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1.
Rev Soc Bras Med Trop ; 53: e20190364, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31994667

RESUMO

The present report describes the first case of postpartum disseminated histoplasmosis in a 24-year-old HIV-negative woman. On the tenth day after vaginal delivery, the patient presented with dyspnea, fever, hypotension, tachycardia, and painful hepatomegaly. Yeast-like Histoplasma capsulatum features were isolated in the buffy coat. The phylogenetic analysis demonstrated that the fungal isolate was similar to other H. capsulatum isolates identified in HIV patients from Ceará and Latin America. Thus, histoplasmosis development in individuals with transitory immunosuppression or during the period of immunological recovery should be carefully examined.


Assuntos
DNA Fúngico/análise , DNA Espaçador Ribossômico/genética , Histoplasma/genética , Histoplasmose/diagnóstico , Período Pós-Parto , Adulto , Feminino , Histoplasma/isolamento & purificação , Histoplasmose/microbiologia , Humanos , Filogenia , Reação em Cadeia da Polimerase
2.
BMC Infect Dis ; 19(1): 992, 2019 Nov 21.
Artigo em Inglês | MEDLINE | ID: mdl-31752711

RESUMO

BACKGROUND: Histoplasmosis is one of the invasive fungal infections and presents with symptoms mainly in the lungs. Disseminated histoplasmosis (DH) is rare and its lesions in the gastrointestinal tract are even uncommon. The concomitant involvement of the upper and lower gastrointestinal tract has never been described in the immunocompetent individuals. CASE PRESENTATION: A 44-year-old immunocompetent Chinese man presented with fever, hepatosplenomegaly, fungal esophagitis and protuberant lesions with central depression and erosion along the mucous membrane of the colon. The patient was diagnosed as disseminated histoplasmosis by gastrointestinal endoscopy. CONCLUSIONS: Histoplasmosis should be taken caution in patients with fever and hepatosplenomegaly. Actions should be taken to avoid its disseminated infection associated high mortality.


Assuntos
Histoplasma/isolamento & purificação , Histoplasmose/diagnóstico , Adulto , Colo/diagnóstico por imagem , Colo/patologia , Endoscopia Gastrointestinal , Histoplasma/classificação , Histoplasma/genética , Histoplasmose/diagnóstico por imagem , Histoplasmose/imunologia , Histoplasmose/microbiologia , Humanos , Hospedeiro Imunocomprometido , Masculino
4.
Dermatol Online J ; 25(8)2019 Aug 15.
Artigo em Inglês | MEDLINE | ID: mdl-31553862

RESUMO

Histoplasmosis is a systemic mycosis caused by the dimorphic fungus Histoplasma capsulatum, with disseminated histoplasmosis (HD) being one of its clinical forms. As a consequence of the HIV-AIDS pandemic, HD has become prevalent not only in regions that are recognized as endemic but also in areas not considered endemic, such as Europe and Asia. Its clinical manifestations are varied and mimic several infectious diseases, mainly tuberculosis. In endemic areas, it is the first manifestation of AIDS in 50 to 70% of patients. The diagnosis of histoplasmosis is difficult and HD can lead to death if not diagnosed early and if proper treatment is not instituted. The present report presents a patient with a recent diagnosis of HIV-AIDS, in treatment for miliary tuberculosis, who was diagnosed with disseminated histoplasmosis because of his dermatological manifestations.


Assuntos
Síndrome de Imunodeficiência Adquirida/tratamento farmacológico , Fármacos Anti-HIV/uso terapêutico , Antituberculosos/uso terapêutico , Dermatomicoses/diagnóstico , Histoplasmose/diagnóstico , Tuberculose Miliar/tratamento farmacológico , Síndrome de Imunodeficiência Adquirida/complicações , Anfotericina B/uso terapêutico , Antifúngicos/uso terapêutico , Estado Terminal , Dermatomicoses/complicações , Dermatomicoses/tratamento farmacológico , Dermatomicoses/patologia , Histoplasma , Histoplasmose/complicações , Histoplasmose/tratamento farmacológico , Histoplasmose/patologia , Humanos , Itraconazol/uso terapêutico , Masculino , Tuberculose Miliar/complicações , Adulto Jovem
5.
Medicina (B Aires) ; 79(4): 287-290, 2019.
Artigo em Espanhol | MEDLINE | ID: mdl-31487250

RESUMO

Histoplasmosis and leishmaniasis are neglected and endemic diseases in Argentina, and generally are found associated with immunosuppression. We report the case of an immunocompetent 16-years-old man with simultaneous occurrence of central nervous system histoplasmosis and cutaneous leishmaniasis. Upon admission, the patient showed a one-month old skin lesion in a leg and mild paraparesis. Imaging studies detected thickening and edema in the spinal cord and the cerebrospinal fluid analysis was within normal range. The case was diagnosed as a demyelinating disorder and treated with high-dose short-term steroids. Seventy-two hours later the patient showed severe paraparesis and nuclear magnetic resonance imaging revealed nodular lesions in the spinal cord. Histoplasma capsulatum belonging to the phylogenetic species LamB was isolated from cerebrospinal fluid samples. The patient received intravenous antifungal therapy with amphotericin B for 30 days, followed by oral fluconazole and itraconazole for one year. Three months after initiation of antifungal treatment, the cutaneous lesion recrudesced and Leishmania amastigotes were observed on microscopic examination. The cutaneous leishmaniasis was treated with intramuscular meglumine antimoniate. The patient's outcome was favorable after treatment for both diseases.


Assuntos
Infecções Fúngicas do Sistema Nervoso Central/complicações , Histoplasmose/complicações , Leishmaniose Cutânea/complicações , Adolescente , Antibacterianos/administração & dosagem , Antifúngicos/administração & dosagem , Infecções Fúngicas do Sistema Nervoso Central/diagnóstico , Infecções Fúngicas do Sistema Nervoso Central/tratamento farmacológico , Histoplasmose/diagnóstico , Histoplasmose/tratamento farmacológico , Humanos , Imunocompetência , Leishmaniose Cutânea/diagnóstico , Leishmaniose Cutânea/tratamento farmacológico , Masculino
6.
PLoS Negl Trop Dis ; 13(8): e0007692, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31449526

RESUMO

BACKGROUND: Histoplasmosis is a neglected disease that affects mainly immunocompromised patients, presenting a progressive dissemination pattern and a high mortality rate, mainly due to delayed diagnosis, caused by slow fungal growth in culture. Therefore, a fast, suitable and cost-effective assay is required for the diagnosis of histoplasmosis in resource-limited laboratories. This study aimed to develop and evaluate two new molecular approaches for a more cost-effective diagnosis of histoplasmosis. METHODOLOGY: Seeking a fast, suitable, sensitive, specific and low-cost molecular detection technique, we developed a new Loop-mediated Isothermal Amplification (LAMP) assay and nested PCR, both targeting the Internal Transcribed Spacer (ITS) multicopy region of Histoplasma capsulatum. The sensitivity was evaluated using 26 bone marrow and 1 whole blood specimens from patients suspected to have histoplasmosis and 5 whole blood samples from healthy subjects. All specimens were evaluated in culture, as a reference standard test, and Hcp100 nPCR, as a molecular reference test. A heparin-containing whole blood sample from a heathy subject was spiked with H. capsulatum cells and directly assayed with no previous DNA extraction. RESULTS: Both assays were able to detect down to 1 fg/µL of H. capsulatum DNA, and ITS LAMP results could also be revealed to the naked-eye by adding SYBR green to the reaction tube. In addition, both assays were able to detect all clades of Histoplasma capsulatum cryptic species complex. No cross-reaction with other fungal pathogens was presented. In comparison with Hcp100 nPCR, both assays reached 83% sensitivity and 92% specificity. Furthermore, ITS LAMP assay showed no need for DNA extraction, since it could be directly applied to crude whole blood specimens, with a limit of detection of 10 yeasts/µL. CONCLUSION: ITS LAMP and nPCR assays have the potential to be used in conjunction with culture for early diagnosis of progressive disseminated histoplasmosis, allowing earlier, appropriate treatment of the patient. The possibility of applying ITS LAMP, as a direct assay, with no DNA extraction and purification steps, makes it suitable for resource-limited laboratories. However, more studies are necessary to validate ITS LAMP and nPCR as direct assay in other types of clinical specimens.


Assuntos
DNA Espaçador Ribossômico/genética , Histoplasma/isolamento & purificação , Histoplasmose/diagnóstico , Técnicas de Diagnóstico Molecular/métodos , Técnicas de Amplificação de Ácido Nucleico/métodos , Sangue/microbiologia , Medula Óssea/microbiologia , Histoplasma/genética , Humanos , Estudos Prospectivos , Sensibilidade e Especificidade
8.
Malays J Pathol ; 41(2): 223-227, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31427560

RESUMO

INTRODUCTION: Histoplasmosis can present in a myriad of clinical manifestations, which often makes its diagnosis difficult and occasionally, deceptive. CASE REPORT: We describe a case of a 33 years old gentleman who was clinically diagnosed as acute appendicitis at initial presentation in view of a one-week history of fever, right lower quadrant abdominal pain- and guarding at right iliac fossa. He had thrombocytopenia and lymphopenia on presentation. Mesenteric lymphadenitis and small bowel lesion were found intraoperatively, which was respectively biopsied and resected. Histopathological result confirms disseminated histoplasmosis. Retroviral screen was positive. He was treated with amphotericin B for one week, subsequently switched to oral itraconazole, followed by initiation of highly active antiretroviral therapy (HAART). DISCUSSION: This case illustrates the various nature of histoplasmosis presentation. A high index of suspicion is needed to clinch the diagnosis and subsequently institute prompt treatment as disseminated disease can be fatal if left untreated in an immunosuppressed host.


Assuntos
Histoplasmose/diagnóstico , Histoplasmose/imunologia , Histoplasmose/patologia , Hospedeiro Imunocomprometido , Adulto , Apendicite/diagnóstico , Apendicite/patologia , Diagnóstico Diferencial , Infecções por HIV/complicações , Humanos , Masculino
10.
J Vet Diagn Invest ; 31(5): 770-773, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31378198

RESUMO

Following treatment for pneumonia, a 1-y-old female Nubian goat was presented because of a persistent fever for 3 mo and peripheral lymphadenopathy for 1 mo. Cytology and histology of the superficial cervical and prefemoral lymph nodes demonstrated a moderate-to-marked "left-shifted" lymphoid population, suggestive of lymphoma, and extremely rare extracellular, 2-4 µm, oval, basophilic yeast, consistent with Histoplasma capsulatum. On immunohistochemistry, >95% of the lymphocytes demonstrated positive cytoplasmic and membranous immunoreactivity for CD3. Histoplasma spp. urine antigen and serum antibody testing were positive and negative, respectively. Panfungal PCR and sequencing of DNA extracted from scrolls of formalin-fixed, paraffin-embedded tissue yielded matches to H. capsulatum with 99-100% identity. Given the poor prognosis and persistent pyrexia, the animal was euthanized. Postmortem examination confirmed concurrent multicentric, intermediate-size, T-cell, lymphoblastic lymphoma and histoplasmosis; lesions consistent with intestinal coccidiosis and suspected pulmonary Rhodococcus equi were also noted. Although dimorphic fungi have been described previously in goats, lesions of Histoplasma spp. had not been documented in this species, to our knowledge. Given the low disease burden, it is suspected that the lymphoma was primary, leading to an immunocompromised state and development of secondary, opportunistic infections.


Assuntos
Doenças das Cabras/diagnóstico , Histoplasma/isolamento & purificação , Histoplasmose/veterinária , Linfoma/veterinária , Animais , DNA de Protozoário/análise , Evolução Fatal , Feminino , Doenças das Cabras/parasitologia , Doenças das Cabras/patologia , Cabras , Histoplasmose/diagnóstico , Histoplasmose/parasitologia , Histoplasmose/patologia , Linfoma/diagnóstico , Linfoma/patologia , Reação em Cadeia da Polimerase/veterinária , Análise de Sequência de DNA/veterinária
12.
Int J Infect Dis ; 86: 147-156, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31330326

RESUMO

BACKGROUND: Histoplasmosis is a systemic disease caused by the dimorphic fungus Histoplasma capsulatum. Diagnosis is often delayed, or it is misdiagnosed as tuberculosis. In Brazil, the infection is common and cases of histoplasmosis have been described in all regions of the country; however, the real problem is underestimated since notification of histoplasmosis is not mandatory. METHODS: Human histoplasmosis cases diagnosed in Brazil and published up to December 2018 were identified through a search conducted in the PubMed/MEDLINE, SciELO, and Web of Science databases. Moreover, the isolation of H. capsulatum from animals or environmental sources in Brazil was also evaluated. RESULTS: A total of 207 articles fulfilled the inclusion criteria and were evaluated, involving a total of 3530 patients with a diagnosis of histoplasmosis during the period studied. Of these patients, 78.3% were male, giving a male-to-female ratio of approximately 4:1. Histoplasmosis presented a higher frequency in individuals between the fourth and fifth decades of life. Disseminated disease was the most common form of histoplasmosis. Isolation of H. capsulatum on culture media and histopathology using staining methods were the diagnostic methods with the best efficiency. The best results in the identification of the H. capsulatum were achieved for samples from mononuclear phagocyte system components, skin and mucosa, and hematological samples. Regarding predisposing factors for histoplasmosis, HIV infection was the most common underlying condition. The overall mortality rate was 33.1%. CONCLUSIONS: This study represents the first available systematic review demonstrating Brazilian cases of histoplasmosis in the literature and highlights that the disease is more widespread in the Brazilian territory than has previously been thought.


Assuntos
Histoplasmose/epidemiologia , Animais , Brasil/epidemiologia , Feminino , Infecções por HIV/complicações , Histoplasma/isolamento & purificação , Histoplasmose/complicações , Histoplasmose/diagnóstico , Humanos , Masculino
13.
Transpl Infect Dis ; 21(4): e13126, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31169962

RESUMO

We report a case of disseminated histoplasmosis in a renal transplant recipient who presented with a nodular pulmonary lesion and elevated serum and bronchoalveolar lavage (BAL) Aspergillus galatomannan. This almost led to an erroneous diagnosis of invasive aspergillosis since the donor respiratory tract was known to be colonized with Aspergillus terreus. However, distinctive intracelluar Histoplasma yeasts on peripheral blood smear led to early diagnosis and appropriate treatment. The cross-reactivity between Aspergillus galactomannan and Histoplasma antigen is discussed further.


Assuntos
Histoplasmose/sangue , Histoplasmose/diagnóstico , Transplante de Rim/efeitos adversos , Mananas/sangue , Transplantados , Antifúngicos/uso terapêutico , Aspergilose/sangue , Aspergillus/imunologia , Corantes Azur , Sangue/microbiologia , Líquido da Lavagem Broncoalveolar/microbiologia , Feminino , Histoplasma/imunologia , Histoplasma/isolamento & purificação , Histoplasmose/tratamento farmacológico , Humanos , Pessoa de Meia-Idade
14.
Vet Clin Pathol ; 48(2): 250-254, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31175684

RESUMO

Histoplasmosis is one of the most common systemic fungal diseases in cats from the United States. It commonly causes respiratory or disseminated disease and is often associated with one or more cytopenias. Here, we describe 32 cats in which a Histoplasma-like fungal infection was associated with concurrent hemophagia in at least one sample site, commonly spleen, bone marrow, liver, and/or lymph node. The degree of hemophagia was characterized as moderate or marked in the majority of cases, and in all cases, there was a predominance of phagocytized mature erythrocytes. A few cases also had macrophages with phagocytized erythroid precursors, platelets, and/or neutrophils. Complete blood count results were available for 25 cats, and cytopenias were common (20/25), including solitary anemia (10), anemia and thrombocytopenia (5), solitary neutropenia (2), pancytopenia (2), and anemia and neutropenia (1). Bone marrow samples were only available in a small subset of cases, preventing the further assessment of the causes of the cytopenias. Hemophagocytosis has been previously reported in cats with neoplastic diseases and a cat with calicivirus infection, and likely occurs with other conditions as well, such as hemorrhage or hemolysis. Results of this report suggest that systemic fungal disease is an additional differential to consider when there is hemophagia in a feline cytology sample.


Assuntos
Doenças do Gato/diagnóstico , Histoplasmose/veterinária , Micoses/veterinária , Animais , Biópsia por Agulha Fina/veterinária , Contagem de Células Sanguíneas/veterinária , Medula Óssea/patologia , Doenças do Gato/microbiologia , Doenças do Gato/patologia , Gatos , Eritrócitos/patologia , Feminino , Histoplasmose/diagnóstico , Histoplasmose/microbiologia , Histoplasmose/patologia , Fígado/patologia , Linfonodos/patologia , Macrófagos/patologia , Masculino , Micoses/diagnóstico , Micoses/microbiologia , Micoses/patologia , Fagocitose , Baço/patologia
16.
Pan Afr Med J ; 32: 43, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31143348

RESUMO

Histoplasmosis is an endemic mycosis with global distribution, primarily reported in immunocompromised individuals. A 29-year old immunocompetent male presented with fever, hepatosplenomegaly and pancytopenia. His peripheral blood showed features suggestive of intravascular hemolysis and echocardiography showed features suggestive of pulmonary arterial hypertension. Bone marrow showed yeast with morphology suggestive of Histoplasma capsulatum. Further investigations revealed hyperferritinemia, hypofibrinogenemia and increased triglycerides. With a diagnosis of progressive disseminated histoplasmosis with secondary Haemophagocytic lymphohistiocytosis, he was successfully treated with amphotericin B followed by itraconazole. We report this case to highlight the atypical and rare manifestations of histoplasmosis.


Assuntos
Antifúngicos/administração & dosagem , Insuficiência Cardíaca/etiologia , Histoplasmose/diagnóstico , Linfo-Histiocitose Hemofagocítica/etiologia , Adulto , Anfotericina B/administração & dosagem , Febre/etiologia , Hemólise , Hepatomegalia/etiologia , Histoplasmose/complicações , Histoplasmose/tratamento farmacológico , Humanos , Imunocompetência , Itraconazol/administração & dosagem , Masculino , Pancitopenia/etiologia , Esplenomegalia/etiologia
18.
Jpn J Infect Dis ; 72(5): 330-333, 2019 Sep 19.
Artigo em Inglês | MEDLINE | ID: mdl-31061355

RESUMO

Histoplasmosis is occasionally encountered in non-endemic countries owing to more frequent international travel and migration, as well as an increase in the number of vulnerable hosts (e.g., patients with cellular immunodeficiencies). However, the diagnosis of endemic mycoses may be challenging because of its rarity and the limited availability of diagnostic tests. We report a case of disseminated histoplasmosis in a human immunodeficiency virus (HIV)-infected Japanese man who had often travelled to histoplasmosis-endemic countries. We also reviewed the reported cases of HIV-associated histoplasmosis in Japan. To the best of our knowledge, this is the ninth case report of co-infection with Histoplasma and HIV in Japan and the second involving a Japanese patient. This case emphasizes the importance of noting the details of not only the present residence of patients, but also their previous residence and travels. If histoplasmosis is suspected, physicians should inform laboratory personnel that fungal cultures should be incubated for 6 weeks, and compliance with biosafety guidelines for handling the specimens should be practiced. Since death occurs in nearly 50% of HIV-associated histoplasmosis cases in Japan, early recognition, timely diagnosis, and appropriate treatment are mandatory.


Assuntos
Infecções por HIV/complicações , Histoplasma/isolamento & purificação , Histoplasmose/diagnóstico , Histoplasmose/patologia , Adulto , Humanos , Japão , Pulmão/diagnóstico por imagem , Pulmão/patologia , Masculino , Técnicas Microbiológicas , Pessoa de Meia-Idade , Radiografia Torácica , Pele/patologia , Tomografia Computadorizada por Raios X
19.
Transpl Infect Dis ; 21(4): e13102, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31063620

RESUMO

Histoplasma capsulatum is an endemic fungus that most oftenly causes a self-limiting illness but can result in severe infections in immunocompromised patients including pulmonary or extra-pulmonary disease. Rarely it can also cause a chronic progressive infection of the larynx. Herein, we report a case of laryngeal histoplasmosis in a kidney transplant patient who presented with progressive symptoms of several weeks of hoarseness, dysphagia and odynophagia. Laryngoscopic examination revealed thick plaques in the oropharynx with surrounding hyper-erythema and histopathology showed numerous intracellular yeasts forms consistent with H capsulatum. Patient was initiated on treatment with itraconazole. Infection of the larynx due to H capsulatum is highly uncommon and therefore can result in an inappropriate or delayed diagnosis. A review of literature showed four previously reported cases of laryngeal histoplasmosis in patients with solid organ transplant. This is the first case series of laryngeal histoplasmosis in transplant recipients.


Assuntos
Histoplasmose/diagnóstico , Histoplasmose/etiologia , Transplante de Rim/efeitos adversos , Laringe/microbiologia , Transplantados , Idoso , Antifúngicos/uso terapêutico , Histoplasma/efeitos dos fármacos , Humanos , Hospedeiro Imunocomprometido , Itraconazol/uso terapêutico , Rim/patologia , Masculino
20.
Clin Rheumatol ; 38(6): 1691-1697, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30980192

RESUMO

Hypocomplementemic urticarial vasculitis syndrome (HUVS) is a rare type III hypersensitivity disorder characterized by urticarial vasculitis and prolonged hypocomplementemia. Individuals with HUVS may also have joint involvement, pulmonary manifestations, ocular disease, kidney inflammation, or any other form of organ involvement. Hypocomplementemia, the presence of C1q antibody in the serum, and urticarial vasculitis are the keys to the diagnosis of HUVS. It has been reported to accompany certain infections such as hepatitis B, hepatitis C, infectious mononucleosis, and coxsackie group A. However, it has never been reported to be linked to histoplasmosis in the literature. To the best of our knowledge, we report the first case of HUVS presenting concurrently with pulmonary histoplasmosis.


Assuntos
Proteínas do Sistema Complemento/deficiência , Histoplasmose/diagnóstico , Pneumopatias Fúngicas/diagnóstico , Urticária/diagnóstico , Vasculite/diagnóstico , Histoplasmose/complicações , Humanos , Pulmão/patologia , Pneumopatias Fúngicas/complicações , Masculino , Pessoa de Meia-Idade , Síndrome , Tomografia Computadorizada por Raios X , Urticária/complicações , Urticária/patologia , Vasculite/complicações , Vasculite/patologia
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