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1.
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
2.
Open forum infect. dis ; 6(4): ofz073, Apr. 2019. ilus, tab
Artigo em Inglês | Sec. Est. Saúde SP, SESSP-IIERPROD, Sec. Est. Saúde SP | ID: biblio-1017346

RESUMO

BACKGROUND: Histoplasmosis is highly endemic in the American continent. This condition is associated with a high mortality, particularly in people living with HIV/AIDS (PLWHA). Diagnosis of histoplasmosis is usually late in South America, as Histoplasma antigen detection is rarely available. Here we determined the prevalence, risk factors, and outcome of histoplasmosis in PLWHA in Brazilian hospitals. METHODS: This was a prospective cohort study (2016­2018) involving 14 tertiary medical centers in Brazil. We included hospitalized PLWHA presenting with fever and additional clinical findings. Patients were investigated at each participant center with classical mycology methods. Also, Histoplasma antigen detection was performed in urine samples (IMMY). Probable/proven histoplasmosis was defined according to European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group/National Institute of Allergy and Infectious Diseases Mycoses Study Group criteria. RESULTS: From 616 eligible patients, 570 were included. Histoplasmosis was identified in 21.6% (123/570) of patients. Urine antigen testing increased the diagnostic yield in 53.8%, in comparison with standard mycology methods. Variables independently associated with histoplasmosis were CD4+ count <50 cells/mm3, use of an antiretroviral (protective effect), and sample collection in the Northeast region of Brazil. Dyspnea at presentation was independently associated with death. Histoplasmosis was more frequent than tuberculosis in patients with low CD4+ counts. Overall 30-day mortality was 22.1%, decreasing to 14.3% in patients with antigen-based diagnosis. CONCLUSIONS: Histoplasmosis is a very frequent condition affecting PLWHA in Brazil, particularly when CD4+ counts are lower than 50 cells/mm3. Antigen detection may detect earlier disease, with a probable impact on outcomes. Access to this diagnostic tool is needed to improve clinical management of PLWHA in endemic countries


Assuntos
Humanos , Brasil/epidemiologia , HIV , Infecções Oportunistas Relacionadas com a AIDS , Histoplasma , Histoplasmose/epidemiologia
3.
Med Mycol ; 57(2): 256-259, 2019 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-29471422

RESUMO

Histoplasma capsulatum var. duboisii (Hcd) infections have been well documented to cause chronic granulomatous disease, mainly involving the skin of baboons and humans in African countries primarily. This retrospective study classified the subspecies of Histoplasma and developed a phylogenetic tree utilizing DNA sequences extracted from formalin-fixed, paraffin embedded (FFPE) tissues from 9 baboons from a research colony in Texas histologically diagnosed with Hcd. Based on sequence analysis of ITS-2, Tub-1, and ARF, Hcd isolated from the archived samples closely aligns with the African clade and has 88% sequence homology with a sample isolated from an individual in Senegal.


Assuntos
Histoplasma/classificação , Histoplasma/isolamento & purificação , Histoplasmose/veterinária , Papio/microbiologia , Filogenia , Doenças dos Primatas/microbiologia , África/epidemiologia , Animais , DNA Fúngico/genética , DNA Espaçador Ribossômico/genética , Formaldeído , Genes Fúngicos/genética , Histoplasma/genética , Histoplasmose/epidemiologia , Histoplasmose/microbiologia , Epidemiologia Molecular , Inclusão em Parafina/veterinária , Doenças dos Primatas/epidemiologia , Estudos Retrospectivos , Análise de Sequência de DNA , Texas/epidemiologia
5.
Mycoses ; 62(3): 261-267, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30561870

RESUMO

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.


Assuntos
Síndrome de Imunodeficiência Adquirida/complicações , Anticorpos Antifúngicos/sangue , Western Blotting/métodos , Testes Diagnósticos de Rotina/métodos , Histoplasma/imunologia , Histoplasmose/diagnóstico , Adulto , Distribuição por Idade , Antígenos de Fungos/imunologia , Brasil/epidemiologia , Contagem de Linfócito CD4 , Feminino , Histoplasmose/epidemiologia , Histoplasmose/mortalidade , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Sensibilidade e Especificidade , Distribuição por Sexo , Análise de Sobrevida
6.
BMC Infect Dis ; 18(1): 673, 2018 Dec 18.
Artigo em Inglês | MEDLINE | ID: mdl-30563472

RESUMO

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.


Assuntos
Histoplasmose/epidemiologia , Imunocompetência , Viagem , Doença Aguda , Animais , Histoplasma/isolamento & purificação , Histoplasmose/diagnóstico , Histoplasmose/imunologia , Humanos
7.
Curr Top Med Chem ; 18(15): 1333-1348, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30277157

RESUMO

The thermally-dimorphic systemic fungal group includes several important human pathogens: Blastomyces dermatitides, Coccidioides immitis and C. posadasii, Histoplasma capsulatum, Paracoccidioides brasiliensis, P. lutzii, and Talaromyces (Penicillium) marneffei. They usually are geographically restricted and have natural habitats in soil or in plants, and when fungal propagules invade mammalian host by inhalation, they initiate an inflammatory reaction that can result in self-resolution of the infection or cause an acute or chronic disease. In the setting of the AIDS pandemic and the developments in modern medicine, such as immunosuppressive therapy in cancer surgery patients and in transplantation and autoimmune diseases, the incidence of endemic mycoses has progressively increased. Another important factor of the increased incidence of systemic mycoses in certain regions is the progressive devastation of tropical and subtropical forests. In this review, we focus on two of the most important systemic mycoses: paracoccidioidomycosis and histoplasmosis, and their major characteristics in epidemiology, clinical aspects and laboratorial diagnosis.


Assuntos
Antifúngicos/farmacologia , Histoplasma/efeitos dos fármacos , Histoplasmose/diagnóstico , Histoplasmose/tratamento farmacológico , Paracoccidioides/efeitos dos fármacos , Paracoccidioidomicose/diagnóstico , Paracoccidioidomicose/tratamento farmacológico , Antifúngicos/química , Histoplasma/isolamento & purificação , Histoplasmose/epidemiologia , Humanos , Testes de Sensibilidade Microbiana , Paracoccidioides/isolamento & purificação , Paracoccidioidomicose/epidemiologia
8.
Emerg Infect Dis ; 24(11): 2068-2070, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30334708

RESUMO

We describe a case series of histoplasmosis caused by Histoplasma capsulatum var. duboisii during July 2011-January 2014 in Kimpese, Democratic Republic of the Congo. Cases were confirmed by histopathology, immunohistochemistry, and reverse transcription PCR. All patients were HIV negative. Putative sources for the pathogen were cellar bats and guano fertilizer exploitation.


Assuntos
Histoplasma/isolamento & purificação , Histoplasmose/epidemiologia , Adolescente , Adulto , Criança , Pré-Escolar , República Democrática do Congo/epidemiologia , Feminino , Histoplasma/genética , Histoplasmose/microbiologia , Histoplasmose/patologia , Humanos , Imuno-Histoquímica , Masculino , Pessoa de Meia-Idade , Adulto Jovem
9.
Emerg Infect Dis ; 24(10): 1835-1839, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30226187

RESUMO

Maps of Histoplasma capsulatum infection prevalence were created 50 years ago; since then, the environment, climate, and anthropogenic land use have changed drastically. Recent outbreaks of acute disease in Montana and Nebraska, USA, suggest shifts in geographic distribution, necessitating updated prevalence maps. To create a weighted overlay geographic suitability model for Histoplasma, we used a geographic information system to combine satellite imagery integrating land cover use (70%), distance to water (20%), and soil pH (10%). We used logistic regression modeling to compare our map with state-level histoplasmosis incidence data from a 5% sample from the Centers for Medicare and Medicaid Services. When compared with the state-based Centers data, the predictive accuracy of the suitability score-predicted states with high and mid-to-high histoplasmosis incidence was moderate. Preferred soil environments for Histoplasma have migrated into the upper Missouri River basin. Suitability score mapping may be applicable to other geographically specific infectious vectors.


Assuntos
Exposição Ambiental , Histoplasma/classificação , Histoplasmose/epidemiologia , Histoplasmose/microbiologia , Área Sob a Curva , Geografia Médica , Humanos , Incidência , Vigilância da População , Prevalência , Solo/química , Microbiologia do Solo , Estados Unidos/epidemiologia
10.
Wilderness Environ Med ; 29(4): 531-540, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30266238

RESUMO

INTRODUCTION: Histoplasma capsulatum is a dimorphic fungus that causes histoplasmosis, a sporadic endemic mycosis with environmental, occupational, and wilderness exposure-related risk factors. The objectives of this review are to describe these risk factors, to alert clinicians to the different presenting manifestations of histoplasmosis, and to recommend effective management and prevention strategies. METHODS: Internet search engines were queried with keywords to select articles for review over the study period, 1950 to 2018. Articles selected for review included case series, epidemiologic analyses of surveillance data, clinical and laboratory updates, immunologic investigations, and observational and longitudinal studies. Articles excluded from review included systemic mycosis reviews and clinicopathologic conference reports. RESULTS: The principal transmission mechanism of histoplasmosis is by inhalation of spores aerosolized by soil disruption, resulting in pneumonic infections ranging from asymptomatic to disseminated. Although histoplasmosis is more common in endemic regions, nonendemic regions have reported increasing autochthonous and imported cases. Immunocompromised persons are at significantly increased risks of contracting histoplasmosis. Environmental and wilderness-related risk factors for histoplasmosis include bird and bat watching, cave and cave entrance exploration, and bamboo removal and burning. Occupational risk factors for histoplasmosis include road construction, roofing, bridge and water tower work, demolition, and masonry. CONCLUSIONS: Histoplasmosis can result in considerable morbidity. Increased awareness of disease risk factors among the public and the international healthcare community will improve the timely diagnosis and treatment of histoplasmosis and prevent disease progression and dissemination.


Assuntos
Transmissão de Doença Infecciosa/prevenção & controle , Exposição Ambiental , Histoplasma/fisiologia , Histoplasmose/diagnóstico , Histoplasmose/epidemiologia , Animais , Quirópteros/microbiologia , Reservatórios de Doenças , Transmissão de Doença Infecciosa/estatística & dados numéricos , Geografia , Histoplasmose/patologia , Histoplasmose/terapia , Humanos , Fatores de Risco
12.
J Travel Med ; 25(1)2018 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-30085265

RESUMO

Background: International travel has increased in the past few decades, placing more travellers at risk of acquiring systemic endemic mycoses. There are limited published data on systemic endemic mycoses among international travellers. We report epidemiological characteristics of non-migrant, international travellers who acquired systemic endemic mycoses during travel. Methods: We analysed records of non-migrant international travellers with a confirmed diagnosis of histoplasmosis, coccidioidomycosis, paracoccidioidomycosis, blastomycosis or talaromycosis reported from 1997 through 2017 to GeoSentinel, a global surveillance network now consisting of 70 travel or tropical medicine centres in 31 countries. Results: Sixty-nine records met the inclusion criteria. Histoplasmosis was most frequently reported; the 51 travellers with histoplasmosis had the lowest median age (30 years; range: 8-85) and shortest median duration of travel (12 days; range: 5-154). Coccidioidomycosis was reported in 14 travellers; travellers with coccidioidomycosis were older (median 62 years; range: 22-78) and had the longest median number of days between return from travel and presentation to a GeoSentinel site (55 days; range: 17-273). Almost all travellers with coccidioidomycosis were exposed in the USA. Other systemic endemic mycoses were less frequently reported, including blastomycosis (three travellers) and talaromycosis (one traveller). Conclusions: Although relatively rare, systemic endemic mycoses should be considered as potential travel-related infections in non-migrant international travellers. Epidemiological exposures should be used to guide diagnostic evaluations and treatment.


Assuntos
Coccidioidomicose/epidemiologia , Histoplasmose/epidemiologia , Paracoccidioidomicose/epidemiologia , Doença Relacionada a Viagens , Viagem/estatística & dados numéricos , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Criança , Coccidioidomicose/diagnóstico , Feminino , Saúde Global , Histoplasmose/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Micoses/epidemiologia , Paracoccidioidomicose/diagnóstico , Fatores de Risco , Adulto Jovem
13.
Lancet Infect Dis ; 18(10): 1150-1159, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30146320

RESUMO

BACKGROUND: Fungal infections remain a major contributor to the opportunistic infections that affect people living with HIV. Among them, histoplasmosis is considered neglected, often being misdiagnosed as tuberculosis, and is responsible for numerous deaths in Latin America. The objective of this study was to estimate the burden of HIV-associated histoplasmosis compared with tuberculosis in Latin American countries. METHODS: For this modelling study, we estimated prevalence of previous exposure to Histoplasma capsulatum, HIV-associated histoplasmosis annual incidence, and number of deaths in 2012 in Latin American countries based on historical histoplasmin skin test studies in the general population, with an antigen dilution level of more than 1/10. Studies were identified in a literature search. Data on HIV-associated tuberculosis were extracted from the WHO notifications and outcomes tables and data on people living with HIV were extracted from the UNAIDS report for the year 2012. We systematically propagated uncertainty throughout all the steps of the estimation process. FINDINGS: Among 1310 articles identified as of June 1, 2015, 24 articles were included in the study, representing 129 histoplasmin skin test studies led in the general population of Latin American countries. For the year 2012, we estimated a range of 6710 (95% CI 5680-7867) to 15 657 (13 254-18 357) cases of symptomatic HIV-associated histoplasmosis in Latin America. Hotspot areas for histoplasmosis prevalence (>30%) and incidence (>1·5 cases per 100 people living with HIV) were Central America, the northernmost part of South America, and Argentina. According to realistic scenarios, we estimated a range of 671 (95% CI 568-787) to 9394 (7952-11 014) deaths related to histoplasmosis, compared with 5062 (3777-6405) deaths related to tuberculosis reported in Latin America. INTERPRETATION: Our estimates of histoplasmosis incidence and deaths are high and consistent with published data. For the first time, the burden of histoplasmosis is estimated to be equivalent in incidence and even higher in deaths when compared with tuberculosis among people living with HIV in Latin America. FUNDING: None.


Assuntos
Infecções por HIV/complicações , Histoplasmose/epidemiologia , Tuberculose/epidemiologia , Efeitos Psicossociais da Doença , Humanos , Incidência , América Latina/epidemiologia
14.
Rev Soc Bras Med Trop ; 51(4): 479-484, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30133631

RESUMO

INTRODUCTION: In many settings, the lack of sensitive biomarkers of disseminated histoplasmosis (DH) leads to a clinical reliance on older diagnostic methods and delayed treatment initiation. The early recognition of DH is critical for survival, especially in patients with human immunodeficiency virus (HIV). This study aimed to identify clinical and laboratory findings associated with the definitive diagnosis of DH in low-income HIV patients in endemic areas. METHODS: Febrile AIDS patients with suspected DH who were admitted to a reference hospital in northeastern Brazil from January 2006 to January 2007 were evaluated for clinical and laboratory findings associated with DH diagnosis. RESULTS: One hundred seventeen patients with fever were included, and 48 (41%) cases of DH were determined by Histoplasma capsulatum identification. A higher fever (≥38.5ºC), maculopapular/papular rash, splenomegaly, hepatomegaly, wheezing, hemoglobin ≤9.5g/dL, platelets ≤80,000/µL, CD4 count ≤75/µL, aspartate aminotransferase (AST) level ≥2.5 times the upper limit of normal (ULN), lactate dehydrogenase (LDH) ≥5times the ULN; and international normalized ratio (INR) >2 times the ULN were significantly associated with DH. A multivariable analysis identified hepatomegaly [adjusted (a) prevalence ratio (PR)= 1.96; 95% confidence interval (CI): 1.21-3.16), CD4 count ≤75/µL (aPR = 2.02; 95% CI: 1.06-3.83), LDH ≥5 times the ULN (aPR = 2.23; 95% CI: 1.44-3.48), and maculopapular/papular rash (aPR = 1.70; 95% CI: 1.02-2.83) were independent risk factors for DH. CONCLUSIONS: These easily assessed parameters can facilitate clinical decision-making for febrile AIDS patients with suspected DH in low socioeconomic and Histoplasma-endemic regions.


Assuntos
Infecções Oportunistas Relacionadas com a AIDS/diagnóstico , Febre/microbiologia , Histoplasma/isolamento & purificação , Histoplasmose/diagnóstico , Infecções Oportunistas Relacionadas com a AIDS/epidemiologia , Adolescente , Adulto , Brasil/epidemiologia , Contagem de Linfócito CD4 , Feminino , Histoplasmose/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Prospectivos , Fatores de Risco , Fatores Socioeconômicos , Adulto Jovem
15.
Emerg Infect Dis ; 24(7): 1257-1266, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29912691

RESUMO

Endemic mycoses represent a growing public health challenge in North America. We describe the epidemiology of 1,392 microbiology laboratory-confirmed cases of blastomycosis, histoplasmosis, and coccidioidomycosis in Ontario during 1990-2015. Blastomycosis was the most common infection (1,092 cases; incidence of 0.41 cases/100,000 population), followed by histoplasmosis (211 cases) and coccidioidomycosis (89 cases). Incidence of blastomycosis increased from 1995 to 2001 and has remained elevated, especially in the northwest region, incorporating several localized hotspots where disease incidence (10.9 cases/100,000 population) is 12.6 times greater than in any other region of the province. This retrospective study substantially increases the number of known endemic fungal infections reported in Canada, confirms Ontario as an important region of endemicity for blastomycosis and histoplasmosis, and provides an epidemiologic baseline for future disease surveillance. Clinicians should include blastomycosis and histoplasmosis in the differential diagnosis of antibiotic-refractory pneumonia in patients traveling to or residing in Ontario.


Assuntos
Blastomicose/epidemiologia , Coccidioidomicose/epidemiologia , Histoplasmose/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Blastomicose/história , Blastomicose/microbiologia , Coccidioidomicose/história , Coccidioidomicose/microbiologia , Feminino , Geografia Médica , Histoplasmose/história , Histoplasmose/microbiologia , História do Século XX , História do Século XXI , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Ontário/epidemiologia , Prevalência , Vigilância em Saúde Pública , Adulto Jovem
16.
Indian J Med Microbiol ; 36(1): 61-64, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29735828

RESUMO

Purpose of Study: The western and North-Western parts of India are usually considered non-endemic for histoplasmosis. On the contrary, we observe histoplasmosis cases with relatively higher frequency from this region although the awareness and laboratory facility to diagnose the disease are not adequate. Hence, we planned the present retrospective study to compile the cases and to analyse different clinical parameters. Materials and Methods: Medical records of the patients diagnosed with histoplasmosis during January 2012-August 2017 at two infectious disease clinics of Ahmedabad were included in this study. Results: During the study, 12 cases of histoplasmosis were diagnosed. The median age of the patients was 53 years; all males except one. The diagnosis of histoplasmosis was confirmed on histopathology for 11 cases, and one patient was diagnosed as probable histoplasmosis. The patients were either from Gujarat or Rajasthan without any travel history to endemic zone of histoplasmosis, except one patient. The majority (67%) of the patients had no apparent immunosuppression. Adrenal enlargement, oral ulcers and lymphadenopathy were common presentations in four patients each. We lost two patients in follow-up, and rest 10 patients responded to either to amphotericin B deoxycholate and/or itraconazole therapy. Conclusion: This study highlights that Gujarat and Rajasthan are an endemic region for histoplasmosis, and a systematic study is required to understand epidemiology of the disease. Histoplasmosis should be a differential diagnosis in a patient presenting with adrenal enlargement, lymphadenopathy, oral ulcers and fever of unknown origin in this region.


Assuntos
Anfotericina B/uso terapêutico , Antifúngicos/uso terapêutico , Ácido Desoxicólico/uso terapêutico , Histoplasma/isolamento & purificação , Histoplasmose/tratamento farmacológico , Histoplasmose/epidemiologia , Adulto , Idoso , Combinação de Medicamentos , Feminino , Histoplasmose/diagnóstico , Humanos , Hospedeiro Imunocomprometido , Índia/epidemiologia , Itraconazol/uso terapêutico , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Microbiologia do Solo , Voriconazol/uso terapêutico
17.
Clin Transplant ; 32(7): e13289, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29782660

RESUMO

Invasive fungal infections are a feared complication in kidney transplant recipients (KTRs). Here we present the University of Wisconsin experience with 5 invasive fungal infections-aspergillosis, cryptococcosis, histoplasmosis, blastomycosis, and coccidioidomycosis-in KTRs transplanted between 01/01/1994 and 06/30/2014. During this period, there were 128 cases of fungal infections; aspergillosis was the most common (72), followed by cryptococcosis (29), histoplasmosis (14), blastomycosis (10), and coccidioidomycosis (3). The mean interval from transplant to fungal infection was 3.19 ± 3.58 years (range 5 days-15.8 years). By 6 months postinfection, there were 53 (41%) graft failures and 24 (19%) deaths. Graft failure occurred in 46%, 38%, 21%, 40%, and 67% of patients with aspergillosis, cryptococcosis, histoplasmosis, blastomycosis, and coccidioidomycosis, respectively. Anti-thymocyte globulin (ATG) induction (HR, 1.49; 95% CI, 1.03-2.16; P = .04), diabetes (HR, 1.53; 95% CI, 1.05-2.21; P = .03), and age (HR, 1.47; 95% CI, 1.27-1.70; P ≤ .001) were associated with an increased risk for infection in univariate analysis. Multivariate adjustment retained ATG induction and older age. A large proportion of kidney transplant recipients with invasive fungal infections suffer graft failure within 3 years. Preventive, therapeutic, and monitoring strategies are needed to improve graft and patient outcomes.


Assuntos
Fungos/patogenicidade , Rejeição de Enxerto/mortalidade , Sobrevivência de Enxerto , Falência Renal Crônica/mortalidade , Transplante de Rim/efeitos adversos , Micoses/complicações , Adulto , Antifúngicos/uso terapêutico , Aspergilose/complicações , Aspergilose/epidemiologia , Aspergilose/microbiologia , Blastomicose/complicações , Blastomicose/epidemiologia , Blastomicose/microbiologia , Coccidioidomicose/complicações , Coccidioidomicose/epidemiologia , Coccidioidomicose/microbiologia , Criptococose/complicações , Criptococose/epidemiologia , Criptococose/microbiologia , Feminino , Seguimentos , Fungos/classificação , Rejeição de Enxerto/tratamento farmacológico , Rejeição de Enxerto/etiologia , Histoplasmose/complicações , Histoplasmose/epidemiologia , Histoplasmose/microbiologia , Humanos , Falência Renal Crônica/microbiologia , Falência Renal Crônica/cirurgia , Masculino , Pessoa de Meia-Idade , Micoses/epidemiologia , Micoses/microbiologia , Complicações Pós-Operatórias , Prognóstico , Estudos Prospectivos , Taxa de Sobrevida , Fatores de Tempo , Transplantados
19.
J Mycol Med ; 28(1): 211-214, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29519625

RESUMO

Histoplasmosis is a fungal infection caused by a dimorphic fungus, Histoplasma capsulatum. We report a first case of disseminated histoplasmosis in a 34-year-old woman, infected with human immunodeficiency virus (HIV), originating from Ivory Coast and living in Tunisia for 4 years. She was complaining from fever, chronic diarrhoea and pancytopenia. The Histoplasma capsulatum var. capsulatum was identified by direct microscopic examination of the bone marrow. She was treated by Amphotericin B, relayed by itraconazole. Even though a regression of symptoms and normalization of blood cell count (BCC), the patient died in a respiratory distress related to CMV hypoxemic pneumonia.


Assuntos
Medula Óssea/microbiologia , Infecções por HIV/microbiologia , Histoplasma/isolamento & purificação , Histoplasmose/sangue , Histoplasmose/diagnóstico , Infecções Oportunistas Relacionadas com a AIDS/complicações , Infecções Oportunistas Relacionadas com a AIDS/epidemiologia , Infecções Oportunistas Relacionadas com a AIDS/microbiologia , Infecções Oportunistas Relacionadas com a AIDS/virologia , Adulto , Anfotericina B/uso terapêutico , Antifúngicos/uso terapêutico , Doenças Transmissíveis Importadas/epidemiologia , Doenças Transmissíveis Importadas/microbiologia , Costa do Marfim/epidemiologia , Evolução Fatal , Feminino , Infecções por HIV/complicações , Infecções por HIV/epidemiologia , Histoplasma/ultraestrutura , Histoplasmose/epidemiologia , Histoplasmose/microbiologia , Humanos , Itraconazol/uso terapêutico , Microscopia , Síndrome do Desconforto Respiratório do Adulto/epidemiologia , Síndrome do Desconforto Respiratório do Adulto/microbiologia , Tunísia/epidemiologia
20.
Emerg Infect Dis ; 24(3): 425-431, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-29460731

RESUMO

Histoplasmosis is one of the most common mycoses endemic to the United States, but it was reportable in only 10 states during 2016, when a national case definition was approved. To better characterize the epidemiologic features of histoplasmosis, we analyzed deidentified surveillance data for 2011-2014 from the following 12 states: Alabama, Arkansas, Delaware, Illinois, Indiana, Kentucky, Michigan, Minnesota, Mississippi, Nebraska, Pennsylvania, and Wisconsin. We examined epidemiologic and laboratory features and calculated state-specific annual and county-specific mean annual incidence rates. A total of 3,409 cases were reported. Median patient age was 49 (interquartile range 33-61) years, 2,079 (61%) patients were male, 1,273 (57%) patients were hospitalized, and 76 (7%) patients died. Incidence rates varied markedly between and within states. The high hospitalization rate suggests that histoplasmosis surveillance underestimates the true number of cases. Improved surveillance standardization and surveillance by additional states would provide more comprehensive knowledge of histoplasmosis in the United States.


Assuntos
Histoplasma , Histoplasmose/epidemiologia , Histoplasmose/microbiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Geografia Médica , Histoplasmose/história , Histoplasmose/mortalidade , História do Século XXI , Hospitalização , Humanos , Incidência , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Vigilância em Saúde Pública , Estados Unidos/epidemiologia , Adulto Jovem
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