Implementation of rapid diagnostics assays for detection of histoplasmosis and cryptococcosis in central american people living with HIV.

OBJECTIVES: Histoplasmosis and cryptococcosis are important public health problems in people living with HIV (PLHIV) in Central America. Conventional laboratory assays, based on microscopy and culture, are not optimal for the diagnosis of either disease. However, antigen (Ag) assays are rapid and highly accurate for the diagnosis of these infections. METHODS: Laboratory surveillance of PLHIV was carried out in four hospitals in Panama, Honduras and Nicaragua, between 2015 and 2019. Detection of Histoplasma antigens in urine was performed by enzyme immunoassay (EIA), and Cryptococcus antigen detection in sera and cerebrospinal fluid specimens was performed by lateral flow assay (LFA). RESULTS: A total of 4,453 PLHIV with clinical suspicion of histoplasmosis (n = 1,343) or cryptococcosis (n = 3,110; 2,721 sera and 389 CSF) were tested. Of 1,343 patients suspected of having histoplasmosis, 269 (20%) were Histoplasma Ag positive. Of 3,110 patients tested using the Cryptococcus Ag assay, 329 (11%) were positive. Honduras reported the highest positivity rates (32% for Histoplasma Ag, and 16% for Cryptococcus Ag); Panama reported the largest number of patients testing positive using the Histoplasma Ag assay (n = 201); and Nicaragua reported the largest number of patients testing positive using the Cryptococcus Ag assay (n = 170). CONCLUSION: Here, we show how the implementation of rapid diagnostics assays impacted case detection and was useful for the care of people with advanced HIV. Rapid and accurate diagnosis could reduce mortality associated with histoplasmosis and cryptococcosis in PLHIV.

Antimicrobial profile of Acinetobacter baumannii at a tertiary hospital in Honduras: a cross-sectional analysis.

Acinetobacter baumannii is considered to be a worldwide threat to public health due to its high antimicrobial resistance rates and the severe infections it can cause. Little is known about this pathogen's resistance in Central America. This report aims to describe the antimicrobial resistance profile of A. baumannii at a tertiary hospital in Honduras. The cross-sectional analysis was conducted at the tertiary care laboratory hospital in San Pedro Sula in 2015 - 2017. A total of 113 consecutive microbiological reports were analyzed, comprising 100 individuals from whom A. baumannii was isolated. Epidemiological and microbiological data, including the isolation setting and patient information, were recorded. Prevalence of multi-drug and extensive-drug resistance was assessed according to international standards. The median age of individuals was 22 years (2 - 35 years); female was the predominant gender (53%). The hospital's pediatric wards had the highest number of isolates (n = 48). The most frequent specimen from which A. baumannii was isolated was skin and soft tissue (n = 39). Resistance to carbapenems was reported to be 40.7% among the isolates (n = 46); multi-drug resistant, 35.4% (n = 40); and extensively-drug resistant, 7.1% (n = 8). This report reveals the threat of this pathogen to public health in Honduras and appeals for antibiotic stewardship programs throughout Central America.

Acinetobacter baumannii se considera como una amenaza mundial para la salud pública debido a sus tasas elevadas de resistencia a los antimicrobianos y a las infecciones graves que puede causar. Es poco lo que se conoce acerca de la resistencia de este agente patógeno en Centroamérica, por lo que el propósito de este informe es describir el perfil de resistencia a los antimicrobianos de A. baumannii mediante un estudio llevado a cabo en un hospital de atención terciaria en Honduras. Entre el 2015 y el 2017, se realizó un análisis transversal en el laboratorio de atención terciaria en el Instituto Hondureño de Seguridad Social en San Pedro Sula. Se analizó un total de 113 informes de análisis microbiológicos consecutivos, en los que las cepas aisladas de A. Baumannii provenían de un grupo de 100 personas. Se registraron los datos epidemiológicos y microbianos, así como el entorno de aislamiento y la información del paciente. La prevalencia de la multirresistencia y la resistencia extensa se evaluó con base en las normas internacionales. La mediana de edad de las personas fue de 22 años (intervalo: de 2 a 35 años de edad) y predominó el sexo femenino (53%). Las salas de pediatría del hospital presentaron el número más alto de cepas aisladas (n = 48). La piel y el tejido blando (n = 39) fueron las muestras más frecuente de las cuales se aisló la cepa A. Baumannii. Se notificó 40,7% de resistencia a los fármacos carbapenémicos en las cepas aisladas (n = 46); 35,4% de multirresistencia (n = 40); y 7,1% de resistencia extensa (n = 8). Este informe pone en evidencia la amenaza que este agente patógeno representa para la salud pública en Honduras. Asimismo, sirve para alertar a los programas de optimización del uso de antibióticos en Centroamérica.

Acinetobacter baumannii é considerado uma ameaça à saúde pública em todo o mundo devido às suas altas taxas de resistência antimicrobiana e às graves infecções que pode causar. Sabe-se pouco sobre a resistência deste patógeno na América Central. Este artigo visa descrever o perfil de resistência antimicrobiana de A. baumannii em um hospital terciário em Honduras. Realizamos uma análise transversal no hospital terciário de San Pedro Sula, de 2015 a 2017. Analisamos um total de 113 laudos microbiológicos consecutivos, que envolveram 100 pessoas das quais foi isolado A. baumannii. Registramos dados epidemiológicos e microbiológicos, incluindo o ambiente onde foi feito o isolamento e informações sobre os pacientes. Avaliamos a prevalência de resistência a múltiplos fármacos e resistência extensiva, de acordo com padrões internacionais. A idade mediana dos participantes foi de 22 anos (intervalo, 2 a 35 anos); a maioria dos participantes foi do sexo feminino (53%). As enfermarias pediátricas do hospital tiveram o maior número de isolados (n = 48). A pele e os tecidos moles foram os espécimes mais frequentes de isolamento de A. baumannii (n = 39). A resistência aos carbapenens foi constatada em 40,7% dos isolados (n = 46), a resistência a múltiplos fármacos esteve presente em 35,4% (n = 40) e a resistência extensiva em 7,1% (n = 8). Este artigo revela a ameaça que este patógeno representa à saúde pública em Honduras e faz um apelo pela implantação de programas de gestão do uso de antibióticos em toda a América Central.

Feasibility of a Symptom Management Intervention for Honduran Adults Undergoing Chemotherapy.

Evidence-based interventions often need to be adapted to maximize their implementation potential in low-to middle-income countries. A single-arm feasibility study was conducted to determine the feasibility and acceptability of a telephone-delivered, nurse-led, symptom management intervention for adults undergoing chemotherapy in Honduras. Over the course of 6 months, nurses engaged 25 patients undergoing chemotherapy in the intervention. Each participant received an average of 16.2 attempts to contact them for telephone sessions (SD = 8.0, range = 2-28). Collectively, the participants discussed 24 different types of symptoms. The most commonly discussed symptoms were pain (12%), nausea (7%), and constipation (5%). Qualitative and quantitative data were used to identify treatment manual modifications (i.e., adding content about different symptoms and addressing scheduling of treatment) and workplace modifications (i.e., dedicated nurse time and space) that are needed to optimize implementation of the intervention.

Unexplored Genetic Diversity of Multidrug- and Extremely Drug-Resistant Acinetobacter baumannii Isolates from Tertiary Hospitals in Honduras.

Although Acinetobacter baumannii has become one of the most important nosocomial pathogens worldwide, very little is known about the genetic identity of isolates from less developed countries in Latin America. To alleviate this, we sequenced the genomes of 16 A. baumannii isolates from Honduras. Whole-genome sequencing was conducted on 16 isolates from five Honduran Hospitals. With the sequences of these Honduran isolates and other 42 publically available genomes, a maximum likelihood phylogeny was constructed to establish the relationship between the Honduran isolates and those belonging to the International Clones (ICs). In addition, sequence type (ST) assignation was conducted by the PubMLST, and antibiotic resistance genes were identified using ResFinder. The Honduran isolates are highly diverse and contain new allele combinations under the Bartual multilocus sequence typing scheme. The most common STs were STB447/STP10 and STB758/STP156. Furthermore, none of these isolates belongs to clonal complexes related to the ICs. Antibiotic susceptibility profiles of these isolates showed that they are multidrug resistant (MDR) or extensively drug resistant (XDR). In addition, the Honduran isolates had genes involved in resistance to seven antibiotic families. For instance, several blaOXA alleles were found, including blaOXA-23 and a gene encoding the metallo-beta-lactamase NDM-1. Notably, nine of the Honduran isolates have antibiotic resistance genes to three or more antibiotic families. In summary, in this study, we unveiled an untapped source of genetic diversity of MDR and XDR isolates; notably, these isolates did not belong to the well-known ICs.