful ulceration of the oral and nasal mucosa. Histopathologic examination of the skin and mucosal lesions demonstrated granulomatous inflammation with numerous yeast forms of fungal organisms with morphological characteristics of Histoplasma species. This was confirmed to be H. capsulatum on fungal culture and direct panfungal polymerase chain reaction assay. Although the patient had not left the United Kingdom for more than 20 years, she gave a travel history involving multiple trips to countries where histoplasmosis is known to occur, before that. This case exemplifies the challenges involved in making a diagnosis of histoplasmosis in nonendemic regions for both clinicians and pathologists alike. In this particular patient, the diagnostic difficulties were compounded by the clinicopathological overlap with other cutaneous and systemic granulomatous disorders like granulomatous rosacea and suspected sarcoidosis and also the exceptionally long latency period between the purported historical primary infection and recent recrudescence. We highlight this unusual case to increase an awareness of histoplasmosis, which is very rare in nonendemic regions like the United Kingdom and involves cases acquired during residence in or travel to endemic areas, to ensure its prompt recognition and treatment.
Collapse
Affiliation(s)
- Eleanor Earp
- Department of Dermatology, Lauriston Building, Edinburgh, United Kingdom
| | | | - Adrian Tan
- Rheumatology, Borders General Hospital, Melrose, United Kingdom
| | - Iain Page
- Regional Infectious Disease Unit, Western General Hospital, Edinburgh, United Kingdom
| | - Chee K Thum
- Department of Pathology, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | | | - Elizabeth Johnson
- UK National Mycology Reference Laboratory, UK Health Security Agency-South West, Bristol, United Kingdom
- MRC Centre for Medical Mycology, Exeter University, Exeter, United Kingdom; and
| | - Asok Biswas
- Department of Pathology, Western General Hospital and The University of Edinburgh, Edinburgh, United Kingdom
| |
Collapse
|
6
|
Antinori S, Giacomelli A, Corbellino M, Torre A, Schiuma M, Casalini G, Parravicini C, Milazzo L, Gervasoni C, Ridolfo AL. Histoplasmosis Diagnosed in Europe and Israel: A Case Report and Systematic Review of the Literature from 2005 to 2020. J Fungi (Basel) 2021; 7:481. [PMID: 34198597 PMCID: PMC8231918 DOI: 10.3390/jof7060481] [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: 05/13/2021] [Revised: 06/07/2021] [Accepted: 06/10/2021] [Indexed: 12/22/2022] Open
Abstract
Human histoplasmosis is a mycosis caused by two distinct varieties of a dimorphic fungus: Histoplasma capsulatum var. capsulatum and H. capsulatum var. duboisii. In Europe, it is usually imported by migrants and travellers, although there have been some autochthonous cases, especially in Italy; however, most European physicians are unfamiliar with its clinical and pathological picture, particularly among immunocompromised patients without HIV infection. This systematic review of all the cases of histoplasmosis reported in Europe and Israel between 2005 and 2020 identified 728 cases diagnosed in 17 European countries and Israel described in 133 articles. The vast majority were imported (mainly from Central and South America), but there were also seven autochthonous cases (six in Europe and one in Israel). The patients were prevalently males (60.4%), and their ages ranged from 2 to 86 years. The time between leaving an endemic region and the diagnosis of histoplasmosis varied from a few weeks to more than 40 years. Progressive disseminated histoplasmosis was the most frequent clinical picture among people living with HIV infection (89.5%) or a different immunocompromising condition (57.1%), but it was also recorded in 6.2% of immunocompetent patients. Twenty-eight cases were caused by Histoplasma duboisii. Immunocompromised patients without HIV infection had the worst outcomes, with a mortality rate of 32%.
Collapse
Affiliation(s)
- Spinello Antinori
- Luigi Sacco Department of Biomedical and Clinical Sciences, Università di Milano, 20157 Milan, Italy; (A.G.); (M.S.); (G.C.)
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, 20157 Milan, Italy; (M.C.); (A.T.); (L.M.); (C.G.); (A.L.R.)
| | - Andrea Giacomelli
- Luigi Sacco Department of Biomedical and Clinical Sciences, Università di Milano, 20157 Milan, Italy; (A.G.); (M.S.); (G.C.)
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, 20157 Milan, Italy; (M.C.); (A.T.); (L.M.); (C.G.); (A.L.R.)
| | - Mario Corbellino
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, 20157 Milan, Italy; (M.C.); (A.T.); (L.M.); (C.G.); (A.L.R.)
| | - Alessandro Torre
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, 20157 Milan, Italy; (M.C.); (A.T.); (L.M.); (C.G.); (A.L.R.)
| | - Marco Schiuma
- Luigi Sacco Department of Biomedical and Clinical Sciences, Università di Milano, 20157 Milan, Italy; (A.G.); (M.S.); (G.C.)
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, 20157 Milan, Italy; (M.C.); (A.T.); (L.M.); (C.G.); (A.L.R.)
| | - Giacomo Casalini
- Luigi Sacco Department of Biomedical and Clinical Sciences, Università di Milano, 20157 Milan, Italy; (A.G.); (M.S.); (G.C.)
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, 20157 Milan, Italy; (M.C.); (A.T.); (L.M.); (C.G.); (A.L.R.)
| | | | - Laura Milazzo
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, 20157 Milan, Italy; (M.C.); (A.T.); (L.M.); (C.G.); (A.L.R.)
| | - Cristina Gervasoni
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, 20157 Milan, Italy; (M.C.); (A.T.); (L.M.); (C.G.); (A.L.R.)
| | - Anna Lisa Ridolfo
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, 20157 Milan, Italy; (M.C.); (A.T.); (L.M.); (C.G.); (A.L.R.)
| |
Collapse
|
7
|
Bernal-Martínez L, Herrera L, Valero C, de la Cruz P, Ghimpu L, Mesa-Arango AC, Santoni G, Goterris L, Millán R, Buitrago MJ. Differential Diagnosis of Fungal Pneumonias vs. Tuberculosis in AIDS Patients by Using Two New Molecular Methods. J Fungi (Basel) 2021; 7:jof7050336. [PMID: 33925404 PMCID: PMC8145742 DOI: 10.3390/jof7050336] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 04/16/2021] [Accepted: 04/20/2021] [Indexed: 12/30/2022] Open
Abstract
Opportunistic fungal pneumonias (OFP) are the main cause of death in AIDS patients worldwide. Diagnosis of these infections is often late as tuberculosis (TB) is frequently the first suspicion. In addition, diagnostic tools have limitations and are unavailable in disadvantaged regions. To perform the differential diagnosis of the main fungi causing OFP in AIDS patients (Histoplasma capsulatum, Cryptococcus neoformans/C. gattii and Pneumocystis jirovecii) vs. the Mycobacterium tuberculosis complex (MTBC), two new assays were developed: (i) a multiplex real-time PCR (MRT-PCR) and (ii) a simple and cost-effective method based on real-time PCR and the analysis of melting curves after amplification (MC-PCR). Both of the techniques were optimized and standardized “in vitro”, showing a suitable reproducibility (CV ranged between 1.84 and 3.81% and 1.41 and 4.83%, respectively), a 100% specificity and detection limits between 20 and 2 fg of genomic DNA per 20 µL of reaction. A validation study was performed by retrospectively using 42 clinical samples from 37 patients with proven fungal infection or TB, and 33 controls. The overall sensitivity for the MRT-PCR assay and the MC-PCR assay was 88% and 90.4%, respectively. Both techniques were fast, sensitive and reproducible, allowing for the detection of these pathogens and the performance of a differential diagnosis.
Collapse
Affiliation(s)
- Leticia Bernal-Martínez
- Centro Nacional de Microbiología, Mycology Reference Laboratory, Instituto de Salud Carlos III, Majadahonda, 28220 Madrid, Spain; (L.B.-M.); (C.V.); (P.d.l.C.); (L.G.); (A.C.M.-A.); (G.S.); (L.G.)
| | - Laura Herrera
- Centro Nacional de Microbiología, Mycobacteria Unit, Instituto de Salud Carlos III, 28220 Madrid, Spain;
| | - Clara Valero
- Centro Nacional de Microbiología, Mycology Reference Laboratory, Instituto de Salud Carlos III, Majadahonda, 28220 Madrid, Spain; (L.B.-M.); (C.V.); (P.d.l.C.); (L.G.); (A.C.M.-A.); (G.S.); (L.G.)
| | - Paula de la Cruz
- Centro Nacional de Microbiología, Mycology Reference Laboratory, Instituto de Salud Carlos III, Majadahonda, 28220 Madrid, Spain; (L.B.-M.); (C.V.); (P.d.l.C.); (L.G.); (A.C.M.-A.); (G.S.); (L.G.)
| | - Larisa Ghimpu
- Centro Nacional de Microbiología, Mycology Reference Laboratory, Instituto de Salud Carlos III, Majadahonda, 28220 Madrid, Spain; (L.B.-M.); (C.V.); (P.d.l.C.); (L.G.); (A.C.M.-A.); (G.S.); (L.G.)
| | - Ana C. Mesa-Arango
- Centro Nacional de Microbiología, Mycology Reference Laboratory, Instituto de Salud Carlos III, Majadahonda, 28220 Madrid, Spain; (L.B.-M.); (C.V.); (P.d.l.C.); (L.G.); (A.C.M.-A.); (G.S.); (L.G.)
| | - Gabriela Santoni
- Centro Nacional de Microbiología, Mycology Reference Laboratory, Instituto de Salud Carlos III, Majadahonda, 28220 Madrid, Spain; (L.B.-M.); (C.V.); (P.d.l.C.); (L.G.); (A.C.M.-A.); (G.S.); (L.G.)
| | - Lidia Goterris
- Centro Nacional de Microbiología, Mycology Reference Laboratory, Instituto de Salud Carlos III, Majadahonda, 28220 Madrid, Spain; (L.B.-M.); (C.V.); (P.d.l.C.); (L.G.); (A.C.M.-A.); (G.S.); (L.G.)
| | - Rosario Millán
- Department of Microbiology, Hospital Universitario Puerta de Hierro, 28220 Madrid, Spain;
| | - María José Buitrago
- Centro Nacional de Microbiología, Mycology Reference Laboratory, Instituto de Salud Carlos III, Majadahonda, 28220 Madrid, Spain; (L.B.-M.); (C.V.); (P.d.l.C.); (L.G.); (A.C.M.-A.); (G.S.); (L.G.)
- Correspondence:
| |
Collapse
|
8
|
Wagner G, Moertl D, Glechner A, Mayr V, Klerings I, Zachariah C, Van den Nest M, Gartlehner G, Willinger B. Paracoccidioidomycosis Diagnosed in Europe-A Systematic Literature Review. J Fungi (Basel) 2021; 7:157. [PMID: 33672212 PMCID: PMC7926554 DOI: 10.3390/jof7020157] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 02/10/2021] [Accepted: 02/11/2021] [Indexed: 11/19/2022] Open
Abstract
Paracoccidioidomycosis is a systemic mycosis that is endemic in geographical regions of Central and South America. Cases that occur in nonendemic regions of the world are imported through migration and travel. Due to the limited number of cases in Europe, most physicians are not familiar with paracoccidioidomycosis and its close clinical and histopathological resemblance to other infectious and noninfectious disease. To increase awareness of this insidious mycosis, we conducted a systematic review to summarize the evidence on cases diagnosed and reported in Europe. We searched PubMed and Embase to identify cases of paracoccidioidomycosis diagnosed in European countries. In addition, we used Scopus for citation tracking and manually screened bibliographies of relevant articles. We conducted dual abstract and full-text screening of references yielded by our searches. To identify publications published prior to 1985, we used the previously published review by Ajello et al. Overall, we identified 83 cases of paracoccidioidomycosis diagnosed in 11 European countries, published in 68 articles. Age of patients ranged from 24 to 77 years; the majority were male. Time from leaving the endemic region and first occurrence of symptoms considerably varied. Our review illustrates the challenges of considering systemic mycosis in the differential diagnosis of people returning or immigrating to Europe from endemic areas. Travel history is important for diagnostic-workup, though it might be difficult to obtain due to possible long latency period of the disease.
Collapse
Affiliation(s)
- Gernot Wagner
- Department for Evidence-Based Medicine and Evaluation, Danube University Krems, Dr.-Karl-Dorrek-Strasse 30, 3500 Krems, Austria; (A.G.); (V.M.); (I.K.); (C.Z.); (G.G.)
| | - Deddo Moertl
- Clinical Department of Internal Medicine III, University Hospital St. Poelten, Karl Landsteiner University of Health Sciences, Dunant-Platz 1, 3100 St. Poelten, Austria;
| | - Anna Glechner
- Department for Evidence-Based Medicine and Evaluation, Danube University Krems, Dr.-Karl-Dorrek-Strasse 30, 3500 Krems, Austria; (A.G.); (V.M.); (I.K.); (C.Z.); (G.G.)
| | - Verena Mayr
- Department for Evidence-Based Medicine and Evaluation, Danube University Krems, Dr.-Karl-Dorrek-Strasse 30, 3500 Krems, Austria; (A.G.); (V.M.); (I.K.); (C.Z.); (G.G.)
| | - Irma Klerings
- Department for Evidence-Based Medicine and Evaluation, Danube University Krems, Dr.-Karl-Dorrek-Strasse 30, 3500 Krems, Austria; (A.G.); (V.M.); (I.K.); (C.Z.); (G.G.)
| | - Casey Zachariah
- Department for Evidence-Based Medicine and Evaluation, Danube University Krems, Dr.-Karl-Dorrek-Strasse 30, 3500 Krems, Austria; (A.G.); (V.M.); (I.K.); (C.Z.); (G.G.)
| | - Miriam Van den Nest
- Department for Infection Control and Hospital Epidemiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria;
- Division of Clinical Microbiology, Department of Laboratory Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria;
| | - Gerald Gartlehner
- Department for Evidence-Based Medicine and Evaluation, Danube University Krems, Dr.-Karl-Dorrek-Strasse 30, 3500 Krems, Austria; (A.G.); (V.M.); (I.K.); (C.Z.); (G.G.)
- RTI International, 3040 East Cornwallis Road, P.O. Box 12194, Research Triangle Park, NC 27709-2194, USA
| | - Birgit Willinger
- Division of Clinical Microbiology, Department of Laboratory Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria;
| |
Collapse
|
9
|
Toscanini MA, Nusblat AD, Cuestas ML. Diagnosis of histoplasmosis: current status and perspectives. Appl Microbiol Biotechnol 2021; 105:1837-1859. [PMID: 33587157 DOI: 10.1007/s00253-021-11170-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 01/29/2021] [Accepted: 02/03/2021] [Indexed: 11/29/2022]
Abstract
Histoplasmosis is a worldwide-distributed systemic mycosis caused by the dimorphic fungus Histoplasma capsulatum. Its clinical manifestations range from subclinical or mild respiratory illness to progressive disseminated histoplasmosis (PDH), a life-threatening disease, whose accurate diagnosis is still challenging and limited in many countries, where this disease is highly endemic. In this regard, Histoplasma antigen testing is now included in the WHO Essential Diagnostics List. The final diagnosis of histoplasmosis is established by culture and/or visualization of the yeast cells by cytology or histopathology using specific stains. However, both procedures have limited sensitivity to detect the disease and cultures are time-consuming. Antibody detection assays are effective for the subacute and chronic clinical forms of histoplasmosis. However, their sensitivity is low in the immunocompromised host. Several molecular "in-house" tests were also developed and showed promising results, but none of these tests are commercially available and their standardization and validation are still pending. Antigen detection assays have high sensitivity in PDH cases and are of great value for the follow-up of patients with histoplasmosis; however, cross-reactivity with other related fungi are common. In addition, this assay is expensive and only performed in few laboratories. Novel protein antigen candidates have been recently identified and produced by DNA-recombinant techniques in order to obtain standardized and specific reagents for the diagnosis of histoplasmosis, as opposed to the unspecific antigens or crude extracts currently used. This review describes the currently available assays, highlighting their strengths and limitations and reports the latest approaches to achieve reliable and rapid diagnostic tests for histoplasmosis. KEY POINTS: • PDH causes thousands of deaths per year globally. • Rapid accurate diagnosis of PDH is unfeasible in many regions. • Fast, accurate, and low-cost diagnostic alternatives are currently under development.
Collapse
Affiliation(s)
- María Agustina Toscanini
- Facultad de Farmacia y Bioquímica, CONICET, Instituto de Nanobiotecnología (NANOBIOTEC), Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Alejandro David Nusblat
- Facultad de Farmacia y Bioquímica, CONICET, Instituto de Nanobiotecnología (NANOBIOTEC), Universidad de Buenos Aires, Buenos Aires, Argentina
| | - María Luján Cuestas
- CONICET, Instituto de Investigaciones en Microbiología y Parasitología Médica (IMPaM), Universidad de Buenos Aires, Buenos Aires, Argentina.
| |
Collapse
|
10
|
Diagnosis of Breakthrough Fungal Infections in the Clinical Mycology Laboratory: An ECMM Consensus Statement. J Fungi (Basel) 2020; 6:jof6040216. [PMID: 33050598 PMCID: PMC7712958 DOI: 10.3390/jof6040216] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 10/06/2020] [Accepted: 10/07/2020] [Indexed: 12/11/2022] Open
Abstract
Breakthrough invasive fungal infections (bIFI) cause significant morbidity and mortality. Their diagnosis can be challenging due to reduced sensitivity to conventional culture techniques, serologic tests, and PCR-based assays in patients undergoing antifungal therapy, and their diagnosis can be delayed contributing to poor patient outcomes. In this review, we provide consensus recommendations on behalf of the European Confederation for Medical Mycology (ECMM) for the diagnosis of bIFI caused by invasive yeasts, molds, and endemic mycoses, to guide diagnostic efforts in patients receiving antifungals and support the design of future clinical trials in the field of clinical mycology. The cornerstone of lab-based diagnosis of breakthrough infections for yeast and endemic mycoses remain conventional culture, to accurately identify the causative pathogen and allow for antifungal susceptibility testing. The impact of non-culture-based methods are not well-studied for the definite diagnosis of breakthrough invasive yeast infections. Non-culture-based methods have an important role for the diagnosis of breakthrough invasive mold infections, in particular invasive aspergillosis, and a combination of testing involving conventional culture, antigen-based assays, and PCR-based assays should be considered. Multiple diagnostic modalities, including histopathology, culture, antibody, and/or antigen tests and occasionally PCR-based assays may be required to diagnose breakthrough endemic mycoses. A need exists for diagnostic tests that are effective, simple, cheap, and rapid to enable the diagnosis of bIFI in patients taking antifungals.
Collapse
|
11
|
de Oliveira MS, Fernandes TB, de Lima Medeiros Y, de Abreu Guimarães LD, Sanches GT, de Carvalho MF, Vilela EM. Diagnosis at different stages of paracoccidioidomycosis with oral manifestation: Report of two cases. J Mycol Med 2020; 30:101025. [PMID: 32855057 DOI: 10.1016/j.mycmed.2020.101025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 06/21/2020] [Accepted: 07/31/2020] [Indexed: 12/18/2022]
Abstract
Paracocciodiomycosis (PCDM) is a chronic systemic fungal infection, mainly affecting residents and rural workers, being characterized by a long incubation period, which it can take months or years without clinical manifestations, making diagnosis late and difficult. Depending on the stage of the disease, it can cause sequelae and low quality of life, so its correct diagnosis is of great importance for the accurate treatment. Therefore, the aim of this report is to present two cases of diagnosis of patients with PCDM at different stages, who developed chronic manifestations, pain, clinical involvement of the oral cavity and in one case also presented lung injury with fibrosis, as well as to weight loss, dysphagia and cachexia. Both of patients were treated with antifungal therapy and it was observed total remission of the lesions and no recurrences were detected.
Collapse
Affiliation(s)
- M S de Oliveira
- Dentistry Student, Federal University of Juiz de Fora, Minas Gerais, Brazil
| | - T B Fernandes
- Dentistry Student, Federal University of Juiz de Fora, Minas Gerais, Brazil
| | - Y de Lima Medeiros
- Dentistry Student, Federal University of Juiz de Fora, Minas Gerais, Brazil
| | | | - G T Sanches
- Department of Stomatology, University of São Paulo, São Paulo, Brazil
| | - M F de Carvalho
- Department of Dental Clinical, Federal University of Juiz de Fora, Minas Gerais, Brazil
| | - E M Vilela
- Department of Dental Clinical, Federal University of Juiz de Fora, Minas Gerais, Brazil.
| |
Collapse
|
12
|
Buitrago MJ, Martín-Gómez MT. Timely Diagnosis of Histoplasmosis in Non-endemic Countries: A Laboratory Challenge. Front Microbiol 2020; 11:467. [PMID: 32269555 PMCID: PMC7109444 DOI: 10.3389/fmicb.2020.00467] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 03/04/2020] [Indexed: 12/18/2022] Open
Abstract
Human histoplasmosis is a fungal infection caused by the inhalation of microconidia of the thermally dimorphic fungi Histoplasma capsulatum. Autochthonous cases of histoplasmosis have been diagnosed in almost every country, but it is considered an endemic infection in specific areas of the world. Many of them are popular travel destinations or the source of migratory movements. Thus, the vast majority of the registered cases in non-endemic countries are imported. They correspond to people having been exposed to the fungus in endemic locations as immigrants, expatriates, transient workers or tourists, with reported cases also associated to organ donation. Misdiagnosis and delays in initiation of treatment are not uncommon in cases of imported histoplasmosis. They are associated to high fatality-rates specially in patients with compromised cellular immunity in which progressive disseminated forms develop. The diagnosis of this infection in non-endemic countries is hampered by the lack of clinical suspicion and a dearth of available diagnostic tools adequate to offer rapid and accurate results. Non-culture-based assays such as nucleic-acid amplification tests present as a suitable alternative in this situation, offering improved sensitivity and specificity, shortened turnaround time, and increased biosafety by avoiding culture manipulation. In non-endemic regions, molecular techniques are being used mainly in laboratories from countries that have registered an increase in the incidence of imported cases. However, the number of published techniques is limited and lack consensus. Efforts are currently under way to standardize nucleic acid amplification-based techniques for its implementation in areas registering a rising number of imported cases.
Collapse
Affiliation(s)
- María José Buitrago
- Mycology Reference Laboratory, National Centre of Microbiology, Instituto de Salud Carlos III, Madrid, Spain
| | | |
Collapse
|
13
|
Endemic Fungi in Transplant and Immunocompromised Hosts: Epidemiology, Diagnosis, Treatment, and Prevention. CURRENT TREATMENT OPTIONS IN INFECTIOUS DISEASES 2020. [DOI: 10.1007/s40506-020-00212-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
14
|
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: 143] [Impact Index Per Article: 35.8] [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.
Collapse
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.
| |
Collapse
|
15
|
Souza RADL, Bonan PRF, Pinto MBR, Prado JD, de Castro JFL, Carvalho EJDA, Perez DEDC. Oral paracoccidioidomycosis in a non-endemic region from Brazil: A short case series. J Clin Exp Dent 2019; 11:e865-e870. [PMID: 31636854 PMCID: PMC6797468 DOI: 10.4317/jced.56199] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 09/09/2019] [Indexed: 11/25/2022] Open
Abstract
Background Although the paracoccidioidomycosis (PCM) is endemic in Brazil, the occurrence in most states from the North and Northeastern Brazil is very unusual. The aim of this study was to evaluate the clinicopathologic features of a case series of oral PCM in a non-endemic region from Brazil (Northeastern region), discussing the clinical and histopathological differential diagnoses of the oral manifestations of the disease. Material and Methods Between 2000 and 2017, all cases of oral PCM were retrieved from the Oral Pathology Laboratory, Universidade Federal de Pernambuco, located at Northeastern Brazil. Clinical data, such as age, gender, origin, occupation, site, symptoms, time of complaints, clinical presentation, number of lesions, and clinical hypotheses of diagnosis, were collected from the clinical charts. All cases were histologically reviewed in hematoxylin-eosin and Gomori-Grocott staining. Results Six cases were identified. All patients were male, with a mean age of 53.8 years (ranging from 40 to 73 years). Four cases appeared as multiple ulcers and two presented single lesions (buccal mucosa and hard palate). Clinically, in five cases, squamous cell carcinoma was considered in the differential diagnosis. The common histopathological features consisted of hyperplastic epithelium, intraepithelial microabscesses, and formation of granulomatous chronic inflammatory reaction in a fibrous connective tissue with severe chronic inflammatory reaction. Yeasts were observed either inside of multinucleated giant cells or extracellularly. Conclusions Although rare in non-endemic regions, oral PCM should be considered in the differential diagnosis of oral chronic ulcers, mainly those multiple. Key words:Oral mucosa, mycology, paracoccidoidomycosis, ulcer.
Collapse
Affiliation(s)
- Reydson-Alcides-de Lima Souza
- DDS, MSc student, Piracicaba Dental School, Oral Pathology Area, State University of Campinas, Piracicaba, São Paulo, Brazil
| | - Paulo-Rogério-Ferreti Bonan
- DDS, PhD, School of Dentistry, Stomatology Unit, Universidade Federal da Paraíba, João Pessoa, Paraíba, Brazil
| | | | - José-Divaldo Prado
- DDS, A. C. Camargo Cancer Center, Department of Stomatology, São Paulo, São Paulo, Brazil
| | - Jurema-Freire-Lisboa de Castro
- DDS, PhD, Professor, School of Dentistry, Oral Pathology Unit, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil
| | | | - Danyel-Elias-da Cruz Perez
- DDS, PhD, Professor, School of Dentistry, Oral Pathology Unit, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil
| |
Collapse
|
16
|
Histoplasmosis aguda importada en un adolescente con sospecha de síndrome linfoproliferativo. Arch Bronconeumol 2019; 55:342-344. [DOI: 10.1016/j.arbres.2018.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Accepted: 11/06/2018] [Indexed: 11/17/2022]
|
17
|
Staffolani S, Buonfrate D, Angheben A, Gobbi F, Giorli G, Guerriero M, Bisoffi Z, Barchiesi F. Acute histoplasmosis in immunocompetent travelers: a systematic review of literature. BMC Infect Dis 2018; 18:673. [PMID: 30563472 PMCID: PMC6299618 DOI: 10.1186/s12879-018-3476-z] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Accepted: 10/31/2018] [Indexed: 11/15/2022] Open
Abstract
Background Histoplasmosis is a fungal infection highly endemic in the American continent. The disease can be severe in immunocompromised subjects. In immunocompetent subjects the clinical manifestations are variable. Aim of this work was to review the cases of acute histoplasmosis in immunocompetent travelers reported in literature. Methods A systematic review of literature was conducted. Electronic search was performed in Pubmed and LILACS. Two reviewers independently extracted data on demographic, clinical and radiological features, and treatment. Cases were classified according to Wheat’s definitions. Results Seventy-one studies were included in the analysis, comprising a total of 814 patients. Twenty-one patients diagnosed at the Centre of Tropical Diseases, Negrar (VR), Italy were also included. The most common travel destination was Central America (168 people, 29.8%); the most common way of exposure to histoplasma was the exploration of caves and/or contact with bat guano (349 people, 60.9%). The multivariate logistic regression model showed association between the development of disseminated histoplasmosis (DH) and activities that involved the exploration of caves and/or the contact with bats’ guano (adjusted OR: 34.20 95% CI: 5.29 to 220.93) or other outdoor activities (adjusted OR: 4.61 95% CI: 1.09 to 19.56). No significant difference in the attack rate between countries of destination was observed (p-value: 0.8906, Kruskal-Wallis test). Conclusions Histoplasmosis often causes no or mild symptoms in immunocompetent individuals, although a severe syndrome may occur. The infection can mimic other diseases, and the epidemiological risk of exposure is an important clue to raise the index of suspicion. Electronic supplementary material The online version of this article (10.1186/s12879-018-3476-z) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Silvia Staffolani
- Centro per le Malattie Tropicali, IRCCS Istituto di Ricovero e Cura a Carattere Scientifico, Ospedale Sacro Cuore - Don Calabria, Via Don Sempreboni 5, 37024, Verona, Negrar, Italy. .,SOD Malattie Infettive emergenti e degli immunodepressi, Azienda Ospedaliero Universitaria, Ospedali Riuniti di Ancona, Via Conca Torrette, Ancona, Italy.
| | - Dora Buonfrate
- Centro per le Malattie Tropicali, IRCCS Istituto di Ricovero e Cura a Carattere Scientifico, Ospedale Sacro Cuore - Don Calabria, Via Don Sempreboni 5, 37024, Verona, Negrar, Italy
| | - Andrea Angheben
- Centro per le Malattie Tropicali, IRCCS Istituto di Ricovero e Cura a Carattere Scientifico, Ospedale Sacro Cuore - Don Calabria, Via Don Sempreboni 5, 37024, Verona, Negrar, Italy
| | - Federico Gobbi
- Centro per le Malattie Tropicali, IRCCS Istituto di Ricovero e Cura a Carattere Scientifico, Ospedale Sacro Cuore - Don Calabria, Via Don Sempreboni 5, 37024, Verona, Negrar, Italy
| | - Giovanni Giorli
- Centro per le Malattie Tropicali, IRCCS Istituto di Ricovero e Cura a Carattere Scientifico, Ospedale Sacro Cuore - Don Calabria, Via Don Sempreboni 5, 37024, Verona, Negrar, Italy
| | - Massimo Guerriero
- Computer Sciences, Dipartimento di Economia Aziendale, Università degli Studi di Verona, Strada le Grazie, Verona, Italy
| | - Zeno Bisoffi
- Centro per le Malattie Tropicali, IRCCS Istituto di Ricovero e Cura a Carattere Scientifico, Ospedale Sacro Cuore - Don Calabria, Via Don Sempreboni 5, 37024, Verona, Negrar, Italy.,Sezione di Malattie Infettive e Tropicali, Dipartimento di Diagnostica e Sanità Pubblica, Università di Verona, Strada le Grazie, Verona, Italy
| | - Francesco Barchiesi
- Clinica Malattie Infettive, Dipartimento di Scienze Biomediche e Sanità Pubblica, Università Politecnica delle Marche, Azienda Ospedaliera Umberto I° Via Conca Torrette, Ancona, Italy
| |
Collapse
|
18
|
Valero C, Gago S, Monteiro MC, Alastruey-Izquierdo A, Buitrago MJ. African histoplasmosis: new clinical and microbiological insights. Med Mycol 2018; 56:51-59. [PMID: 28431110 DOI: 10.1093/mmy/myx020] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 02/07/2017] [Indexed: 11/13/2022] Open
Abstract
African histoplasmosis is defined as the fungal infection caused by Histoplasma capsulatum var. duboisii (Hcd). Studies focused on distinguishing Hcd and H. capsulatum var. capsulatum (Hcc), which coexist in Africa, are scarce or outdated, and African strains are continuously underrepresented. In this work, 13 cases of African patients with histoplasmosis diagnosed in the Spanish Mycology Reference Laboratory have been reviewed showing that 77% had disseminated disease and AIDS as underlying disease although Hcd infection has been classically considered a rare presentation in AIDS patients. Strains isolated from these patients and other clinical and reference strains were studied by assessing classical identification methods and performing a three-loci multi-locus sequence analysis (MLSA). Classical identification methods based on biochemical tests and measurement of yeast size proved to be useless in distinguishing both varieties. The MLSA defined an African cluster, with a strong statistical support, that included all strains with African origin. Finally, mating type was also determined by using molecular methods revealing an unequal mating type distribution in African strains. In conclusion, historical statements and classical identification methods were useless to distinguish between varieties, whereas molecular analyses revealed that all strains with African origin grouped together suggesting that traditional classification should be revised. Further investigation is required in order to unravel traditional concepts about Hcd infection and support results obtained in this work.
Collapse
Affiliation(s)
- C Valero
- Servicio de Micología. Centro Nacional de Microbiología, Instituto de Salud Carlos III, Ctra. Majadahonda-Pozuelo, Km 2. 28220 Majadahonda (Madrid), Spain
| | - S Gago
- Servicio de Micología. Centro Nacional de Microbiología, Instituto de Salud Carlos III, Ctra. Majadahonda-Pozuelo, Km 2. 28220 Majadahonda (Madrid), Spain
| | - M C Monteiro
- Servicio de Micología. Centro Nacional de Microbiología, Instituto de Salud Carlos III, Ctra. Majadahonda-Pozuelo, Km 2. 28220 Majadahonda (Madrid), Spain
| | - A Alastruey-Izquierdo
- Servicio de Micología. Centro Nacional de Microbiología, Instituto de Salud Carlos III, Ctra. Majadahonda-Pozuelo, Km 2. 28220 Majadahonda (Madrid), Spain
| | - M J Buitrago
- Servicio de Micología. Centro Nacional de Microbiología, Instituto de Salud Carlos III, Ctra. Majadahonda-Pozuelo, Km 2. 28220 Majadahonda (Madrid), Spain
| |
Collapse
|
19
|
de Almeida SM, Salvador GLO, Roza TH, Izycki LF, Dos Santos I, Aragão A, Kulik A, Muro M, Torres LFB, de Noronha L. Geographical evaluation of Neuroparacoccidioidomycosis and Paracoccidioidomycosis in Southern Brazil. Mycoses 2018; 61:587-593. [PMID: 29663530 DOI: 10.1111/myc.12782] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 04/05/2018] [Indexed: 11/30/2022]
Abstract
Paracoccidioidomycosis (PCM) is the most prevalent systemic mycosis among immunocompetent patients in Latin America. This study aimed to describe the expansion over time and the geographical distribution of confirmed Neuroparacoccidioidomycosis (NPCM) and PCM cases, and relate it to environmental characteristics such as climate, soil types and coffee crops. This was a retrospective study of autopsy and biopsy reports between 1951 and 2014 from the Medical Pathology Section of the Hospital de Clinicas, Universidade Federal do Paraná (UFPR), Curitiba, Southern Brazil. PCM was predominant in male agricultural workers. PCM cases predominated in areas with subtropical climate with hot summers in North West Parana state. NPCM cases were distributed statewide more frequent in rural than metropolitan area. There was no association with climate, soil type, or coffee crop culture. Most of the PCM cases were in the metropolitan area of the capital, chiefly due to migration fluxes. Even though the history is predominantly agricultural, PCM cases were distributed mainly in the metropolitan area of the state capital, there was no association with climate and soil. NPCM cases were numerically more frequent in rural than metropolitan area.
Collapse
Affiliation(s)
- Sergio Monteiro de Almeida
- Medical Pathology Department, School of Medicine, Universidade Federal do Paraná, Curitiba, Paraná, Brazil.,Virology Laboratory, Hospital de Clinicas, Universidade Federal do Paraná, Curitiba, Paraná, Brazil.,Faculdades Pequeno Príncipe, Curitiba, Paraná, Brazil.,Instituto de Pesquisa Pelé Pequeno Príncipe, Curitiba, Paraná, Brazil
| | - Gabriel L O Salvador
- Medical Pathology Department, School of Medicine, Universidade Federal do Paraná, Curitiba, Paraná, Brazil
| | - Thiago Henrique Roza
- Medical Pathology Department, School of Medicine, Universidade Federal do Paraná, Curitiba, Paraná, Brazil
| | - Luís Felipe Izycki
- Medical Pathology Department, School of Medicine, Universidade Federal do Paraná, Curitiba, Paraná, Brazil
| | - Isaias Dos Santos
- Medical Pathology Department, School of Medicine, Universidade Federal do Paraná, Curitiba, Paraná, Brazil
| | - Afonso Aragão
- Medical Pathology Department, School of Medicine, Universidade Federal do Paraná, Curitiba, Paraná, Brazil
| | - Amanda Kulik
- Faculdades Pequeno Príncipe, Curitiba, Paraná, Brazil.,Instituto de Pesquisa Pelé Pequeno Príncipe, Curitiba, Paraná, Brazil
| | - Marisol Muro
- Mycology Laboratory, Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, Paraná, Brazil
| | - Luis Fernando Bleggi Torres
- Medical Pathology Department, School of Medicine, Universidade Federal do Paraná, Curitiba, Paraná, Brazil.,Faculdades Pequeno Príncipe, Curitiba, Paraná, Brazil.,Instituto de Pesquisa Pelé Pequeno Príncipe, Curitiba, Paraná, Brazil
| | - Lucia de Noronha
- Medical Pathology Department, School of Medicine, Universidade Federal do Paraná, Curitiba, Paraná, Brazil.,Laboratório de Patologia Experimental, Escola de Medicina- Pontifícia Universidade Católica do Paraná, Curitiba, Paraná, Brazil
| |
Collapse
|
20
|
Molina-Morant D, Sánchez-Montalvá A, Salvador F, Sao-Avilés A, Molina I. Imported endemic mycoses in Spain: Evolution of hospitalized cases, clinical characteristics and correlation with migratory movements, 1997-2014. PLoS Negl Trop Dis 2018; 12:e0006245. [PMID: 29447170 PMCID: PMC5831632 DOI: 10.1371/journal.pntd.0006245] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 02/28/2018] [Accepted: 01/18/2018] [Indexed: 12/04/2022] Open
Abstract
Endemic mycoses are systemic fungal infections. Histoplasmosis is endemic in all temperate areas of the world; coccidioidomycosis and paracoccidioidomycosis are only present in the American continent. These pathogens are not present in Spain, but in the last years there has been an increase of reported cases due to migration and temporary movements. We obtained from the Spanish hospitals records clinical and demographic data of all hospitalized cases between 1997 and 2014. There were 286 cases of histoplasmosis, 94 of Coccidioidomycosis and 25 of paracoccidioidomycosis. Overall, histoplasmosis was strongly related to HIV infection, as well as with greater morbidity and mortality. For the other mycoses, we did not find any immunosuppressive condition in most of the cases. Although we were not able to obtain data about clinical presentation of all the cases, the most frequently found was pulmonary involvement. We also found a temporal correlation between the Spanish population born in endemic countries and the number of hospitalized cases along this period. This study reflects the importance of imported diseases in non-endemic countries due to migratory movements.
Collapse
Affiliation(s)
- Daniel Molina-Morant
- Tropical Medicine Unit, Infectious Diseases Department. PROSICS Barcelona (International Health Program of the Catalan Health Institute), Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Adrián Sánchez-Montalvá
- Tropical Medicine Unit, Infectious Diseases Department. PROSICS Barcelona (International Health Program of the Catalan Health Institute), Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Fernando Salvador
- Tropical Medicine Unit, Infectious Diseases Department. PROSICS Barcelona (International Health Program of the Catalan Health Institute), Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Augusto Sao-Avilés
- Tropical Medicine Unit, Infectious Diseases Department. PROSICS Barcelona (International Health Program of the Catalan Health Institute), Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Israel Molina
- Tropical Medicine Unit, Infectious Diseases Department. PROSICS Barcelona (International Health Program of the Catalan Health Institute), Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| |
Collapse
|
21
|
Endemic Fungal Infection Recommendations for Solid-Organ Transplant Recipients and Donors. Transplantation 2018; 102:S52-S59. [DOI: 10.1097/tp.0000000000002020] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
|
22
|
de Almeida SM, Roza TH, Salvador GLO, Izycki LF, Locatelli G, Santos ID, Aragão A, Torres LFB, de Noronha LH. Autopsy and biopsy study of paracoccidioidomycosis and neuroparacoccidioidomycosis with and without HIV co-infection. Mycoses 2018; 61:237-244. [PMID: 29274088 DOI: 10.1111/myc.12737] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 12/13/2017] [Accepted: 12/16/2017] [Indexed: 11/29/2022]
Abstract
Paracoccidioidomycosis (PCM) is a systemic mycosis prevalent among immunocompetent patients in Latin America. This study aimed to describe the frequency, demographics and clinical characteristics of central nervous system PCM (NPCM) and PCM in an endemic region, and the impact of human immunosuppression virus (HIV) co-infection. This was a retrospective study of autopsy and biopsy reports from the Medical Pathology Section of the Hospital de Clinicas, UFPR, Curitiba, Southern Brazil, between 1951 and 2014. PCM was present in 0.1% of 378,323 cases examined, with 5.7% being NPCM. Infection was prevalent in working-age men, agricultural workers and rural residents. Numbers of HIV autopsy cases increased over time, while those of PCM cases decreased. Prevalence of co-infection of HIV/PCM and HIV/NPCM was 1.6%, and 0.4%, respectively. Adrenals were affected more frequently in the NPCM group compared with the PCM group. Mortality was higher on NPCM group. The clinical course of PCM in HIV patients resembles an acute/sub-acute infection. Association of NPCM and HIV is rare, while diagnosis of NPCM is difficult, it should be considered a differential diagnosis in HIV patients who live in, or have visited, endemic areas and present with neurological symptoms.
Collapse
Affiliation(s)
- Sergio Monteiro de Almeida
- Medical Patology Departament, Medicine School, Universidade Federal do Paraná, Curitiba, Brazil.,Virology Laboratory, Hospital de Clinicas, Universidade Federal do Paraná, Curitiba, Brazil.,Faculdades Pequeno Príncipe, Curitiba, Brazil.,Instituto de Pesquisa Pelé Pequeno Príncipe, Curitiba, Brazil
| | - Thiago Henrique Roza
- Medical Patology Departament, Medicine School, Universidade Federal do Paraná, Curitiba, Brazil
| | - Gabriel L O Salvador
- Medical Patology Departament, Medicine School, Universidade Federal do Paraná, Curitiba, Brazil
| | - Luís Felipe Izycki
- Medical Patology Departament, Medicine School, Universidade Federal do Paraná, Curitiba, Brazil
| | - Giuliana Locatelli
- Medical Patology Departament, Medicine School, Universidade Federal do Paraná, Curitiba, Brazil
| | - Isaias Dos Santos
- Medical Patology Departament, Medicine School, Universidade Federal do Paraná, Curitiba, Brazil
| | - Afonso Aragão
- Medical Patology Departament, Medicine School, Universidade Federal do Paraná, Curitiba, Brazil
| | - Luis Fernando Bleggi Torres
- Medical Patology Departament, Medicine School, Universidade Federal do Paraná, Curitiba, Brazil.,Faculdades Pequeno Príncipe, Curitiba, Brazil.,Instituto de Pesquisa Pelé Pequeno Príncipe, Curitiba, Brazil
| | - Lucia Helena de Noronha
- Medical Patology Departament, Medicine School, Universidade Federal do Paraná, Curitiba, Brazil.,Laboratório de Patologia Experimental, Escola de Medicina- Pontifícia Universidade Católica do Paraná, Curitiba, Brazil
| |
Collapse
|
23
|
|
24
|
Trindade AH, Meira HC, Pereira IF, de Lacerda JCT, de Mesquita RA, Santos VR. Oral paracoccidioidomycosis: Retrospective analysis of 55 Brazilian patients. Mycoses 2017; 60:521-525. [PMID: 28422366 DOI: 10.1111/myc.12622] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 03/07/2017] [Accepted: 03/08/2017] [Indexed: 11/29/2022]
Abstract
Paracoccidioidomycosis (PCM) is a rare fungal infection in the world, but endemic and acquired exclusively in Latin America, with the highest prevalence in South America and Brazil, particularly. Changes in oral cavity are common and constitute the first clinical manifestation in many patients. The aim of this study was to describe the prevalence of oral PCM and analyse the profile of the disease and patients. Retrospective research, consisting of information present in the medical records in the period 1998-2015, whose histopathological diagnosis was oral PCM. Fifty-five oral PCM cases were confirmed. Of these patients, 90.9% were males and 9.1% were females. The average age was 49.66 years and the most reported occupation was rural workers. The painful symptomatology was present in 61.82% of patients. Erythematous lesions were predominant in 73% of them. In single lesions (22 cases), the most common locations were jugal mucosa and tongue. In multiple involvement (30 cases), the most affected regions were lips, jugal mucosa and alveolar ridge. Epidemiology of PCM, was similar to several other studies, especially in Brazil. This is the most important fungal infection in Latin America and the recognition of oral lesions is extremely important, as is often the first and in many cases the only manifestation of the disease.
Collapse
Affiliation(s)
- Aline Heloísa Trindade
- Department of Clinical Pathology and Surgery, School of Dentistry, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Henrique Côrtes Meira
- Department of Clinical Pathology and Surgery, School of Dentistry, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Igor Figueiredo Pereira
- Department of Clinical Pathology and Surgery, School of Dentistry, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | | | - Ricardo Alves de Mesquita
- Department of Clinical Pathology and Surgery, School of Dentistry, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Vagner Rodrigues Santos
- Department of Clinical Pathology and Surgery, School of Dentistry, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| |
Collapse
|
25
|
Gundacker ND, Rolfe RJ, Rodriguez JM. Infections associated with adventure travel: A systematic review. Travel Med Infect Dis 2017; 16:3-10. [PMID: 28351605 PMCID: PMC7185378 DOI: 10.1016/j.tmaid.2017.03.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 03/20/2017] [Accepted: 03/21/2017] [Indexed: 12/16/2022]
Abstract
AIM To review infections associated with adventure travel. METHODS The PubMed, Embase and Scopus databases were searched combining the words infection with the following keywords: rafting, whitewater, surfing, (surfer* or windsurf*), (caves or caving or spelunking), (triathlon or trekking) or (hiking or adventure race), bicycling, backpacking, (mountain climb* or bouldering), horseback riding, orienteering, trekking, and skiing. RESULTS Adventure travel is becoming much more common among travelers and it is associated with a subset of infectious diseases including: leptospirosis, schistosomiasis, viral hemorrhagic fevers, rickettsial diseases and endemic mycosis. Caving and whitewater rafting places individuals at particular risk of leptospirosis, schistosomiasis and endemic mycosis, while adventure races also place individuals at high risk of a variety of infections including campylobacter, norovirus and leptospirosis. CONCLUSION Travel practitioners need to be aware of the risks associated with adventure travel and should educate individuals about the risks associated with various activities. Doxycycline prophylaxis should be considered for travelers who are susceptible to leptospirosis due to participation in high-risk sports such as whitewater rafting, caving or adventure races.
Collapse
Affiliation(s)
- Nathan D Gundacker
- University of Alabama at Birmingham, 1900 University Blvd, THT 229, Birmingham, AL 35294, United States.
| | - Robert J Rolfe
- University of Alabama at Birmingham, 1900 University Blvd, THT 229, Birmingham, AL 35294, United States.
| | - J Martin Rodriguez
- University of Alabama at Birmingham, 1900 University Blvd, THT 229, Birmingham, AL 35294, United States.
| |
Collapse
|
26
|
Wagner G, Moertl D, Eckhardt A, Sagel U, Wrba F, Dam K, Willinger B. Chronic Paracoccidioidomycosis with adrenal involvement mimicking tuberculosis - A case report from Austria. Med Mycol Case Rep 2016; 14:12-16. [PMID: 27995053 PMCID: PMC5154971 DOI: 10.1016/j.mmcr.2016.12.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 11/30/2016] [Accepted: 12/01/2016] [Indexed: 11/16/2022] Open
Abstract
Paracoccidioidomycosis is a systemic fungal infection caused by Paracoccidioides brasiliensis and endemic in certain areas of Central and South America. We report a case of a 62-year-old-man with a complex history of tuberculosis and imaging findings of a cerebral lesion and bilateral adrenal enlargement. Biopsy of adrenal gland revealed Paracoccidioides brasiliensis. This case highlights the importance of travel history for diagnosis of paracoccidioidomycosis in non-endemic areas and emphasizes the clinical and histopathological similarities with tuberculosis.
Collapse
Affiliation(s)
- Gernot Wagner
- Clinical Department of Internal Medicine II, University Hospital St. Poelten, Karl Landsteiner University of Health Sciences, Propst-Fuehrer-Strasse 4, 3100 St. Poelten, Austria; Department for Evidence-based Medicine and Clinical Epidemiology, Danube University Krems, Dr.-Karl-Dorrek-Strasse 30, 3500 Krems, Austria
| | - Deddo Moertl
- Clinical Department of Internal Medicine III, University Hospital St. Poelten, Karl Landsteiner University of Health Sciences, Propst-Fuehrer-Strasse 4, 3100 St. Poelten, Austria
| | - Axel Eckhardt
- Clinical Department of Internal Medicine II, University Hospital St. Poelten, Karl Landsteiner University of Health Sciences, Propst-Fuehrer-Strasse 4, 3100 St. Poelten, Austria
| | - Ulrich Sagel
- Institute for Hygiene and Microbiology, University Hospital St. Poelten, Karl Landsteiner University of Health Sciences, Propst-Fuehrer-Strasse 4, 3100 St. Poelten, Austria
| | - Friedrich Wrba
- Department of Clinical Pathology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Karl Dam
- Clinical Department of Internal Medicine II, University Hospital St. Poelten, Karl Landsteiner University of Health Sciences, Propst-Fuehrer-Strasse 4, 3100 St. Poelten, Austria
| | - Birgit Willinger
- Division of Clinical Microbiology, Department of Laboratory Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| |
Collapse
|
27
|
Alves da Costa T, Di Gangi R, Thomé R, Barreto Felisbino M, Pires Bonfanti A, Lumi Watanabe Ishikawa L, Sartori A, Burger E, Verinaud L. Severe Changes in Thymic Microenvironment in a Chronic Experimental Model of Paracoccidioidomycosis. PLoS One 2016; 11:e0164745. [PMID: 27736987 PMCID: PMC5063316 DOI: 10.1371/journal.pone.0164745] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Accepted: 09/29/2016] [Indexed: 12/26/2022] Open
Abstract
T cell maturation takes place within the thymus, a primary lymphoid organ that is commonly targeted during infections. Previous studies showed that acute infection with Paracoccidioides brasiliensis (Pb), the causative agent of paracoccidioidomycosis (PCM), promotes thymic atrophy that is associated with the presence of yeast cells in the organ. However, as human PCM is a chronic infection, it is imperative to investigate the consequences of Pb infection over the thymic structure and function in chronic infection. In this sense, we developed a new experimental model where Pb yeast cells are injected through the intraperitoneal route and mice are evaluated over 120 days of infection. Thymuses were analyzed in chronically infected mice and we found that the thymus underwent extensive morphological alterations and severe infiltration of P. brasiliensis yeast cells. Further analyses showed an altered phenotype and function of thymocytes that are commonly found in peripheral mature T lymphocytes. We also observed activation of the NLRP3 inflammasome in the thymus. Our data provide new information on the severe changes observed in the thymic microenvironment in a model of PCM that more closely mimics the human infection.
Collapse
Affiliation(s)
- Thiago Alves da Costa
- Department of Structural and Functional Biology, Institute of Biology, University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Rosária Di Gangi
- Department of Structural and Functional Biology, Institute of Biology, University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Rodolfo Thomé
- Department of Structural and Functional Biology, Institute of Biology, University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Marina Barreto Felisbino
- Department of Structural and Functional Biology, Institute of Biology, University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Amanda Pires Bonfanti
- Department of Structural and Functional Biology, Institute of Biology, University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Larissa Lumi Watanabe Ishikawa
- Department of Microbiology and Immunology, Institute of Biosciences of Botucatu, Univ. Estadual Paulista (UNESP), Botucatu, São Paulo, Brazil
| | - Alexandrina Sartori
- Department of Microbiology and Immunology, Institute of Biosciences of Botucatu, Univ. Estadual Paulista (UNESP), Botucatu, São Paulo, Brazil
| | - Eva Burger
- Department of Microbiology and Immunology, Institute of Biomedical Sciences, Federal University of Alfenas (UNIFAL-MG), Alfenas, Minas Gerais, Brazil
| | - Liana Verinaud
- Department of Structural and Functional Biology, Institute of Biology, University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
- * E-mail:
| |
Collapse
|
28
|
Duong TN, Waldman SE. Importance of a Travel History in Evaluation of Respiratory Infections. CURRENT EMERGENCY AND HOSPITAL MEDICINE REPORTS 2016; 4:141-152. [PMID: 32226655 PMCID: PMC7100244 DOI: 10.1007/s40138-016-0109-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
PURPOSE OF REVIEW International travel has increased at a fast pace and will continue to rapidly rise. Concomitantly, with this increase in travel is the increase in post travel-related diseases, such as respiratory illnesses. Identifying the cause of the posttravel respiratory illness is a complex challenge for many healthcare professionals because similar presentations occur for both infectious and noninfectious causes. Not only is diagnosis important but also transmission prevention. In the last two decades, there have been several severe infectious respiratory syndromes that have spread through international travel causing epidemics in many countries. RECENT FINDINGS A detailed travel history with the chronology of symptoms paired with the patient's medical risk factors and exposures along with some basic knowledge of infectious respiratory illnesses will help facilitate clinical decision making. This framework will help create a broad, but appropriate differential diagnosis to guide clinical workup, prevent delays in diagnosis, and implement the appropriate precautions to prevent transmission if appropriate. SUMMARY The foundation to diagnosing a travel-related respiratory illness lies within integrating the patient's travel history, comorbid conditions, clinical presentation, exposures, and mode of transmission. A timely and accurate diagnosis benefits not only the patient but also the surrounding community to prevent further individual transmission, epidemics, and pandemics.
Collapse
Affiliation(s)
- Theresa N. Duong
- Division of Hospital Medicine, Department of Internal Medicine, University of California, Davis Medical Center, Sacramento, CA USA
| | - Sarah E. Waldman
- Division of Infectious Diseases, Department of Internal Medicine, University of California, Davis Medical Center, Sacramento, CA USA
| |
Collapse
|
29
|
Muraosa Y, Toyotome T, Yahiro M, Watanabe A, Shikanai-Yasuda MA, Kamei K. Detection of Histoplasma capsulatum from clinical specimens by cycling probe-based real-time PCR and nested real-time PCR. Med Mycol 2015; 54:433-8. [PMID: 26705837 DOI: 10.1093/mmy/myv106] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 11/19/2015] [Indexed: 11/13/2022] Open
Abstract
We developed new cycling probe-based real-time PCR and nested real-time PCR assays for the detection of Histoplasma capsulatum that were designed to detect the gene encoding N-acetylated α-linked acidic dipeptidase (NAALADase), which we previously identified as an H. capsulatum antigen reacting with sera from patients with histoplasmosis. Both assays specifically detected the DNAs of all H. capsulatum strains but not those of other fungi or human DNA. The limited of detection (LOD) of the real-time PCR assay was 10 DNA copies when using 10-fold serial dilutions of the standard plasmid DNA and 50 DNA copies when using human serum spiked with standard plasmid DNA. The nested real-time PCR improved the LOD to 5 DNA copies when using human serum spiked with standard plasmid DNA, which represents a 10-fold higher than that observed with the real-time PCR assay. To assess the ability of the two assays to diagnose histoplasmosis, we analyzed a small number of clinical specimens collected from five patients with histoplasmosis, such as sera (n = 4), formalin-fixed paraffin-embedded (FFPE) tissue (n = 4), and bronchoalveolar lavage fluid (BALF) (n = 1). Although clinical sensitivity of the real-time PCR assay was insufficiently sensitive (33%), the nested real-time PCR assay increased the clinical sensitivity (77%), suggesting it has a potential to be a useful method for detecting H. capsulatum DNA in clinical specimens.
Collapse
Affiliation(s)
- Yasunori Muraosa
- Medical Mycology Research Center, Chiba University, Chiba, Japan
| | - Takahito Toyotome
- Research Unit for Risk Analysis, Diagnostic Center for Animal Health and Food Safety, Obihiro University of Agriculture and Veterinary Medicine, Hokkaido, Japan
| | - Maki Yahiro
- Medical Mycology Research Center, Chiba University, Chiba, Japan
| | - Akira Watanabe
- Medical Mycology Research Center, Chiba University, Chiba, Japan
| | - Maria Aparecida Shikanai-Yasuda
- Laboratory of Immunology, Hospital das Clínicas, Faculdade de Medicina, University of São Paulo and Department of Infectious and Parasitic Diseases, Faculdade de Medicina, University of São Paulo, São Paulo, Brazil
| | - Katsuhiko Kamei
- Medical Mycology Research Center, Chiba University, Chiba, Japan
| |
Collapse
|
30
|
Bahr NC, Antinori S, Wheat LJ, Sarosi GA. Histoplasmosis infections worldwide: thinking outside of the Ohio River valley. CURRENT TROPICAL MEDICINE REPORTS 2015; 2:70-80. [PMID: 26279969 PMCID: PMC4535725 DOI: 10.1007/s40475-015-0044-0] [Citation(s) in RCA: 144] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
In the United States, histoplasmosis is generally thought to occur mainly in the Ohio and Mississippi River Valleys, and the classic map of histoplasmosis distribution reflecting this is second nature to many U.S. physicians. With the advent of the HIV pandemic reports of patients with progressive disseminated histoplasmosis and AIDS came from regions of known endemicity, as well as from regions not thought to be endemic for histoplasmosis throughout the world. In addition, our expanding armamentarium of immunosuppressive medications and biologics has increased the diagnosis of histoplasmosis worldwide. While our knowledge of areas in which histoplasmosis is endemic has improved, it is still incomplete. Our contention is that physicians should consider histoplasmosis with the right constellations of symptoms in any febrile patient with immune suppression, regardless of geographic location or travel history.
Collapse
Affiliation(s)
- Nathan C Bahr
- Division of Infectious Diseases and International Medicine, Department of Medicine, University of Minnesota, Minneapolis, MN, USA
- Department of Medicine, University of Minnesota, Minneapolis MN, USA
| | - Spinello Antinori
- Department of Clinical and Biomedical Sciences, “Luigi Sacco,” III Division of Infectious Diseases, University of Milano, Milano, Italy
| | | | - George A. Sarosi
- Department of Medicine, University of Minnesota, Minneapolis MN, USA
- Department of Medicine, Minneapolis Veterans Affairs Medical Center, Minneapolis MN, USA
| |
Collapse
|
31
|
Coutinho ZF, Wanke B, Travassos C, Oliveira RM, Xavier DR, Coimbra CEA. Hospital morbidity due to paracoccidioidomycosis in Brazil (1998-2006). Trop Med Int Health 2015; 20:673-680. [PMID: 25645820 DOI: 10.1111/tmi.12472] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To analyse hospital morbidity records due to paracoccidioidomycosis in Brazil, including its nationwide distribution in time and space, as well as key epidemiological and sociodemographic characteristics. METHODS Descriptive analysis of hospital morbidity records due to paracoccidioidomycosis covering the period January 1998 to December 2006. Hospital records were obtained from the Hospital Information System of the Brazilian Unified Health System (SIH/SUS). RESULTS There were 6732 hospitalisations (82% male) due to paracoccidioidomycosis in the period, representing 4.3 per 1.0 million inhabitants. Admissions due to this mycosis were recorded in 27% of the 5560 Brazilian municipalities, covering 35% of the country. Ten municipalities concentrated 52% of all admissions. The temporal distribution of admissions for paracoccidioidomycosis showed a slight increase. The geographical analysis showed two distinct patterns of the disease: (i) traditional areas of southern and south-eastern regions, covering 60% of admissions, and (ii) a second pattern in northern Brazil revealed a transverse band of higher concentration with about 27% of admissions, particularly along the southern border of the Amazon region. CONCLUSION This first nationwide analysis of hospitalisation due to paracoccidioidomycosis in Brazil shows that it is the most prevalent systemic mycosis in Brazil. Despite its importance, there are major deficits in its proper registry, diagnostics and treatment. The particular epidemiological and medical challenges of paracoccidioidomycosis will not be met while the disease continues to be perceived as an isolated infectious entity restricted to a few faraway regions of the globe.
Collapse
Affiliation(s)
| | - Bodo Wanke
- Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | | | | | | | | |
Collapse
|
32
|
Antifungal Activity of Decyl Gallate against Several Species of Pathogenic Fungi. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2014; 2014:506273. [PMID: 25505923 PMCID: PMC4258339 DOI: 10.1155/2014/506273] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Revised: 10/13/2014] [Accepted: 10/28/2014] [Indexed: 01/28/2023]
Abstract
This work aims to demonstrate that the gallic acid structure modification to the decyl gallate (G14) compound contributed to increase the antifungal activity against several species of pathogenic fungi, mainly, Candida spp., Cryptococcus spp., Paracoccidioides spp., and Histoplasma capsulatum, according to standardized microdilution method described by Clinical Laboratory Standard Institute (CLSI) documents. Moreover this compound has a particularly good selectivity index value, which makes it an excellent candidate for broad-spectrum antifungal prototype and encourages the continuation of subsequent studies for the discovery of its mechanism of action.
Collapse
|
33
|
|
34
|
|
35
|
López-Martínez R, Hernández-Hernández F, Méndez-Tovar LJ, Manzano-Gayosso P, Bonifaz A, Arenas R, Padilla-Desgarennes MDC, Estrada R, Chávez G. Paracoccidioidomycosis in Mexico: clinical and epidemiological data from 93 new cases (1972-2012). Mycoses 2014; 57:525-30. [PMID: 24698656 DOI: 10.1111/myc.12190] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Revised: 01/15/2014] [Accepted: 02/20/2014] [Indexed: 11/30/2022]
Abstract
Paracoccidioidomycosis (PCM) is an endemic systemic infection in several countries of Latin America. The few registered cases in Mexico most likely do not reflect the real frequency. Disseminate the epidemiological and clinical data of unreported cases of PCM in Mexico from 1972 until 2012 is the aim of this work. Epidemiological and clinical information of non-published cases of PCM was requested from the principal mycological diagnosis centres in Mexico. A total of 93 cases were received. The infection was found predominantly in men (95.7%), peasants (88.5%) and individual between 31 and 60 years of age. Most of the cases were found in tropical areas of the Gulf of Mexico (54.84%) and the Pacific littoral (20.3%). The main sites of dissemination were the oral mucosa (39.38%) and skin (34.05%). The most effective treatments were itraconazole alone and the combination of itraconazole with sulfamethoxazole-trimethoprim. PCM is a subdiagnosed pathology in Mexico. Therefore, adequate training is necessary to determine the current status of this mycosis.
Collapse
Affiliation(s)
- Rubén López-Martínez
- Departamento de Microbiología y Parasitología, Facultad de Medicina, Universidad Nacional Autónoma de México, México, D. F., México
| | | | | | | | | | | | | | | | | |
Collapse
|
36
|
Progressive disseminated histoplasmosis in the HIV population in Europe in the HAART era. Case report and literature review. Infection 2014; 42:611-20. [PMID: 24627267 DOI: 10.1007/s15010-014-0611-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2013] [Accepted: 02/28/2014] [Indexed: 12/16/2022]
Abstract
INTRODUCTION In highly endemic areas, up to 20 % of human immunodeficiency virus (HIV)-infected persons will develop progressive disseminated histoplasmosis (PDH). Europe is not endemic to histoplasmosis, and the disease is mainly found in immigrants often co-infected with HIV. METHODS We present a case of a patient with HIV and PDH highlighting the possible diagnostic difficulties that may arise in a non-endemic area and review the literature of histoplasmosis in the context of HIV infection with special focus on Europe. DISCUSSION When cellular immunity wanes (usually at CD4 T-lymphocyte counts <150 cells/μL) histoplasma infection, acquired earlier, can reactivate and disseminate. PDH is an acquired immune deficiency syndrome(AIDS)-defining disease and a life-threatening infection, with a clinical spectrum ranging from an acute, fatal course with lung infiltrates and respiratory failure, shock, coagulopathy and multi-organ failure, to a more subacute disease with focal organ involvement, pancytopenia and hepatosplenomegaly. Mortality rates remain high for untreated patients, but early diagnosis, proper antifungal treatment and early initiation of antiretroviral therapy have improved the prognosis. CONCLUSION European infectious diseases physicians, microbiologists and pathologists must be aware of histoplasmosis, particularly when facing HIV-infected immigrants from endemic areas. This is increasingly important due to migration and travel activities from these areas.
Collapse
|
37
|
[Aspergillus galactomannan assay for the management of histoplasmosis due to Histoplasma capsulatum var. duboisii in HIV-infected patients: education from a clinical case]. J Mycol Med 2014; 24:166-70. [PMID: 24636196 DOI: 10.1016/j.mycmed.2014.01.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Revised: 12/06/2013] [Accepted: 01/06/2014] [Indexed: 11/21/2022]
Abstract
The diagnosis of histoplasmosis due to Histoplasma capsulatum var capsulatum is based on a direct examination identifying encapsulated yeast with narrow-based budding. Galactomannan antigenemia facilitates diagnosis, as well as the monitoring of patients receiving treatment. The case of a HIV-positive patient from Congo-Brazzaville with a disseminated form of African histoplasmosis highlighted the positive galactomannan antigen in this disease due to Histoplasma capsulatum var duboisii. Galactomannan antigenemia remained high with a very slow decrease during antifungal therapy and slow regression of clinical lesions. African histoplasmosis is a rare disease that is difficult to diagnose and rarely described in immunocompromised patients, in whom differential diagnosis can be common. This observation underlines the importance of the galactomannan antigen assay in patients who have travelled to endemic areas. As in the case of Histoplasma capsulatum var capsulatum, the positivity of the Aspergillus galactomannan antigen is very useful in the diagnosis and monitoring of African histoplasmosis.
Collapse
|
38
|
Buitrago MJ, Canteros CE, Frías De León G, González Á, Marques-Evangelista De Oliveira M, Muñoz CO, Ramirez JA, Toranzo AI, Zancope-Oliveira R, Cuenca-Estrella M. Comparison of PCR protocols for detecting Histoplasma capsulatum DNA through a multicenter study. Rev Iberoam Micol 2013; 30:256-60. [DOI: 10.1016/j.riam.2013.03.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2012] [Revised: 02/28/2013] [Accepted: 03/04/2013] [Indexed: 10/26/2022] Open
|
39
|
Bocca AL, Amaral AC, Teixeira MM, Sato PK, Shikanai-Yasuda MA, Soares Felipe MS. Paracoccidioidomycosis: eco-epidemiology, taxonomy and clinical and therapeutic issues. Future Microbiol 2013; 8:1177-91. [DOI: 10.2217/fmb.13.68] [Citation(s) in RCA: 140] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Acquired by inhalation of the thermal dimorphic fungi Paracoccidioides spp. conidia, paracoccidioidomycosis ranges from symptomatic to severe and potentially fatal disseminated disease. The main focus of this review is to highlight clinical aspects of paracoccidioidomycosis and, its pathogens’ diversity ecology and particularities. In addition, we present strategies for therapy, including DNA vaccines and nanostructured drugs. Molecular and morphological data supported the split of the Paracoccidioides genus into two species, Paracoccidioides brasiliensis and Paracoccidioides lutzii. An acute form of the disease affects approximately 5% of cases and involves the phagocytic mononuclear system, resulting in progressive lymphadenopathy. The chronic form affects adult men and frequently involves lungs, skin and mucous membranes, lymph nodes, and adrenal glands. The clinical manifestations depend on the ability of the host to control the fungal multiplication and dissemination. The long survival time of the fungus in the host tissues allows it to evade immune responses; therefore, successful treatment often requires long-time therapy. The consensus for treatment must consider the severity of the disease and includes sulfone derivatives, amphotericin B and azoles. Novel strategies for therapy, based on DNA vaccines and nanostructured drugs are also presented and discussed in this review.
Collapse
Affiliation(s)
| | - André Corrêa Amaral
- Biotechnology, Institute of Tropical Pathology & Public Health, Universidade Federal de Goiás, Goiania, GO, Brazil
| | | | - Paula Keiko Sato
- Laboratory of Clinical Immunology, Hospital das Clínicas, Faculdade de Medicina, University of São Paulo, Brazil
| | - Maria Aparecida Shikanai-Yasuda
- Laboratory of Clinical Immunology, Hospital das Clínicas, Faculdade de Medicina, University of São Paulo, Brazil
- Department of Infectious & Parasitic Diseases, Faculdade de Medicina, University of São Paulo, São Paulo, Brazil
| | | |
Collapse
|
40
|
Ardizzoni A, Baschieri MC, Manca L, Salvadori C, Marinacci G, Farina C, Viale P, Blasi E. The mycoarray as an aid for the diagnosis of an imported case of histoplasmosis in an Italian traveler returning from Brazil. J Travel Med 2013; 20:336-9. [PMID: 23992579 DOI: 10.1111/jtm.12060] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2013] [Revised: 06/14/2013] [Accepted: 06/17/2013] [Indexed: 11/27/2022]
Abstract
We describe an imported case of histoplasmosis, whose serological profile was established by means of a protein-based microarray platform, the recently described mycoarray. Because of its peculiarities, such a novel tool greatly facilitates the rapid and multiparametric assessment of patients' serological status and lends itself to be employed as an aid in the diagnosis of primary mycoses, especially in nonendemic countries.
Collapse
Affiliation(s)
- Andrea Ardizzoni
- Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | | | | | | | | | | | | | | |
Collapse
|
41
|
Marchiori E, Ferreira EC, Zanetti G, Hochhegger B. Whole-body magnetic resonance imaging for the evaluation of thoracic involvement in disseminated paracoccidioidomycosis. J Bras Pneumol 2013; 39:248-50. [PMID: 23670513 PMCID: PMC4075830 DOI: 10.1590/s1806-37132013000200019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
|
42
|
Denis B, Lortholary O. [Pulmonary fungal infection in patients with AIDS]. Rev Mal Respir 2013; 30:682-95. [PMID: 24182654 DOI: 10.1016/j.rmr.2013.02.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2011] [Accepted: 02/07/2013] [Indexed: 01/15/2023]
Abstract
Fungal infections are the most common opportunistic infections (OI) occurring during the course of HIV infection, though their incidence has decreased dramatically with the introduction of highly active antiretroviral therapy (cART). Most cases occur in untreated patients, noncompliant patients or patients whose multiple antiretroviral regimens have failed and they are a good marker of the severity of cellular immunodepression. Pneumocystis jiroveci pneumonia is the second most frequent OI in France and cryptococcosis remains a major problem in the Southern Hemisphere. With the increase in travel, imported endemic fungal infection can occur and may mimic other infections, notably tuberculosis. Fungal infections often have a pulmonary presentation but an exhaustive search for dissemination should be made in patients infected with HIV, at least those at an advanced stage of immune deficiency. Introduction of cART in combination with anti-fungal treatment depends on the risk of AIDS progression and on the risk of cumulative toxicity and the immune reconstitution inflammatory syndrome (IRIS) if introduced too early. Fungal infections in HIV infected patients remain a problem in the cART era. IRIS can complicate the management and requires an optimised treatment regime.
Collapse
Affiliation(s)
- B Denis
- Service des maladies infectieuses et tropicales, centre d'infectiologie Necker-Pasteur, université Paris Descartes, hôpital Necker-Enfants-Malades, 149, rue de Sèvres, 75743 Paris cedex 15, France
| | | |
Collapse
|
43
|
Abstract
Paracoccidioidomycosis is an endemic systemic mycosis that predominates in southern Mexico, parts of Central America, and South America. It is caused by a dimorphic fungus and is generally acquired through the lungs, from where it disseminates. Paracoccidioidomycosis has different clinical manifestations that require differentiation with tuberculosis, Hodgkin disease, several systemic and subcutaneous mycoses, and squamous cell carcinoma. Diagnosis is made by finding the organism in a biopsy specimen and isolating it in fungal culture. Treatment includes sulfamethoxazole-trimethoprim for mild forms and itraconazole for moderate cases. Fluconazole and voriconazole can be used for meningeal involvement, and amphotericin B is indicated for severe disease.
Collapse
Affiliation(s)
- Sílvio Alencar Marques
- Department of Dermatology and Radiotherapy, Botucatu Medical School, São Paulo State University (UNESP), Rua Costa Leite 515, 18600-010, Botucatu, São Paulo, Brazil.
| |
Collapse
|
44
|
Cottle LE, Gkrania-Klotsas E, Williams HJ, Brindle HE, Carmichael AJ, Fry G, Beeching NJ. A multinational outbreak of histoplasmosis following a biology field trip in the Ugandan rainforest. J Travel Med 2013; 20:83-7. [PMID: 23464714 DOI: 10.1111/jtm.12012] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2012] [Revised: 11/17/2012] [Accepted: 11/19/2012] [Indexed: 12/26/2022]
Abstract
BACKGROUND Outbreaks of histoplasmosis have been increasingly reported in association with travel to endemic areas. Multiple outbreaks have been reported following travel to the Americas, but reports of pulmonary histoplasmosis in short-term immunocompetent travelers to Africa are rare. METHODS A biology student was referred to our unit with suspected pulmonary histoplasmosis following her return from a field trip in the Ugandan rainforest. The patient informed us that several of her multinational student colleagues on the same expedition had developed a similar illness. Using an alert in ProMED-mail and a questionnaire forwarded to each of the symptomatic students, we accumulated data on the other cases involved in this apparent outbreak of pulmonary histoplasmosis. RESULTS Thirteen of 24 students developed respiratory symptoms following the expedition. Chest X-ray appearances were often suggestive of miliary tuberculosis but in most cases a final diagnosis of histoplasmosis was made (confirmed with serology in five cases, clinically diagnosed in six, and retrospectively suspected in two). Detailed questioning indicated that the likely source was a large hollow bat-infested tree within the rainforest. CONCLUSIONS This is an unusual outbreak of histoplasmosis following short-term travel to Africa. Pulmonary histoplasmosis should always be considered in the differential diagnosis of an acute febrile respiratory illness in travelers returning from endemic areas or reporting activities suggesting exposure.
Collapse
Affiliation(s)
- Lucy E Cottle
- Tropical and Infectious Disease Unit, Royal Liverpool University Hospital, Liverpool, UK.
| | | | | | | | | | | | | |
Collapse
|
45
|
Igami TZ, Solano F, Preti RC, Pagliari C, Takahashi WY, Hida RY. Retinal involvement of Paracoccioidomycosis: A Case Report. Trop Med Health 2013; 40:149-53. [PMID: 23532715 PMCID: PMC3598072 DOI: 10.2149/tmh.2012-27] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2012] [Accepted: 10/24/2012] [Indexed: 11/13/2022] Open
Abstract
Purpose: to describe the clinicopathologic features and treatment of a rare case of systemic paracoccidioidomycosis with choroidal and retinal involvement. Design: retrospective interventional case report. Participant: A 36-year-old young man with visual impairment in left eye with anterior uveitis and presence of whitish perimacular choroidal nodule, multiple underlying whitish spots and mid-periphery exudative retinal detachment. A primary extensive work-up for systemic infectious, autoimmune, neoplasic or inflammatory conditions was performed and high-resolution computer tomography scan demonstrated asymmetric parietal thickening of the trachea and bilateral diffuse multiple lobular opacities. Pulmonary bronchoscopy/biopsy of larynx, trachea and bronchial tube were also performed. Histopathological evaluation showed characteristic of Paracoccidioidomycosis. Intervention: Patient was treated with oral sulphadiazine (1.5 g/day). Main Outcome Measures: Anterior uveitis, retinal examination, histopathological evaluation and primary clinical outcome were observed during systemic treatment. Results: After 3 months of irregular treatment, choroidal lesions decreased in size forming atrophic scars and fibrotic spots; however visual acuity did not show any improvement. Conclusion: We report a rare case of systemic paracoccidioidomycosis with choroidal and retinal involvement treated with oral sulphadiazine.
Collapse
Affiliation(s)
- Thais Z Igami
- Department of Ophthalmology, University of São Paulo, School of Medicine (Hospital das Clínicas da Universidade de São Paulo- São Paulo- HC-USP)- Brazil ; Department of Ophthalmology, Santa Casa de São Paulo, Brazil
| | | | | | | | | | | |
Collapse
|
46
|
Navascués A, Rubio MT, Monzón FJ. [Paracoccidioidomycosis in an Ecuadorian immigrant]. Enferm Infecc Microbiol Clin 2013; 31:415-6. [PMID: 23332607 DOI: 10.1016/j.eimc.2012.11.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Revised: 11/08/2012] [Accepted: 11/12/2012] [Indexed: 10/27/2022]
|
47
|
Bitterman R, Oren I, Geffen Y, Sprecher H, Schwartz E, Neuberger A. Prolonged fever and splinter hemorrhages in an immunocompetent traveler with disseminated histoplasmosis. J Travel Med 2013; 20:57-9. [PMID: 23279234 DOI: 10.1111/jtm.12000] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2012] [Revised: 10/22/2012] [Accepted: 10/25/2012] [Indexed: 11/30/2022]
Abstract
We present a case of progressive disseminated histoplasmosis in an immunocompetent traveler. Histoplasmosis was acquired in South America; its manifestations included prolonged fever, splinter hemorrhages, erythema multiforme, arthritis, and mediastinal lymphadenopathy. To the best of our knowledge no splinter hemorrhages had previously been reported in a patient with histoplasmosis.
Collapse
Affiliation(s)
- Roni Bitterman
- Internal Medicine B, Rambam Medical Center, Haifa, Israel
| | | | | | | | | | | |
Collapse
|
48
|
Rivière S, Denis B, Bougnoux ME, Lanternier F, Lecuit M, Lortholary O. Serum Aspergillus galactomannan for the management of disseminated histoplasmosis in AIDS. Am J Trop Med Hyg 2012; 87:303-5. [PMID: 22855762 DOI: 10.4269/ajtmh.2012.12-0119] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Disseminated histoplasmosis is an emerging infection in patients with cellular immune deficiency in non-endemic countries, caused by the migration from endemic regions and the development of travels. Diagnosis can be challenging in this context because rapid diagnostic tools such as Histoplasma antigen detection or appropriate molecular tools are generally unavailable, serology is often negative in immunosuppressed patients, and isolation of the fungus from cultures often takes several weeks. Here, we report the contribution of galactomannan serum detection for the management of an HIV-infected patient with disseminated histoplasmosis.
Collapse
Affiliation(s)
- Sébastien Rivière
- Service des Maladies Infectieuses et Tropicales, Centre d'Infectiologie Necker - Pasteur, Paris, France.
| | | | | | | | | | | |
Collapse
|
49
|
Abreu e Silva MÀD, Salum FG, Figueiredo MA, Cherubini K. Important aspects of oral paracoccidioidomycosis--a literature review. Mycoses 2012; 56:189-99. [PMID: 23088400 DOI: 10.1111/myc.12017] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Paracoccidioidomycosis is a deep mycosis endemic to Latin America, with considerable morbidity and mortality. It is caused by the dimorphic fungus Paracoccidioides brasiliensis, which affects, among other organs in the human body, the oral cavity. Fungus virulence and immunocompetence of the host determine the establishment of infection or active disease, whose severity and clinical behaviour depend mostly on the cellular immune response of the host. Often, oral lesions constitute the first sign and site of confirmation of diagnosis, which in most cases is delayed. The success of the treatment depends on early and correct diagnosis, as well as on the patient's adherence to the drug therapy.
Collapse
|
50
|
|