1
|
Cherabie J, Mazi P, Rauseo AM, Ayres C, Larson L, Rutjanawech S, O’Halloran J, Presti R, Powderly WG, Spec A. Long-Term Mortality after Histoplasma Infection in People with HIV. J Fungi (Basel) 2021; 7:jof7050369. [PMID: 34066845 PMCID: PMC8150352 DOI: 10.3390/jof7050369] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 05/04/2021] [Accepted: 05/06/2021] [Indexed: 11/20/2022] Open
Abstract
Histoplasmosis is a common opportunistic infection in people with HIV (PWH); however, no study has looked at factors associated with the long-term mortality of histoplasmosis in PWH. We conducted a single-center retrospective study on the long-term mortality of PWH diagnosed with histoplasmosis between 2002 and 2017. Patients were categorized into three groups based on length of survival after diagnosis: early mortality (death < 90 days), late mortality (death ≥ 90 days), and long-term survivors. Patients diagnosed during or after 2008 were considered part of the modern antiretroviral therapy (ART) era. Insurance type (private vs. public) was a surrogate indicator of socioeconomic status. Out of 54 PWH infected with histoplasmosis, overall mortality was 37%; 14.8% early mortality and 22.2% late mortality. There was no statistically significant difference in survival based on the availability of modern ART (p = 0.60). Insurance status reached statistical significance with 38% of survivors having private insurance versus only 8% having private insurance in the late mortality group (p = 0.05). High mortality persists despite the advent of modern ART, implicating a contribution from social determinants of health, such as private insurance. Larger studies are needed to elucidate the role of these factors in the mortality of PWH.
Collapse
|
2
|
Abstract
BACKGROUND Progressive disseminated histoplasmosis (PDH) is a serious fungal infection that affects people living with HIV. The best way to treat the condition is unclear. OBJECTIVES We assessed evidence in three areas of equipoise. 1. Induction. To compare efficacy and safety of initial therapy with liposomal amphotericin B versus initial therapy with alternative antifungals. 2. Maintenance. To compare efficacy and safety of maintenance therapy with 12 months of oral antifungal treatment with shorter durations of maintenance therapy. 3. Antiretroviral therapy (ART). To compare the outcomes of early initiation versus delayed initiation of ART. SEARCH METHODS We searched the Cochrane Infectious Diseases Group Specialized Register; Cochrane CENTRAL; MEDLINE (PubMed); Embase (Ovid); Science Citation Index Expanded, Conference Proceedings Citation Index-Science, and BIOSIS Previews (all three in the Web of Science); the WHO International Clinical Trials Registry Platform, ClinicalTrials.gov, and the ISRCTN registry, all up to 20 March 2020. SELECTION CRITERIA We evaluated studies assessing the use of liposomal amphotericin B and alternative antifungals for induction therapy; studies assessing the duration of antifungals for maintenance therapy; and studies assessing the timing of ART. We included randomized controlled trials (RCT), single-arm trials, prospective cohort studies, and single-arm cohort studies. DATA COLLECTION AND ANALYSIS Two review authors assessed eligibility and risk of bias, extracted data, and assessed certainty of evidence. We used the Cochrane 'Risk of bias' tool to assess risk of bias in randomized studies, and ROBINS-I tool to assess risk of bias in non-randomized studies. We summarized dichotomous outcomes using risk ratios (RRs), with 95% confidence intervals (CI). MAIN RESULTS We identified 17 individual studies. We judged eight studies to be at critical risk of bias, and removed these from the analysis. 1. Induction We found one RCT which compared liposomal amphotericin B to deoxycholate amphotericin B. Compared to deoxycholate amphotericin B, liposomal amphotericin B may have higher clinical success rates (RR 1.46, 95% CI 1.01 to 2.11; 1 study, 80 participants; low-certainty evidence). Compared to deoxycholate amphotericin B, liposomal amphotericin B has lower rates of nephrotoxicity (RR 0.25, 95% CI 0.09 to 0.67; 1 study, 77 participants; high-certainty evidence). We found very low-certainty evidence to inform comparisons between amphotericin B formulations and azoles for induction therapy. 2. Maintenance We found no eligible study that compared less than 12 months of oral antifungal treatment to 12 months or greater for maintenance therapy. For both induction and maintenance, fluconazole performed poorly in comparison to other azoles. 3. ART We found one study, in which one out of seven participants in the 'early' arm and none of the three participants in the 'late' arm died. AUTHORS' CONCLUSIONS Liposomal amphotericin B appears to be a better choice compared to deoxycholate amphotericin B for treating PDH in people with HIV; and fluconazole performed poorly compared to other azoles. Other treatment choices for induction, maintenance, and when to start ART have no evidence, or very low certainty evidence. PDH needs prospective comparative trials to help inform clinical decisions.
Collapse
Affiliation(s)
- Marylou Murray
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Paul Hine
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| |
Collapse
|
3
|
Damasceno-Escoura AH, Mora DJ, Cardeal AC, Berto-Nascimento JC, Etchebehere RM, de Meneses ACO, Adad SJ, Micheletti AMR, Silva-Vergara ML. Histoplasmosis in HIV-Infected Patients: Epidemiological, Clinical and Necropsy Data from a Brazilian Teaching Hospital. Mycopathologia 2020; 185:339-346. [PMID: 32078723 DOI: 10.1007/s11046-020-00435-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 02/11/2020] [Indexed: 11/26/2022]
Abstract
Histoplasmosis occurs in 5-10% of HIV-infected patients in endemic areas and evolves to severe and disseminated infection with mortality rates over 50% in some regions. This report presents epidemiological, clinical and outcome data from HIV-infected patients with histoplasmosis confirmed by culture and/or at necropsy who were admitted to a Brazilian teaching hospital. Data from 65 patients were obtained from their respective medical and necropsy records. From 2005 to 2018, 36 HIV-infected patients were diagnosed with histoplasmosis confirmed by culture. At admission, most of these patients presented disseminated fungal infection, whereas 15 (41.7%) were simultaneously diagnosed with both HIV infection and histoplasmosis. Fever, weight loss, hepatosplenomegaly, respiratory and digestive symptoms were present in 86.2%, 50%, 44.4% and 41.7% of the patients, respectively. At admission, 24 patients had low CD4 T-cell count and high viral load values. Among the 30 patients who received antifungals, 16 (53.3%) were cured, 13 (43.3%) died, and one was lost to follow-up. Six patients died prior to therapy. From 1990 to 2018, 63 necropsies of patients with Histoplasma capsulatum infection were performed. Of these patients, 29 (46.0%) were HIV-infected individuals, including 21 (72.4%) who presented disseminated histoplasmosis and 21 (72.4%) who were diagnosed with histoplasmosis at necropsy. The epidemiological, clinical and outcome profiles presented herein are similar to those described elsewhere and reinforce the difficulties that are still present in limited-resource settings where advanced immunodeficiency, combined with severe fungal infection and late patient admissions, is related to poor outcomes.
Collapse
Affiliation(s)
| | - Delio José Mora
- Infectious Diseases Unit, Internal Medicine Department, Triângulo Mineiro Federal University, Mailbox 118, Uberaba, Minas Gerais, 38001-170, Brazil
| | - Anderson Clayton Cardeal
- Infectious Diseases Unit, Internal Medicine Department, Triângulo Mineiro Federal University, Mailbox 118, Uberaba, Minas Gerais, 38001-170, Brazil
| | - Júlio Cesar Berto-Nascimento
- Infectious Diseases Unit, Internal Medicine Department, Triângulo Mineiro Federal University, Mailbox 118, Uberaba, Minas Gerais, 38001-170, Brazil
| | | | | | - Sheila Jorge Adad
- Special Pathology Unit, Triângulo Mineiro Federal University, Uberaba, Minas Gerais, Brazil
| | | | - Mario León Silva-Vergara
- Infectious Diseases Unit, Internal Medicine Department, Triângulo Mineiro Federal University, Mailbox 118, Uberaba, Minas Gerais, 38001-170, Brazil.
| |
Collapse
|
4
|
Cano-Torres JO, Olmedo-Reneaum A, Esquivel-Sánchez JM, Camiro-Zuñiga A, Pérez-Carrisoza A, Madrigal-Iberri C, Flores-Miranda R, Ramírez-González LE, Belaunzarán-Zamudio PF. Progressive disseminated histoplasmosis in Latin America and the Caribbean in people receiving highly active antiretroviral therapy for HIV infection: A systematic review. Med Mycol 2020; 57:791-799. [PMID: 30668766 DOI: 10.1093/mmy/myy143] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 11/20/2018] [Accepted: 11/28/2018] [Indexed: 01/08/2023] Open
Abstract
Histoplasmosis is the most clinically significant mycosis in Latin America; still it has been neglected in people with human immunodeficiency virus (HIV). There is limited information about its contribution to morbidity and mortality in this population. We conducted a systematic review of scientific literature to provide an estimation of the frequency and mortality of histoplasmosis among people with HIV receiving highly active antiretroviral therapy (HAART) in Latin America, and factors associated with mortality. We searched articles in PubMed, Scopus, WHO Global health library, and Scielo using different combination of terms including "histoplasmosis" and HAART. We identified 949 articles, removed 662 duplicated; screened 287 abstracts; reviewed full text of 53 articles; and selected 15 articles that provided information on the number of patients studied, included patients receiving ART, and reported any measure of frequency estimate for qualitative synthesis. Studies were conducted in Argentina (n = 4), Brazil (n = 6), Colombia (n = 2), French Guyana and the Bahamas (=2), and Guatemala (n = 1). Heterogeneity of studies characteristics precluded any aggregated estimates. Histoplamosis was frequent in these cohort studies and mortality was high despite the use of HAART. Low CD4 counts, delayed HAART initiation and poor adherence were related to increased incidence, poor prognosis and increased mortality, respectively. Histoplasmosis may be an important contributor to mortality in people with HIV in Latin America. Diagnostic delays represent an important limitation for improving care of patients suspected to have histoplasmosis. Reducing histoplasmosis diagnostic delays and therapy initiation is needed to further decrease mortality.
Collapse
Affiliation(s)
- J Oggun Cano-Torres
- Departamento de Infectología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México City, México
| | - Alejandro Olmedo-Reneaum
- Departamento de Infectología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México City, México
| | - José M Esquivel-Sánchez
- Departamento de Infectología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México City, México
| | - Antonio Camiro-Zuñiga
- Departamento de Infectología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México City, México
| | - Arely Pérez-Carrisoza
- Departamento de Infectología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México City, México
| | - Carlos Madrigal-Iberri
- Departamento de Infectología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México City, México
| | - Rommel Flores-Miranda
- Departamento de Infectología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México City, México
| | - Luis E Ramírez-González
- Departamento de Infectología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México City, México
| | - Pablo F Belaunzarán-Zamudio
- Departamento de Infectología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México City, México
| |
Collapse
|
5
|
Montenegro-Idrogo JJ, Chiappe-Gonzalez A, Vargas-Gonzales R, Arévalo J, Ñavincopa M, Ticona E. [Disseminated histoplasmosis and haemophagocytic syndrome in HIV patients: A case series in a Peruvian hospital]. Rev Iberoam Micol 2019; 37:28-33. [PMID: 31864850 DOI: 10.1016/j.riam.2019.09.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 09/07/2019] [Accepted: 09/16/2019] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Disseminated histoplasmosis (DH) is an opportunistic fungal infection in severely immunocompromised patients with HIV infection. Haemophagocytic syndrome (HFS), which can occur in these co-infected patients when the immune response is significantly altered, is often associated with high mortality. AIMS To describe the epidemiological, clinical, analytical and microbiological characteristics, along with studying the presence of HFS, in patients with DH-HIV. METHODS A retrospective study was conducted on a case series using data from the clinical records of patients diagnosed with DH and HIV infection during the years 2014 and 2015. RESULTS DH was diagnosed in 8 (1.3%) of 597 HIV patients. All patients were in stage C3, and 75% (6/8) were not receiving combined antiretroviral therapy (CART). The remaining two patients had recently begun CART (possible immune reconstitution syndrome). Five (62.5%) of the 8 patients met criteria for HFS. The most frequent clinical symptoms were lymphoproliferative and consumptive syndrome, respiratory compromise, and cytopenia. Histoplasma was isolated in lymph nodes of 75% (6/8) of the patients, in blood samples in 25% (2/8), and also in intestinal tissue in one patient. The antifungal therapy was amphotericin B deoxycholate, without adjuvants. The overall mortality was 50%. CONCLUSIONS In this case series, DH-HIV co-infection frequently progressed to HFS with high mortality. The clinical picture may resemble that of other systemic opportunistic infections, such as tuberculosis, or can take place simultaneously with other infections. Clinical suspicion is important in patients with severe cytopenia and lymphoproliferative and consumptive syndrome in order to establish an early diagnosis and prescribing a timely specific therapy.
Collapse
Affiliation(s)
- Juan José Montenegro-Idrogo
- Servicio de Enfermedades Infecciosas y Tropicales, Hospital Nacional Dos de Mayo, Lima, Perú; Centro de Investigaciones Tecnológicas Biomédicas y Medioambientales (CITMB), Universidad Nacional Mayor de San Marcos, Lima, Perú; Unidad de Posgrado, Universidad Nacional Mayor de San Marcos, Lima, Perú.
| | - Alfredo Chiappe-Gonzalez
- Servicio de Enfermedades Infecciosas y Tropicales, Hospital Nacional Dos de Mayo, Lima, Perú; Unidad de Posgrado, Universidad Nacional Mayor de San Marcos, Lima, Perú
| | | | - Jorge Arévalo
- Servicio de Enfermedades Infecciosas y Tropicales, Hospital Nacional Dos de Mayo, Lima, Perú
| | - Marcos Ñavincopa
- Servicio de Enfermedades Infecciosas y Tropicales, Hospital Nacional Dos de Mayo, Lima, Perú
| | - Eduardo Ticona
- Servicio de Enfermedades Infecciosas y Tropicales, Hospital Nacional Dos de Mayo, Lima, Perú
| |
Collapse
|
6
|
Histoplasmosis Outbreaks in Brazil: Lessons to Learn About Preventing Exposure. Mycopathologia 2019; 185:881-892. [PMID: 31845177 DOI: 10.1007/s11046-019-00389-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 09/23/2019] [Indexed: 12/18/2022]
Abstract
Histoplasmosis is considered the most common invasive opportunistic fungal disease in the Americas, with outbreaks and micro-epidemics reported for over 80 years. In Brazil, this disease has been described since 1946, reaching a remarkable incidence in the population, especially during the HIV-AIDS pandemic. In this study, published and unpublished outbreaks and micro-epidemics of histoplasmosis in Brazil were revisited by accessing different database sources and evaluating epidemiological and clinical features. We have found reports spanning 1946-2017, across 10 Brazilian states and with involvement of 370 humans and 2 dogs, and 13 disseminated cases and 3 deaths were reported. Rio de Janeiro had the largest number of outbreaks (n = 20/40; 50%) reported in this study. The majority of outbreaks and micro-epidemics was reported in caves (n = 21/40; 52.5%), followed by reports in abandoned/deactivated sites (n = 6/40; 15%), mines (n = 5/40; 12.5%), chicken coops (n = 4/40; 10%). Histoplasmosis is a serious health issue in Brazil considering the attractive and growing market of ecotourism throughout more than 7000 caves, and all levels of poultry farming activity are important to raise awareness about how dangerous this neglected disease can be and establish ways to decrease exposure to contaminated environmental sources through adequate preventive measures.
Collapse
|
7
|
Leitão TMJS, Oliveira Filho AMP, Sousa Filho JEP, Tavares BM, Mesquita JRL, Farias LABG, Mota RS, Nacher M, Damasceno LS. Accuracy of Buffy Coat in the Diagnosis of Disseminated Histoplasmosis in AIDS-Patients in an Endemic Area of Brazil. J Fungi (Basel) 2019; 5:E47. [PMID: 31181847 PMCID: PMC6616638 DOI: 10.3390/jof5020047] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 05/28/2019] [Accepted: 05/31/2019] [Indexed: 12/24/2022] Open
Abstract
The buffy coat is obtained routinely for disseminated histoplamosis (DH) diagnosis in Ceará, Brazil. The aim of this study is to describe the accuracy of staining smears for Histoplasma in the buffy coat of AIDS-patients with DH. From 2012-2013, all results of stained buffy coat smears and culture for fungi performed at São José Hospital were recorded. In total, 489 buffy coats of 361 patients were studied; 19/361 (5.3%; 95%CI = 2.9-7.6%) had positive direct examination stained smears for Histoplasma and 61/361 (16.9%; 95%CI = 13.0-20.8%) had growth in culture. For those with positive Histoplasma cultures, the CD4 count was significantly lower (139.3 vs. 191.7cells/µL; p = 0.014) than others, and death was 18%. The sensitivity and specificity of stained smears was 25.9% and 100%, respectively. A second test, performed up to 36 days from the first one, increased the sensitivity of stained smears to 32.2%. Stained smears of buffy coat have low accuracy; nonetheless, they are easy to perform and can give a quick diagnosis in low-resource endemic areas. Despite the decrease in mortality, it is not yet to the low levels observed in areas that have better and more efficient methods.
Collapse
Affiliation(s)
- Terezinha M J Silva Leitão
- Departamento de Saúde Comunitária, Faculdade de Medicina, Universidade Federal do Ceará, Rodolfo Téofilo, Fortaleza, Ceará 60430-160, Brasil.
- Hospital São José de Doenças Infecciosas, Parquelândia, Fortaleza, Ceará 60455-610, Brasil.
| | - Antonio M P Oliveira Filho
- Departamento de Saúde Comunitária, Faculdade de Medicina, Universidade Federal do Ceará, Rodolfo Téofilo, Fortaleza, Ceará 60430-160, Brasil.
| | - José Evaldo P Sousa Filho
- Departamento de Saúde Comunitária, Faculdade de Medicina, Universidade Federal do Ceará, Rodolfo Téofilo, Fortaleza, Ceará 60430-160, Brasil.
| | - Bruno M Tavares
- Hospital São José de Doenças Infecciosas, Parquelândia, Fortaleza, Ceará 60455-610, Brasil.
| | - Jacó R L Mesquita
- Hospital São José de Doenças Infecciosas, Parquelândia, Fortaleza, Ceará 60455-610, Brasil.
| | - Luís Arthur B G Farias
- Departamento de Saúde Comunitária, Faculdade de Medicina, Universidade Federal do Ceará, Rodolfo Téofilo, Fortaleza, Ceará 60430-160, Brasil.
| | - Rosa S Mota
- Departamento de Saúde Comunitária, Faculdade de Medicina, Universidade Federal do Ceará, Rodolfo Téofilo, Fortaleza, Ceará 60430-160, Brasil.
| | - Mathieu Nacher
- Centre d'Investigation Clinique 1424 Antilles-Guyane, Inserm, Centre Hospitalier de Cayenne, 97 300 Cayenne, France.
| | - Lisandra S Damasceno
- Hospital São José de Doenças Infecciosas, Parquelândia, Fortaleza, Ceará 60455-610, Brasil.
- Faculdade de Medicina, Centro Universitário Unichristus, Cocó, Fortaleza, Ceará 60190-060, Brasil.
| |
Collapse
|
8
|
Almeida MA, Damasceno LS, Pizzini CV, Muniz MDM, Almeida-Paes R, Zancopé-Oliveira RM. Role of western blot assay for the diagnosis of histoplasmosis in AIDS patients from a National Institute of Infectious Diseases in Rio de Janeiro, Brazil. Mycoses 2019; 62:261-267. [PMID: 30561870 DOI: 10.1111/myc.12877] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 12/07/2018] [Accepted: 12/10/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND Histoplasmosis is a frequent fungal infection in HIV/AIDS patients, with high morbimortality rates when diagnosis and treatment are delayed. Antibody detection, which is faster than the gold standard culture test, hastens the laboratory investigation. OBJECTIVES To evaluate the role of WB for antibody detection in the diagnosis of histoplasmosis among HIV/AIDS patients. PATIENTS AND METHODS Fifty patients with proven or probable histoplasmosis were included. Clinical, epidemiological and laboratory data were described in the same population after a review of their medical records. WB was performed using deglycosylated histoplasmin. RESULTS About 82% of patients were adult males and the mean age was 39.3 years. CD4+ T lymphocyte count less than 150 cells/mm3 was observed in 62% patients. Antibodies against Histoplasma capsulatum M antigen were detected in 62% of patients, and against both M and H antigens in 28% of individuals. Sera from 10% of patients were nonreactive. Histoplasmosis was the first opportunistic infection in 38% of the cases. Disseminated and pulmonary histoplasmosis occurred in 84% and 16% of patients, respectively. The overall mortality was 16%. CONCLUSION WB could be useful for the histoplasmosis diagnosis in HIV/AIDS patients because of its easefulness and good sensitivity in a population where antibody production is hampered.
Collapse
Affiliation(s)
- Marcos Abreu Almeida
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil
| | | | - Cláudia Vera Pizzini
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil
| | - Mauro de Medeiros Muniz
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil
| | - Rodrigo Almeida-Paes
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil
| | | |
Collapse
|
9
|
Silva Junior GBD, Parente Filho SLA, Soares DDS, Alencar RDND, Peixoto TTT, Nogueira IS, Oliveira Filho AMPD, Menezes FH, Cavalcante MG, Pires Neto RDJ, Daher EDF. Acute kidney injury and other factors associated with mortality in hiv-infected patients. ACTA ACUST UNITED AC 2018; 64:509-517. [PMID: 30304308 DOI: 10.1590/1806-9282.64.06.509] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 11/02/2017] [Indexed: 11/21/2022]
Abstract
OBJECTIVE HIV-related mortality is still high, especially in developed countries. The aim of this study is to investigate factors associated to death in HIV-infected patients. METHODS This is a cross-sectional study with all HIV adult patients admitted to a tertiary infectious diseases hospital in Fortaleza, Northeast Brazil, from January 2013 to December 2014. Patients were divided into two groups: survivors and non-survivors. Demo-graphical, clinical and laboratory data were compared and a logistic regression was performed in order to investigate risk factors for death. P values ≤0.05 were considered statistically significant. RESULTS A total of 200 patients with mean age of 39 years were including in the study, 69.5% males. Fifteen patients (7.5%) died. Non-survivors presented a higher percentage of males (93.3 vs. 67.3%, p = 0.037). Non-survivors presented AKI (73.3 vs. 10.3%, p < 0.001), liver dysfunction (33.3 vs. 11.5, p = 0.031), dyspnea (73.3 vs. 33.0%, p = 0.002) and disorientation (33.3 vs. 12.4%, p = 0.025) more frequently. Non-survivors also had higher levels of urea (73.8 ± 52.7vs. 36.1 ± 29.1 mg/dL, p < 0.001), creatinine (1.98 ± 1.65 vs. 1.05 ± 1.07 mg/dL, p < 0.001), aspartate aminotransferase (130.8 vs. 84.8 U/L, p = 0.03), alanine aminotransferase (115.6 vs. 85.4 U/L, p = 0.045) and lactate dehydrogenase (LDH) (1208 vs. 608 U/L, p = 0.012), as well as lower levels of bicarbonate (18.0 ± 4.7 vs. 21.6 ± 4.6 mEq/L, p = 0.016) and PCO2 (27.8 ± 7.7 vs. 33.0 ± 9.3 mmHg, p = 0.05). In multivariate analysis, disorientation (p = 0.035, OR = 5.523, 95%CI = 1.130 - 26.998), dyspnoea (p = 0.046, OR = 4.064, 95%CI = 1.028 - 16.073), AKI (p < 0.001, OR = 18.045, 95%CI = 4.308 - 75.596) and disseminated histoplasmosis (p = 0.016, OR = 12.696, 95%CI = 1.618 - 99.646) and LDH > 1000 U/L (p = 0.038, OR = 4.854, 95%CI = 1.093 - 21.739) were risk factors for death.]CONCLUSION: AKI and disseminated histoplasmosis (DH) were the main risk factors for death in the studied population. Neurologic and respiratory impairment as well as higher levels of LDH also increased mortality in HIV-infected patients.
Collapse
Affiliation(s)
- Geraldo Bezerra da Silva Junior
- School of Medicine, Public Health and Medical Sciences Post-Graduation Programs, Health Sciences Center, University of Fortaleza. Fortaleza, Ceará, Brasil
| | | | - Douglas de Sousa Soares
- Department of Internal Medicine, School of Medicine, Federal University of Ceará.Fortaleza, Ceará, Brasil
| | | | - Tiago Tomaz Teles Peixoto
- Department of Internal Medicine, School of Medicine, Federal University of Ceará.Fortaleza, Ceará, Brasil
| | - Isadora Sales Nogueira
- Department of Internal Medicine, School of Medicine, Federal University of Ceará.Fortaleza, Ceará, Brasil
| | | | - Fernanda Holanda Menezes
- Department of Internal Medicine, School of Medicine, Federal University of Ceará.Fortaleza, Ceará, Brasil
| | - Malena Gadelha Cavalcante
- School of Medicine, Medical Sciences and PharmacologyPost-Graduation Programs, Federal University of Ceará. Fortaleza, Ceará, Brasil
| | - Roberto da Justa Pires Neto
- Department of Community Health, Public Health Post-Graduation Program, School of Medicine, Federal University of Ceará. Fortaleza, Ceará, Brasil
| | - Elizabeth de Francesco Daher
- Department of Internal Medicine, School of Medicine, Federal University of Ceará.Fortaleza, Ceará, Brasil.,School of Medicine, Medical Sciences and PharmacologyPost-Graduation Programs, Federal University of Ceará. Fortaleza, Ceará, Brasil
| |
Collapse
|
10
|
Denning DW. Minimizing fungal disease deaths will allow the UNAIDS target of reducing annual AIDS deaths below 500 000 by 2020 to be realized. Philos Trans R Soc Lond B Biol Sci 2017; 371:rstb.2015.0468. [PMID: 28080991 PMCID: PMC5095544 DOI: 10.1098/rstb.2015.0468] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2016] [Indexed: 12/17/2022] Open
Abstract
Deaths from AIDS (1 500 000 in 2013) have been falling more slowly than anticipated with improved access to antiretroviral therapy. Opportunistic infections account for most AIDS-related mortality, with a median age of death in the mid-30s. About 360 000 (24%) of AIDS deaths are attributed to tuberculosis. Fungal infections deaths in AIDS were estimated at more than 700 000 deaths (47%) annually. Rapid diagnostic tools and antifungal agents are available for these diseases and would likely have a major impact in reducing deaths. Scenarios for reduction of avoidable deaths were constructed based on published outcomes of the real-life impact of diagnostics and generic antifungal drugs to 2020. Annual deaths could fall for cryptococcal disease by 70 000, Pneumocystis pneumonia by 162 500, disseminated histoplasmosis by 48 000 and chronic pulmonary aspergillosis by 33 500, with approximately 60% coverage of diagnostics and antifungal agents; a total of >1 000 000 lives saved over 5 years. If factored in with the 90–90–90 campaign rollout and its effect, AIDS deaths could fall to 426 000 annually by 2020, with further reductions possible with increased coverage. Action could and should be taken by donors, national and international public health agencies, NGOs and governments to achieve the UNAIDS mortality reduction target, by scaling up capability to detect and treat fungal disease in AIDS. This article is part of the themed issue ‘Tackling emerging fungal threats to animal health, food security and ecosystem resilience’.
Collapse
Affiliation(s)
- David W Denning
- Global Action Fund for Fungal Infections (GAFFI), Rue de l'Ancien-Port 14, 1211 Geneva 1, Geneva, Switzerland .,The National Aspergillosis Centre, University Hospital of South Manchester, The University of Manchester, Manchester Academic Health Science Centre, Manchester M23 9LT, UK
| |
Collapse
|
11
|
Almeida MDA, Pizzini CV, Damasceno LS, Muniz MDM, Almeida-Paes R, Peralta RHS, Peralta JM, Oliveira RDVC, Vizzoni AG, de Andrade CLT, Zancopé-Oliveira RM. Validation of western blot for Histoplasma capsulatum antibody detection assay. BMC Infect Dis 2016; 16:87. [PMID: 26905567 PMCID: PMC4765212 DOI: 10.1186/s12879-016-1427-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 02/10/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Histoplasmosis is worldwide systemic mycoses caused by the dimorphic fungus Histoplasma capsulatum. The isolation and identification of H. capsulatum in culture is the reference test for histoplasmosis diagnosis confirmation. However, in the absence of it, serology has been used as a presumptive diagnosis through antibody and antigen detection. The purpose of the present study was to validate an immunoassay method (western blot) for antibodies detection in the diagnosis of histoplasmosis. METHODS To validate the western blot (WB) a study was conducted using 118 serum samples from patients with histoplasmosis and 118 serum controls collected from January 2000 to December 2013 in residents of the Rio de Janeiro State, Brazil. Diagnostic validation parameters were calculated based on the categorization of results obtained in a 2 × 2 table and subjected to statistical analysis. In addition, the viability of deglycosylated histoplasmin antigen (ptHMIN) onto nitrocellulose membranes previously sensitized was evaluated during the same period. RESULTS The WB test showed sensitivity of 94.9 %, specificity of 94.1 %, positive predictive value of 94.1 %, negative predictive value of 94.9 %, accuracy of 94.5 %, and almost perfect precision. Besides, the strips have proved to be viable for using at least 5 years after ptHMIN antigen sensitization. CONCLUSION Western blot test using ptHMIN provides sensitive, specific, and faster results. Therefore, could be considered a useful tool in the diagnosis of histoplasmosis being used by public health system, even in situations where laboratory facilities are relatively limited.
Collapse
Affiliation(s)
- Marcos de Abreu Almeida
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Avenida Brasil, 4365, Manguinhos, Rio de Janeiro, RJ, Brazil.
| | - Cláudia Vera Pizzini
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Avenida Brasil, 4365, Manguinhos, Rio de Janeiro, RJ, Brazil.
| | - Lisandra Serra Damasceno
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Avenida Brasil, 4365, Manguinhos, Rio de Janeiro, RJ, Brazil.
| | - Mauro de Medeiros Muniz
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Avenida Brasil, 4365, Manguinhos, Rio de Janeiro, RJ, Brazil.
| | - Rodrigo Almeida-Paes
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Avenida Brasil, 4365, Manguinhos, Rio de Janeiro, RJ, Brazil.
| | | | - José Mauro Peralta
- Instituto de Microbiologia Prof. Paulo de Goes, Universidade Federal do Rio de Janeiro, Avenida Carlos Chagas Filho, Cidade Universitária, Ilha do Fundão, Rio de Janeiro, RJ, 373, Brazil.
| | | | - Alexandre Gomes Vizzoni
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Avenida Brasil, 4365, Manguinhos, Rio de Janeiro, RJ, Brazil.
| | | | - Rosely Maria Zancopé-Oliveira
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Avenida Brasil, 4365, Manguinhos, Rio de Janeiro, RJ, Brazil.
| |
Collapse
|
12
|
Could Histoplasma capsulatum Be Related to Healthcare-Associated Infections? BIOMED RESEARCH INTERNATIONAL 2015; 2015:982429. [PMID: 26106622 PMCID: PMC4461736 DOI: 10.1155/2015/982429] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Revised: 05/12/2015] [Accepted: 05/12/2015] [Indexed: 02/07/2023]
Abstract
Healthcare-associated infections (HAI) are described in diverse settings. The main etiologic agents of HAI are bacteria (85%) and fungi (13%). Some factors increase the risk for HAI, particularly the use of medical devices; patients with severe cuts, wounds, and burns; stays in the intensive care unit, surgery, and hospital reconstruction works. Several fungal HAI are caused by Candida spp., usually from an endogenous source; however, cross-transmission via the hands of healthcare workers or contaminated devices can occur. Although other medically important fungi, such as Blastomyces dermatitidis, Paracoccidioides brasiliensis, and Histoplasma capsulatum, have never been considered nosocomial pathogens, there are some factors that point out the pros and cons for this possibility. Among these fungi, H. capsulatum infection has been linked to different medical devices and surgery implants. The filamentous form of H. capsulatum may be present in hospital settings, as this fungus adapts to different types of climates and has great dispersion ability. Although conventional pathogen identification techniques have never identified H. capsulatum in the hospital environment, molecular biology procedures could be useful in this setting. More research on H. capsulatum as a HAI etiologic agent is needed, since it causes a severe and often fatal disease in immunocompromised patients.
Collapse
|
13
|
Putot A, Perrin S, Jolivet A, Vantilcke V. HIV-associated disseminated histoplasmosis in western French Guiana, 2002-2012. Mycoses 2015; 58:160-6. [DOI: 10.1111/myc.12293] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Revised: 11/30/2014] [Accepted: 12/16/2014] [Indexed: 11/28/2022]
Affiliation(s)
- A. Putot
- Department of Medicine; Centre Hospitalier de l'Ouest Guyanais; Saint Laurent du Maroni French Guiana
| | - S. Perrin
- Department of Medicine; Centre Hospitalier de l'Ouest Guyanais; Saint Laurent du Maroni French Guiana
| | - A. Jolivet
- Department of Public Health; Centre Hospitalier de l'Ouest Guyanais; Saint Laurent du Maroni French Guiana
| | - V. Vantilcke
- Department of Medicine; Centre Hospitalier de l'Ouest Guyanais; Saint Laurent du Maroni French Guiana
| |
Collapse
|