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Firacative C, Lizarazo J, Illnait-Zaragozí MT, Castañeda E. The status of cryptococcosis in Latin America. Mem Inst Oswaldo Cruz 2018; 113:e170554. [PMID: 29641639 PMCID: PMC5888000 DOI: 10.1590/0074-02760170554] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 02/06/2018] [Indexed: 12/23/2022] Open
Abstract
Cryptococcosis is a life-threatening fungal infection caused by the encapsulated
yeasts Cryptococcus neoformans and C. gattii,
acquired from the environment. In Latin America, as occurring
worldwide, C. neoformans causes more than 90% of the cases of
cryptococcosis, affecting predominantly patients with HIV, while C.
gattii generally affects otherwise healthy individuals. In this
region, cryptococcal meningitis is the most common presentation, with
amphotericin B and fluconazole being the antifungal drugs of choice. Avian
droppings are the predominant environmental reservoir of C.
neoformans, while C. gattii is associated with
several arboreal species. Importantly, C. gattii has a high
prevalence in Latin America and has been proposed to be the likely origin of
some C. gattii populations in North America. Thus, in the
recent years, significant progress has been made with the study of the basic
biology and laboratory identification of cryptococcal strains, in understanding
their ecology, population genetics, host-pathogen interactions, and the clinical
epidemiology of this important mycosis in Latin America.
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Affiliation(s)
- Carolina Firacative
- Westmead Hospital, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Jairo Lizarazo
- Internal Medicine Department, Hospital Universitario Erasmo Meoz, Universidad de Pamplona, Cúcuta, Colombia
| | - María Teresa Illnait-Zaragozí
- Diagnosis and Reference Centre, Bacteriology-Mycology Department Research, Tropical Medicine Institute Pedro Kourí, Havana, Cuba
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Arechavala A, Negroni R, Messina F, Romero M, Marín E, Depardo R, Walker L, Santiso G. Cryptococcosis in an Infectious Diseases Hospital of Buenos Aires, Argentina. Revision of 2041 cases: Diagnosis, clinical features and therapeutics. Rev Iberoam Micol 2017; 35:1-10. [PMID: 29129578 DOI: 10.1016/j.riam.2017.04.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 02/22/2017] [Accepted: 04/21/2017] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Cryptococcosis is still a life-threatening mycosis that continues to be of serious concern in Latin American countries, especially among HIV+positive population. However, there is not any reliable information about the prevalence of this disease in this region. AIMS The aim of this study is to report data of 2041 patients with cryptococcosis that were attended at the Infectious Diseases Hospital F. J. Muñiz over a 30 year-period. METHODS Information about demographic and clinical data, survival time and the applied treatment, was taken from the Mycology Unit database. Mycological exams from different clinical samples were performed. Cryptococcal capsular antigen in serum and cerebrospinal fluid was detected through the latex agglutination technique. Cryptococcus isolates were phenotypically identified and the genotype was determined in some of them. Susceptibility tests were carried out following M27-A3 document. RESULTS Seventy five percent of HIV+positive patients and 50% of the HIV-negative population were males. Mean ages were 34.1 in HIV+positive patients and 44.8 in the HIV-negative. Cryptococcosis was associated with AIDS in 98% of the cases. Meningeal compromise was seen in 90% of the patients. Although cerebrospinal fluid rendered more positive results, blood culture was the first diagnostic finding in some cases. Cryptococcal antigen showed positive results in 96.2% of the sera samples and in the 93.1% of the cerebrospinal fluid samples. Most of the isolates were Cryptococcus neoformans and belonged to genotype VNI. Minimal inhibitory concentration values were mostly below the epidemiological cutoff values. CONCLUSIONS We observed that thanks to a high level of clinical suspicion, early diagnosis, combined therapy and intracranial pressure control by daily lumbar punctures, the global mortality rate has markedly decreased through the years in the analyzed period.
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Affiliation(s)
- Alicia Arechavala
- Unidad Micología, Hospital de Enfermedades Infecciosas Dr. Francisco J. Muñiz, Uspallata 2272, Buenos Aires City, Argentina.
| | - Ricardo Negroni
- Unidad Micología, Hospital de Enfermedades Infecciosas Dr. Francisco J. Muñiz, Uspallata 2272, Buenos Aires City, Argentina
| | - Fernando Messina
- Unidad Micología, Hospital de Enfermedades Infecciosas Dr. Francisco J. Muñiz, Uspallata 2272, Buenos Aires City, Argentina
| | - Mercedes Romero
- Unidad Micología, Hospital de Enfermedades Infecciosas Dr. Francisco J. Muñiz, Uspallata 2272, Buenos Aires City, Argentina
| | - Emmanuel Marín
- Unidad Micología, Hospital de Enfermedades Infecciosas Dr. Francisco J. Muñiz, Uspallata 2272, Buenos Aires City, Argentina
| | - Roxana Depardo
- Unidad Micología, Hospital de Enfermedades Infecciosas Dr. Francisco J. Muñiz, Uspallata 2272, Buenos Aires City, Argentina
| | - Laura Walker
- Unidad Micología, Hospital de Enfermedades Infecciosas Dr. Francisco J. Muñiz, Uspallata 2272, Buenos Aires City, Argentina
| | - Gabriela Santiso
- Unidad Micología, Hospital de Enfermedades Infecciosas Dr. Francisco J. Muñiz, Uspallata 2272, Buenos Aires City, Argentina
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Vidal JE, Toniolo C, Paulino A, Colombo A, Dos Anjos Martins M, da Silva Meira C, Pereira-Chioccola VL, Figueiredo-Mello C, Barros T, Duarte J, Fonseca F, Alves Cunha M, Mendes C, Ribero T, Dos Santos Lazera M, Rajasingham R, Boulware DR. Asymptomatic cryptococcal antigen prevalence detected by lateral flow assay in hospitalised HIV-infected patients in São Paulo, Brazil. Trop Med Int Health 2016; 21:1539-1544. [PMID: 27699970 DOI: 10.1111/tmi.12790] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To determine the prevalence of asymptomatic cryptococcal antigen (CRAG) using lateral flow assay (LFA) in hospitalised HIV-infected patients with CD4 counts <200 cells/μl. METHODS Hospitalised HIV-infected patients were prospectively recruited at Instituto de Infectologia Emilio Ribas, a tertiary referral hospital to HIV-infected patients serving the São Paulo State, Brazil. All patients were >18 years old without prior cryptococcal meningitis, without clinical suspicion of cryptococcal meningitis, regardless of antiretroviral (ART) status, and with CD4 counts <200 cells/μl. Serum CRAG was tested by LFA in all patients, and whole blood CRAG was tested by LFA in positive cases. RESULTS We enrolled 163 participants of whom 61% were men. The duration of HIV diagnosis was a median of 8 (range, 1-29) years. 26% were antiretroviral (ART)-naïve, and 74% were ART-experienced. The median CD4 cell count was 25 (range, 1-192) cells/μl. Five patients (3.1%; 95%CI, 1.0-7.0%) were asymptomatic CRAG-positive. Positive results cases were cross-verified by performing LFA in whole blood. CONCLUSIONS 3.1% of HIV-infected inpatients with CD4 <200 cells/μl without symptomatic meningitis had cryptococcal antigenemia in São Paulo, suggesting that routine CRAG screening may be beneficial in similar settings in South America. Our study reveals another targeted population for CRAG screening: hospitalised HIV-infected patients with CD4 <200 cells/μl, regardless of ART status. Whole blood CRAG LFA screening seems to be a simple strategy to prevention of symptomatic meningitis.
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Affiliation(s)
- José E Vidal
- Instituto de Infectologia Emilio Ribas, São Paulo, Brazil.,Faculdade de Medicina, Hospital das Clínicas, da Universidade de São Paulo, São Paulo, Brazil.,Instituto de Medicina Tropical da Universidade de São Paulo, São Paulo, Brazil
| | | | | | | | | | | | | | - Claudia Figueiredo-Mello
- Instituto de Infectologia Emilio Ribas, São Paulo, Brazil.,Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brazil
| | - Tiago Barros
- Instituto de Infectologia Emilio Ribas, São Paulo, Brazil
| | | | | | | | - Clara Mendes
- Instituto de Infectologia Emilio Ribas, São Paulo, Brazil
| | - Taiana Ribero
- Instituto de Infectologia Emilio Ribas, São Paulo, Brazil
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Vidal JE. Preemptive Therapy for Cryptococcal Meningitis: A Valid Strategy for Latin America? J Fungi (Basel) 2016; 2:jof2020014. [PMID: 29376931 PMCID: PMC5753076 DOI: 10.3390/jof2020014] [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] [Received: 04/07/2016] [Revised: 05/11/2016] [Accepted: 05/16/2016] [Indexed: 11/16/2022] Open
Abstract
AIDS-related cryptococcal meningitis continues to cause a substantial burden of death in low and middle income countries. Better diagnostics allow detection of cryptococcosis in the asymptomatic phase and using these technologies to screen at-risk persons would likely reduce mortality. The World Health Organization recommends cryptococcal antigen screening among populations with a prevalence of cryptococcal antigenaemia (CRAG) > 3%. There is scarce data about CRAG prevalence in Latin America. Four studies (only one published as a full text) showed asymptomatic CRAG prevalence between 2.7% and 6.2% in several sub-sets of HIV-infected patients. The CRAG lateral flow assay (LFA) has several advantages over other techniques for actual implementation of a screening program. Although more studies are necessary to confirm available data, implementation of the CRAG screening strategy seems to be opportune in Latin America.
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Affiliation(s)
- José E Vidal
- Department of Neurology; Emilio Ribas Institute of Infectious Diseases; Av Doutor Arnaldo 165, Cerqueira César, São Paulo, CEP 05411-000, Brazil.
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Bava AJ, Negroni R, Arechavala A, Robles AM, Bianchi M. Cryptococcosis associated with AIDS in the Muñiz Hospital of Buenos Aires. Mycopathologia 1998; 140:13-7. [PMID: 9608720 DOI: 10.1023/a:1006801502246] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Some epidemiologic, diagnostic and immunologic aspects of 93 (75 males and 18 women) cases of cryptococcosis (CRY) associated with AIDS, hospitalized in the Muñiz Hospital (MH) in Buenos Aires during 1994, were retrospectively studied. The median age (MA) of the patients under study was 28 years (17-49 y); 30 (17-49) y for males and 23 (22-34) y for women. Intravenous drug addiction (34% of patients) and homo/bisexuality in men (17%) were the most frequent risk factors for HIV infection. The MA of these groups were 27.5 (17-41) y and 34 (25-41) y, respectively. Microscopic CSF examination with India ink and the blood cultures (lysis-centrifugation) achieved the diagnosis of CRY in 67 (72%) and 16 (17%) patients, respectively. At diagnosis, the median titers for Cryptococcus neoformans capsular antigen were 1/1,000, 1/100 and 1/1 in serum, CSF and urine, respectively. Sixty five strains of C. neoformans were insolated from clinical samples; all were identified at variety neoformans employing the culture medium proposed by Salkin & Hurd and the D-proline assimilation test. At diagnosis, CD4+ lymphocytes counts were < 50/microliter in 46 patients (83.63%), and were between 51 and 200/microliter in 9 (16.4%). The CD4+/CD8+ ratio was < 1 in all patients. Most patients were born (83%) and lived at diagnosis (96%) in Buenos Aires (Bs As) city, Bs As outskirts towns and cities located in Bs As province.
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Affiliation(s)
- A J Bava
- United Micrologia, Hospital de Infecciosas Francisco J. Muñiz, Buenos Aires, Argentina
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