Riddell, James; Kauffman, Carol A.; Smith, Jeannina A.; Assi, Maha; Blue, Sky; Buitrago, Martha I.; Deresinski, Stan; Wright, Patty W.; Drevets, Douglas A.; Norris, Steven A.; Vikram, Holenarasipur R.; Carson, Paul J.; Vergidis, Paschalis; Carpenter, John; Seidenfeld, Steven M.; Wheat, L. Joseph
Abstract Infective endocarditis is an uncommon manifestation of infection with Histoplasma capsulatum. The diagnosis is frequently missed, and outcomes historically have been poor. We present 14 cases of Histoplasma endocarditis seen in the last decade at medical centers throughout the United States. All patients were men, and 10 of the 14 had an infected prosthetic aortic valve. One patient had an infected left atrial myxoma. Symptoms were present a median of 7 weeks before the diagnosis was established. Blood cultures yielded H. capsulatum in only 6 (43%) patients. Histoplasma antigen was present in urine and/or serum in all but 3 of the patients and provided the first clue to the diagnosis of histoplasmosis for several patients. Antibody testing was positive for H. capsulatum in 6 of 8 patients in whom the test was performed. Eleven patients underwent surgery for valve replacement or myxoma removal. Large, friable vegetations were noted at surgery in most patients, confirming the preoperative transesophageal echocardiography findings. Histopathologic examination of valve tissue and the myxoma revealed granulomatous inflammation and large numbers of organisms in most specimens. Four of the excised valves and the atrial myxoma showed a mixture of both yeast and hyphal forms on histopathology. A lipid formulation of amphotericin B, administered for a median of 29 days, was the initial therapy in 11 of the 14 patients. This was followed by oral itraconazole therapy, in all but 2 patients. The length of itraconazole suppressive therapy ranged from 11 months to lifelong administration. Three patients (21%) died within 3 months of the date of diagnosis. All 3 deaths were in patients who had received either no or minimal (1 day and 1 week) amphotericin B. PMID:25181311
C. E. López
Full Text Available Histoplasma capsulatum es un hongo patógeno dimorfo de importancia en todo el mundo, que causa un amplio espectro de enfermedades. Vive en estado saprobio en fase micelial, presentando hifas con dos tipos de conidios solitarios, macro y microconidias. La infección con H. capsulatum se inicia por vía respiratoria con la inhalación de propágulos fúngicos, constituidos principalmente por microconidios de 1-4 x 2-6 µm o de fragmentos hifales de 5 a 8 µm, que llegan a los bronquiolos terminales y alvéolos pulmonares. Los propágulos inhalados se convierten entonces a la fase levaduriforme, responsable de la patogénesis del H. capsulatum. Por ser un hongo del suelo sin requerimientos conocidos para interactuar con un hospedador mamífero como parte del ciclo de vida obligado, sus estrategias de patogénesis son particularmente notables. Entre éstas se incluyen la transición dimorfa micelio-levadura, entrada en las células fagocíticas del hospedador, localización subcelular, supervivencia y proliferación intracelular durante la infección activa y persistencia durante la infección clínicamente inaparente, con capacidad de reactivación. La patogénesis de H. capsulatum fue estudiada ampliamente a partir del aumento de pacientes inmunosuprimidos. Esta publicación presenta un resumen de los avances realizados en las investigaciones del dimorfismo y la patogénesis de H. capsulatum.Histoplasma capsulatum is a dimorphic fungal pathogen with worldwide significance, which causes a broad spectrum of disease. In the saprophytic stage, it lives as a mycelial form consisting of hyphae bearing both macro and microconidia. Infection with H. capsulatum occurs by inhalation of microconidia (1-4 x 2-6 µm or small mycelia fragments (5-8 µm in the terminal bronchioles and alveoli of the lung. Inhaled conidia then convert into the yeast form that is responsible for the pathogenesis of histoplasmosis. As a soil fungus with no known requirements for
Chemaly, Roy F.; Tomford, J. Walton; Hall, Gerri S.; Sholtis, Mary; Chua, Jimmy D.; Procop, Gary W.
Histoplasma capsulatum is an infrequent but serious cause of endocarditis. The definitive diagnosis requires culture, which may require a long incubation. We demonstrated the ability of the Histoplasma capsulatum AccuProbe to accurately identify this organism when applied directly on an excised valve that contained abundant yeast forms consistent with H. capsulatum. PMID:11427583
Laura Elena Carreto-Binaghi
Full Text Available 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.
Martagon-Villamil, Jose; Shrestha, Nabin; Sholtis, Mary; Isada, Carlos M; Hall, Gerri S; Bryne, Terry; Lodge, Barbara A; Reller, L Barth; Procop, Gary W
We designed and tested a real-time LightCycler PCR assay for Histoplasma capsulatum that correctly identified the 34 H. capsulatum isolates in a battery of 107 fungal isolates tested and also detected H. capsulatum in clinical specimens from three patients that were culture positive for this organism.
Full Text Available Abstract Background In Mexico, primary pulmonary histoplasmosis is the most relevant clinical form of the disease. The geographical distribution of specific strains of Histoplasma capsulatum circulating in Mexico has not been fully established. Outbreaks must be reported in order to have current, updated information on this disease, identifying new endemic areas, manner of exposure to the fungi, and molecular characterization of the causative agents. We report a recent outbreak of histoplasmosis in treasure hunters and the molecular characterization of two isolates obtained from these patients. Methods Six patients admitted to the National Institute of Respiratory Diseases (INER in Mexico City presented severe respiratory symptoms suggestive of histoplasmosis. They acquired the infection in the Veracruz (VZ endemic zone. Diagnosis was made by X-ray and Computed tomography (CT, liver function, immunological techniques, and culture. Identification of H. capsulatum isolates was confirmed by using Polymerase chain reaction (PCR was conducted with a probe from the M antigen, and the isolates were characterized by means of Random amplification of polymorphic DNA (RAPD-PCR employed the 1253 oligonucleotide and a mixture of oligonucleotides 1281 and 1283. These were compared to eight reference strain isolates from neighboring areas. Results X-ray and CT revealed disseminated micronodular images throughout lung parenchyma, as well as bilateral retrocaval, prevascular, subcarinal, and hilar adenopathies, hepatosplenomegaly, and altered liver function tests. Five of the six patients developed disseminated histoplasmosis. Two H. capsulatum strains were isolated. The same band profile was detected in both strains, indicating that both isolates corresponded to the sole H. capsulatum strain. Molecular characterization of the isolates was similar in 100% with the EH-53 Hidalgo human (HG strain (reference strain integrated into the LAm A clade described for
Gomez, F J; Allendoerfer, R; Deepe, G S
HIS-62 is a glycoprotein that has been isolated from the cell wall and cell membrane fraction of the pathogenic fungus Histoplasma capsulatum. It is a target of the cellular immune response to this fungus, and it protects mice against a lethal intravenous inoculum of H. capsulatum yeast cells. In this study, we cloned the gene encoding this antigen to reveal its biological nature and studied the immunological activity of recombinant antigen. The amino acid sequences of the NH2 terminus and in...
... SERVICES (CONTINUED) MEDICAL DEVICES IMMUNOLOGY AND MICROBIOLOGY DEVICES Serological Reagents § 866.3320... capsulatum from clinical specimens or cultured isolates derived from clinical specimens. The identification...
Norkaew, Treepradab; Ohno, Hideaki; Sriburee, Pojana; Tanabe, Koichi; Tharavichitkul, Prasit; Takarn, Piyawan; Puengchan, Tanpalang; Bumrungsri, Sara; Miyazaki, Yoshitsugu
Histoplasmosis is a systemic mycosis caused by inhaling spores of Histoplasma capsulatum, a dimorphic fungus. This fungus grows in soil contaminated with bat and avian excreta. Each year, patients with disseminated histoplasmosis have been diagnosed in Chiang Mai, northern Thailand. No published information is currently available on the environmental sources of this fungus in Chiang Mai or anywhere else in Thailand. The aim of this study was to detect H. capsulatum in soil samples contaminated with bat guano and avian droppings by nested PCR. Two hundred and sixty-five samples were collected from the following three sources: soil contaminated with bat guano, 88 samples; soil contaminated with bird droppings, 86 samples; and soil contaminated with chicken droppings, 91 samples. Genomic DNA was directly extracted from each sample, and H. capsulatum was detected by nested PCR using a primer set specific to a gene encoding 100-kDa-like protein (HcI, HcII and HcIII, HcIV). Histoplasma capsulatum was detected in seven of 88 soil samples contaminated with bat guano, one of 21 soil samples contaminated with pigeon droppings and 10 of 91 soil samples contaminated with chicken droppings. The results indicate the possibility of the association of bat guano and chicken droppings with H. capsulatum in this area of Thailand.
Fabrine Sales Massafera Tristão
Full Text Available INTRODUCTION: During histoplasmosis, Histoplasma capsulatum soluble antigens (CFAg can be naturally released by yeast cells. Because CFAg can be specifically targeted during infection, in the present study we investigated CFAg release in experimental murine histoplasmosis, and evaluated the host humoral immune response against high-molecular-mass antigens (hMMAg. >150 kDa, the more immunogenic CFAg fraction. METHODS: Mice were infected with 2.2x10(4 H. capsulatum IMT/HC128 yeast cells. The soluble CFAg, IgG anti-CFAg, IgG anti-hMMAg, and IgG-hMMAg circulating immune complexes (CIC levels were determined by enzymelinked immunosorbent assay, at days 0, 7, 14, and 28 post-infection. RESULTS: We observed a progressive increase in circulating levels of CFAg, IgG anti-CFAg, IgG anti-hMMAg, and IgG-hMMAg CIC after H. capsulatum infection. The hMMAg showed a high percentage of carbohydrates and at least two main immunogenic components. CONCLUSIONS: We verified for the first time that hMMAg from H. capsulatum IMT/HC128 strain induce humoral immune response and lead to CIC formation during experimental histoplasmosis.
Roberto Daibes Naiff
Full Text Available Twenty-eight isolates of Histoplasma capsulation were obtained from eight species of forest mammals from the States of Amazonas, Pará and Rondônia in the Amazon Region of Brazil. Primary isolates were obtained by inoculating triturated liver and spleen tissue intradermally and intraperito-neally in hamsters. Mycological diagnosis in hamsters presenting lesions was confirmed by histopathology and culture on Sabouraud dextrose-agar. Infected hamsters developed signs of disease within two to nine months; all had disseminated visceral lesions and most also had skin lesions at the sites of inoculation. None of the hamsters inoculated with skin macerates of the original hosts developed histoplasmosis, and histopathological examination of the viscera of the wild hosts failed to reveal H. capsulation. Prevalence of infection was considerably higher in females than in males both for the opossum Didelphis marsupialis and for total wild animals (479 examined. It is proposed that canopy-dwelling mammals may acquire the infection from conidia borne on convective currents in hollow trees with openings at ground-level.Vinte e oito amostras de Histoplasma capsulatum foram obtidas de oito espécies de mamíferos silvestres nos Estados do Amazonas, Pará e Rondônia. Os isolamentos foram feitos mediante inoculação de amostras trituradas de fígado e baço em hamsters por via intradérmica e intraperitoneal. O diagnóstico micológico nos hamsters que apresentaram lesões foi confirmado por histopatologia e cultivo em meio dextrose-agar de Sabouraud. Os hamsters infectados desenvolveram sinais de doença após dois a nove meses; todos apresentaram lesões disseminadas nas vísceras e a maioria apresentou também lesões cutâneas nos locais da inoculação. Nenhum dos hamsters inoculados com material de pele dos hospedeiros originais desenvolveu histoplasmose, e H. capsulatum não foi detectado nos exames histopatológicos dos animais silvestres. A preval
E J Carbó Amoroso
Full Text Available La histoplasmosis diseminada progresiva es una enfermedad que se manifiesta como reactivación de una infección latente en pacientes inmunodeprimidos, especialmente en personas con déficit en la inmunidad celular. Existen formas agudas, subagudas y crónicas. Las lesiones focales, en especial úlceras mucocutáneas, predominan en la forma diseminada crónica. Reportamos el caso de una paciente con artritis reumatoidea, que controlaba su patología con fármacos antirreumáticos modificadores de la enfermedad (DMARD, la que consultó por úlcera de lengua como única manifestación de una histoplasmosis diseminada crónica. La histopatología fue compatible y el cultivo positivo para Histoplasma capsulatum. La serología para el HIV fue negativa. Existen pocos casos publicados de pacientes con esta localización atípica en forma aislada, en particular aquellos HIV negativos. El itraconazol y la anfotericina B son las dos drogas más utilizadas para tratar esta enfermedad. Los datos clínicos sobre los nuevos azoles, voriconazol y posaconazol son limitados.The progressive disseminated histoplasmosis is a disease produced by reactivation of latent infection in immunocompromised host, specially in persons with defective cell-mediated immunity. There are acute, subacute and chronic forms in the progressive illness. Focal lesions, specially mucocutaneous ulcers, are most frequent in the chronic disseminated forms. We reported a patient with rheumatoid arthritis treated with disease modifying antirheumatic drug (DMARD, with an ulcer of the tongue as only clinical manifestation of a chronic disseminated histoplasmosis. The histopathology was compatible, and the culture was positive for Histoplasma capsulatum. The serology for the HIV was negative. There are few published cases of this isolated form, particularly in patients with HIV negative serological test. Itraconazole and amphotericin B are the most frequently drugs used for the treatment in this
Lavie, S; Stotzky, G
The respiration of three phenotypes of Histoplasma capsulatum, the causal agent of histoplasmosis in humans, was markedly reduced by low concentrations of montmorillonite but was reduced less by even higher concentrations of kaolinite or attapulgite (palygorskite). The reduction in respiration followed a pattern that suggested saturation-type kinetics: an initial sharp reduction that occurred with low concentrations of clay (0.01 to 0.5% [wt/vol]), followed by a more gradual reduction with higher concentrations (1 to 8%). Increases in viscosity (which could impair the movement of O2) caused by the clays were not responsible for the reduction in respiration, and the clays did not interfere with the availability of nutrients. Scanning electron microscopy after extensive washing showed that the clay particles were tightly bound to the hyphae, suggesting that the clays reduced the rate of respiration of H. capsulatum by adhering to the mycelial surface and, thereby, interfered with the movement of nutrients, metabolites, and gases across the mycelial wall.
Gomez, F J; Allendoerfer, R; Deepe, G S
HIS-62 is a glycoprotein that has been isolated from the cell wall and cell membrane fraction of the pathogenic fungus Histoplasma capsulatum. It is a target of the cellular immune response to this fungus, and it protects mice against a lethal intravenous inoculum of H. capsulatum yeast cells. In this study, we cloned the gene encoding this antigen to reveal its biological nature and studied the immunological activity of recombinant antigen. The amino acid sequences of the NH2 terminus and internal peptides were obtained by Edman degradation. Degenerate oligonucleotides were used to isolate a gene fragment of HIS-62 by PCR. One 680-bp segment that corresponded to the known peptide sequence was amplified from H. capsulatum DNA. This DNA was used to screen a genomic library, and the full-length gene was isolated and sequenced. The deduced amino acid sequence of the gene demonstrated approximately 70 and approximately 50% identity to heat shock protein 60 (hsp 60) from Saccharomyces cerevisiae and hsp 60 from Escherichia coli, respectively. A cDNA was synthesized by reverse transcription PCR and was expressed in E. coli. Recombinant protein reacted with a monospecific polyclonal rabbit antiserum raised against native HIS-62, with monoclonal HIS-62-reactive T cells, and with splenocytes from mice immunized with viable yeast cells. Moreover, vaccination with the recombinant protein conferred protection in mice against a lethal intranasal inoculation with yeast cells. Thus, HIS-62 is a member of the hsp 60 family, and the recombinant hsp 60 is protective against pulmonary histoplasmosis in mice.
da Silva, Marcos Vinicius; Criado, Paulo Ricardo; Luiz, Olinda do Carmo; Vicentini, Adriana Pardini
Background Although early and rapid detection of histoplasmosis is essential to prevent morbidity and mortality, few diagnostic tools are available in resource-limited areas, especially where it is endemic and HIV/AIDS is also epidemic. Thus, we compared conventional and molecular methods to detect Histoplasma capsulatum in sera and blood from HIV/AIDS patients. Methodology We collected a total of 40 samples from control volunteers and patients suspected of histoplasmosis, some of whom were also infected with other pathogens. Samples were then analyzed by mycological, serological, and molecular methods, and stratified as histoplasmostic with (group I) or without AIDS (group II), uninfected (group III), and infected with HIV and other pathogens only (group IV). All patients were receiving treatment for histoplasmosis and other infections at the time of sample collection. Results Comparison of conventional methods with nested PCR using primers against H. capsulatum 18S rRNA (HC18S), 5.8S rRNA ITS (HC5.8S-ITS), and a 100 kDa protein (HC100) revealed that sensitivity against sera was highest for PCR with HC5.8S-ITS, followed by immunoblotting, double immunodiffusion, PCR with HC18S, and PCR with HC100. Specificity was equally high for double immunodiffusion, immunoblotting and PCR with HC100, followed for PCR with HC18S and HC5.8-ITS. Against blood, sensitivity was highest for PCR with HC5.8S-ITS, followed by PCR with HC18S, Giemsa staining, and PCR with HC100. Specificity was highest for Giemsa staining and PCR with HC100, followed by PCR with HC18S and HC5.8S-ITS. PCR was less efficient in patients with immunodeficiency due to HIV/AIDS and/or related diseases. Conclusion Molecular techniques may detect histoplasmosis even in cases with negative serology and mycology, potentially enabling early diagnosis. PMID:29342162
Katia Cristina Dantas
Full Text Available Although early and rapid detection of histoplasmosis is essential to prevent morbidity and mortality, few diagnostic tools are available in resource-limited areas, especially where it is endemic and HIV/AIDS is also epidemic. Thus, we compared conventional and molecular methods to detect Histoplasma capsulatum in sera and blood from HIV/AIDS patients.We collected a total of 40 samples from control volunteers and patients suspected of histoplasmosis, some of whom were also infected with other pathogens. Samples were then analyzed by mycological, serological, and molecular methods, and stratified as histoplasmostic with (group I or without AIDS (group II, uninfected (group III, and infected with HIV and other pathogens only (group IV. All patients were receiving treatment for histoplasmosis and other infections at the time of sample collection.Comparison of conventional methods with nested PCR using primers against H. capsulatum 18S rRNA (HC18S, 5.8S rRNA ITS (HC5.8S-ITS, and a 100 kDa protein (HC100 revealed that sensitivity against sera was highest for PCR with HC5.8S-ITS, followed by immunoblotting, double immunodiffusion, PCR with HC18S, and PCR with HC100. Specificity was equally high for double immunodiffusion, immunoblotting and PCR with HC100, followed for PCR with HC18S and HC5.8-ITS. Against blood, sensitivity was highest for PCR with HC5.8S-ITS, followed by PCR with HC18S, Giemsa staining, and PCR with HC100. Specificity was highest for Giemsa staining and PCR with HC100, followed by PCR with HC18S and HC5.8S-ITS. PCR was less efficient in patients with immunodeficiency due to HIV/AIDS and/or related diseases.Molecular techniques may detect histoplasmosis even in cases with negative serology and mycology, potentially enabling early diagnosis.
Allan Jefferson Guimarães
Full Text Available Heat shock proteins (Hsps are among the most widely distributed and evolutionary conserved proteins. Hsps are essential regulators of diverse constitutive metabolic processes and are markedly upregulated during stress. A 62 kDa Hsp (Hsp60 of Histoplasma capsulatum (Hc is an immunodominant antigen and the major surface ligand to CR3 receptors on macrophages. However little is known about the function of this protein within the fungus. We characterized Hc Hsp60-protein interactions under different temperature to gain insights of its additional functions oncell wall dynamism, heat stress and pathogenesis. We conducted co-immunoprecipitations with antibodies to Hc Hsp60 using cytoplasmic and cell wall extracts. Interacting proteins were identified by shotgun proteomics. For the cell wall, 84 common interactions were identified among the 3 growth conditions, including proteins involved in heat-shock response, sugar and amino acid/protein metabolism and cell signaling. Unique interactions were found at each temperature [30°C (81 proteins, 37°C (14 and 37/40°C (47]. There were fewer unique interactions in cytoplasm [30°C (6, 37°C (25 and 37/40°C (39] and four common interactions, including additional Hsps and other known virulence factors. These results show the complexity of Hsp60 function and provide insights into Hc biology, which may lead to new avenues for the management of histoplasmosis.
Obtenção de exoantígenos de Histoplasma capsulatum em meio de neopeptona, glicose, tiamina e asparagina (NGTA Histoplasma capsulatum exocellular antigens. Obtention in neopeptone, glucose, thiamine and asparagine medium (NGTA
Nilma Maciel Garcia
Full Text Available O presente trabalho teve como objetivo a produção de exoantígenos H e M das amostras 58, B-679, A-811 e O187 de Histoplasma capsulatum, utilizando o meio NGTA (neopeptona, glicose, tiamina e asparagina em períodos de cultivo de 1, 2 e 3 meses, a 36ºC, sob agitação constante (50 v.p.m.. Os antígenos brutos foram avaliados contra anti-soro e antígeno de Histoplasma capsulatum de referência (Center for Disease Control, 4 soros de pacientes portadores de paracoccidioidomicose, 7 de histoplasmose e soro hiperimune anti-H. capsulatum produzido em coelhos, através da reação de imunodifusão dupla. Verificou-se que, com exceção de B-679 com 1 mês de crescimento, todos os demais exoantígenos apresentaram as frações H e M de precipitação. Os exoantígenos obtidos de A-811 apresentaram só a banda H. Excetuando-se os exoantígenos 58 e B-679 com 1 mês de crescimento, todos os demais exoantígenos reagiram contra soros de pacientes com histoplasmose. Em relação aos soros de pacientes com paracoccidioidomicose, somente os exoantígenos 58 e O187 não apresentaram reação cruzada. Todos os exoantígenos reagiram frente ao soro hiperimune de coelho anti-H. capsulatum. Para obtenção de exoantígenos de H. capsulatum, sugerimos que as amostras sejam cultivadas sob as condições anteriormente descritas, adotando-se o período de 3 meses de crescimento, utilizando-se exoantígenos de referência como controles da reação.The purpose of this work is obtaining exocellular antigens H and M from 4 H. capsulatum strains using NGTA medium (neopeptone, glucose, thiamine and asparagine for periods of 1,2 and 3 months, at 36ºC and continuously shaken. The exocellular antigens were evaluated by double immunodiffusion test against H. capsulatum rabbit antiserum, 7 histoplasmosis sera, 4 paracoccidioidomycosis sera and a reference antigen and antibody furnished by C.D.C. (Atlanta - USA. Except for the exocellular antigen from strain B.679 with 1
Almeida-Paes, Rodrigo; Almeida-Silva, Fernando; Pinto, Gabriela Costa Maia; Almeida, Marcos de Abreu; Muniz, Mauro de Medeiros; Pizzini, Claudia Vera; Gerfen, Gary J; Nosanchuk, Joshua Daniel; Zancopé-Oliveira, Rosely Maria
Melanization of Histoplasma capsulatum remains poorly described, particularly in regards to the forms of melanin produced. In the present study, 30 clinical and environmental H. capsulatum strains were grown in culture media with or without L-tyrosine under conditions that produced either mycelial or yeast forms. Mycelial cultures were not melanized under the studied conditions. However, all strains cultivated under yeast conditions produced a brownish to black soluble pigment compatible with pyomelanin when grew in presence of L-tyrosine. Sulcotrione inhibited pigment production in yeast cultures, strengthening the hyphothesis that H. capsulatum yeast forms produce pyomelanin. Since pyomelanin is produced by the fungal parasitic form, this pigment may be involved in H. capsulatum virulence.
Maza, Paloma K; Suzuki, Erika
Histoplasma capsulatum var. capsulatum is a dimorphic fungus that causes histoplasmosis, a human systemic mycosis with worldwide distribution. In the present work, we demonstrate that H. capsulatum yeasts are able to induce cytokine secretion by the human lung epithelial cell line A549 in integrin- and Src-family kinase (SFK)-dependent manners. This conclusion is supported by small interfering RNA (siRNA) directed to α3 and α5 integrins, and PP2, an inhibitor of SFK activation. siRNA and PP2 reduced IL-6 and IL-8 secretion in H. capsulatum-infected A549 cell cultures. In addition, α3 and α5 integrins from A549 cells were capable of associating with H. capsulatum yeasts, and this fungus promotes recruitment of these integrins and SFKs to A549 cell membrane rafts. Corroborating this finding, membrane raft disruption with the cholesterol-chelator methyl-β-cyclodextrin reduced the levels of integrins and SFKs in these cell membrane domains. Finally, pretreatment of A549 cells with the cholesterol-binding compound, and also a membrane raft disruptor, filipin, significantly reduced IL-6 and IL-8 levels in A549-H.capsulatum cultures. Taken together, these results indicate that H. capsulatum yeasts induce secretion of IL-6 and IL-8 in human lung epithelial cells by interacting with α3 and α5 integrins, recruiting these integrins to membrane rafts, and promoting SFK activation.
Koepsell, Scott A.; Hinrichs, Steven H.
A real-time PCR assay to detect Histoplasma capsulatum in formalin-fixed, paraffin-embedded (FFPE) tissue is described. The assay had an analytical sensitivity of 6 pg/μl of fungal DNA, analytical specificity of 100%, and clinical sensitivity of 88.9%. This proof-of-concept study may aid in the diagnosis of histoplasmosis from FFPE tissue. PMID:22855519
Baltazar, Ludmila M.; Nakayasu, Ernesto S.; Sobreira, Tiago; Choi, Hyungwon; Casadevall, Arturo; Nimrichter, Leonardo; Nosanchuk, Joshua D.
Donnell, Anna M; Lewis, Stephanie; Abraham, Sami; Subramanian, Kavitha; Figueroa, Julio Landero; Deepe, George S; Vonderheide, Anne P
This work sought to assess optimal extraction conditions in the study of the metalloproteome of the dimorphic fungus Histoplasma capsulatum. One of the body's responses to H. capsulatum infection is sequestration of zinc within host macrophage (MØ), as reported by Vignesh et al. (Immunity 39:697-710, 2013) and Vignesh et al. (PLOS Pathog 9:E1003815, 2013). Thus, metalloproteins containing zinc were of greatest interest as it plays a critical role in survival of the fungus. One challenge in metalloproteomics is the preservation of the native structure of proteins to retain non-covalently bound metals. Many of the conventional cell lysis, separation, and identification techniques in proteomics are carried out under conditions that could lead to protein denaturation. Various cell lysis techniques were investigated in an effort to both maintain the metalloproteins during lysis and subsequent analysis while, at the same time, serving to be strong enough to break the cell wall, allowing access to cytosolic metalloproteins. The addition of 1% Triton x-100, a non-ionic detergent, to the lysis buffer was also studied. Seven lysis methods were considered and these included: Glass Homogenizer (H), Bead Beater (BB), Sonication Probe (SP), Vortex with 1% Triton x-100 (V, T), Vortex with no Triton x-100 (V, NT), Sonication Bath, Vortex, and 1% Triton x-100 (SB, V, T) and Sonication Bath, Vortex, and no Triton x-100 (SB, V, NT). A Qubit® Assay was used to compare total protein concentration and inductively coupled plasma-mass spectrometry (ICP-MS) was utilized for total metal analysis of cell lysates. Size exclusion chromatography coupled to ICP-MS (SEC-HPLC-ICP-MS) was used for separation of the metalloproteins in the cell lysate and the concentration of Zn over a wide molecular weight range was examined. Additional factors such as potential contamination sources were also considered. A cell lysis method involving vortexing H. capsulatum yeast cells with 500 μm glass beads
Dos Santos, Bruna; Langoni, Helio; da Silva, Rodrigo Costa; Menozzi, Benedito Donizete; Bosco, Sandra de Moraes Gimenes; Paiz, Laís Moraes; Augusto, Livia Carla Ramos; Richini-Pereira, Virgínia Bodelão
Bats are considered to play a significant role in the epidemiology of histoplasmosis, worldwide. We investigated the occurrence of H. capsulatum in lung samples from 89 bats, from urban areas in Southeastern Brazil, using nested PCR based on ribosomal DNA. Fungal DNA was detected in 31/89 samples (34.8%), of which 13/31 were Molossids (41.9%), 4/31 Eumops spp. (12.9%), 2/31 Artibeus lituratus (6.5%), and 12/31 others (38.7%). This is the first report of natural infection by H. capsulatum in A. lituratus in Southeastern Brazil, which reinforces the importance of these synanthropic animals in the epidemiology of histoplasmosis in urban areas. © The Author(s) 2017. Published by Oxford University Press on behalf of The International Society for Human and Animal Mycology. All rights reserved. For permissions, please e-mail: email@example.com.
Gómez, Luisa F; Torres, Isaura P; Jiménez-A, María Del Pilar; McEwen, Juan Gmo; de Bedout, Catalina; Peláez, Carlos A; Acevedo, José M; Taylor, María L; Arango, Myrtha
Histoplasma capsulatum is the causative agent of histoplasmosis and this fungus inhabits soils rich in phosphorus and nitrogen that are enriched with bird and bat manure. The replacement of organic matter in agroecosystems is necessary in the tropics, and the use of organic fertilizers has increased. Cases and outbreaks due to the presence of the fungus in these components have been reported. The Instituto Colombiano Agropecuario resolution 150 of 2003 contains the parameters set by the Colombian Technical Standard (NTC 5167) on the physicochemical and microbiological features of fertilizers, but it does not regulate the search for H. capsulatum . The aim of this study was to demonstrate H. capsulatum presence in organic fertilizers by nested polymerase chain reaction (PCR). A total of 239 samples were collected: 201 (84.1%) corresponded to organic fertilizers, 30 (12.5%) to bird excrement, and 8 (3.4%) to cave soils. The Hc100 nested PCR had a detection limit of 0.1 pg/µL and a specificity of 100%. A total of 25 (10.5%) samples were positive and validated by sequencing. Seven of the positive samples represented locations where H. capsulatum was previously detected, suggesting the persistence of the fungus. No significant correlations were detected between the physicochemical and microbiological parameters with the presence of H. capsulatum by nested PCR, indicating the fungus existence in organic fertilizers that complied with the NTC 5167. The Hc100 nested PCR targeting H. capsulatum standardized in this work will improve the evaluation of organic fertilizers and ensure the prevention of outbreaks and cases due to manufacturing, marketing, and use of fertilizers contaminated with H. capsulatum .
Scantlebury, C E; Pinchbeck, G L; Loughnane, P; Aklilu, N; Ashine, T; Stringer, A P; Gordon, L; Marshall, M; Christley, R M; McCarthy, A J
Histoplasma capsulatum var. farciminosum, the causative agent of epizootic lymphangitis (EZL), is endemic in parts of Africa. Diagnosis based on clinical signs and microscopy lacks specificity and is a barrier to further understanding this neglected disease. Here, a nested PCR method targeting the internal transcribed spacer (ITS) region of the rRNA operon was validated for application to equine clinical samples. Twenty-nine horses with signs of EZL from different climatic regions of Ethiopia were clinically examined. Blood samples and aspirates of pus from cutaneous nodules were taken, along with blood from a further 20 horses with no cutaneous EZL lesions. Among the 29 horses with suspected cases of EZL, H. capsulatum var. farciminosum was confirmed by extraction of DNA from pus and blood samples from 25 and 17 horses, respectively. Positive PCR results were also obtained with heat-inactivated pus (24 horses) and blood (23 horses) spotted onto Whatman FTA cards. Two positive results were obtained among blood samples from 20 horses that did not exhibit clinical signs of EZL. These are the first reports of the direct detection of H. capsulatum var. farciminosum in equine blood and at high frequency among horses exhibiting cutaneous lesions. The nested PCR outperformed conventional microscopic diagnosis, as characteristic yeast cells could be observed only in 14 pus samples. The presence of H. capsulatum var. farciminosum DNA was confirmed by sequencing the cloned PCR products, and while alignment of the ITS amplicons showed very little sequence variation, there was preliminary single nucleotide polymorphism-based evidence for the existence of two subgroups of H. capsulatum var. farciminosum This molecular diagnostic method now permits investigation of the epidemiology of EZL. Copyright © 2016 Scantlebury et al.
Pinchbeck, G. L.; Loughnane, P.; Aklilu, N.; Ashine, T.; Stringer, A. P.; Gordon, L.; Marshall, M.; Christley, R. M.
Histoplasma capsulatum var. farciminosum, the causative agent of epizootic lymphangitis (EZL), is endemic in parts of Africa. Diagnosis based on clinical signs and microscopy lacks specificity and is a barrier to further understanding this neglected disease. Here, a nested PCR method targeting the internal transcribed spacer (ITS) region of the rRNA operon was validated for application to equine clinical samples. Twenty-nine horses with signs of EZL from different climatic regions of Ethiopia were clinically examined. Blood samples and aspirates of pus from cutaneous nodules were taken, along with blood from a further 20 horses with no cutaneous EZL lesions. Among the 29 horses with suspected cases of EZL, H. capsulatum var. farciminosum was confirmed by extraction of DNA from pus and blood samples from 25 and 17 horses, respectively. Positive PCR results were also obtained with heat-inactivated pus (24 horses) and blood (23 horses) spotted onto Whatman FTA cards. Two positive results were obtained among blood samples from 20 horses that did not exhibit clinical signs of EZL. These are the first reports of the direct detection of H. capsulatum var. farciminosum in equine blood and at high frequency among horses exhibiting cutaneous lesions. The nested PCR outperformed conventional microscopic diagnosis, as characteristic yeast cells could be observed only in 14 pus samples. The presence of H. capsulatum var. farciminosum DNA was confirmed by sequencing the cloned PCR products, and while alignment of the ITS amplicons showed very little sequence variation, there was preliminary single nucleotide polymorphism-based evidence for the existence of two subgroups of H. capsulatum var. farciminosum. This molecular diagnostic method now permits investigation of the epidemiology of EZL. PMID:27707938
Muraosa, Yasunori; Toyotome, Takahito; Yahiro, Maki; Watanabe, Akira; Shikanai-Yasuda, Maria Aparecida; Kamei, Katsuhiko
We developed new cycling probe-based real-time PCR and nested real-time PCR assays for the detection of Histoplasma capsulatum that were designed to detect the gene encoding N-acetylated α-linked acidic dipeptidase (NAALADase), which we previously identified as an H. capsulatum antigen reacting with sera from patients with histoplasmosis. Both assays specifically detected the DNAs of all H. capsulatum strains but not those of other fungi or human DNA. The limited of detection (LOD) of the real-time PCR assay was 10 DNA copies when using 10-fold serial dilutions of the standard plasmid DNA and 50 DNA copies when using human serum spiked with standard plasmid DNA. The nested real-time PCR improved the LOD to 5 DNA copies when using human serum spiked with standard plasmid DNA, which represents a 10-fold higher than that observed with the real-time PCR assay. To assess the ability of the two assays to diagnose histoplasmosis, we analyzed a small number of clinical specimens collected from five patients with histoplasmosis, such as sera (n = 4), formalin-fixed paraffin-embedded (FFPE) tissue (n = 4), and bronchoalveolar lavage fluid (BALF) (n = 1). Although clinical sensitivity of the real-time PCR assay was insufficiently sensitive (33%), the nested real-time PCR assay increased the clinical sensitivity (77%), suggesting it has a potential to be a useful method for detecting H. capsulatum DNA in clinical specimens. © The Author 2015. Published by Oxford University Press on behalf of The International Society for Human and Animal Mycology. All rights reserved. For permissions, please e-mail: firstname.lastname@example.org.
isolation of histoplasma capsulatum from soil samples of four caves from Rio Claro region, department of Antioquia, Colombia Estudio de la presencia de histoplasma capsulatum en la tierra de 4 cuevas localizadas de la región de Río Claro (Antioquia
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Fifty soil specimens from 4 caves located in the Río Claro region of the Department of Antioquia, Colombia, were studied In order to recover Histoplasma capstilatum in its natural form. Two of the specimens, obtained from different sites of one of the caves, were positive. The methods employed for cultivation are described and the implications of the presence of the fungus for tourists visiting the caves are discussed.Se estudiaron 50 muestras de tierra de cuatro cuevas de la región de Río Claro (Antioquia, Colombia, con el fin de aislar Histoplasma capsulatum en su forma natural; se encontraron dos muestras positivas (4% tomadas en sitios diferenes de la Cueva del Cóndor. Se describen los métodos empleados y se discuten algunas implicaciones de la presencia del hongo para las personas que visitan la cuevas.
Contribution to the study of the mycobiota present in the natural habitats of Histoplasma capsulatum: an integrative study in Guerrero, Mexico Contribución al conocimiento de la micobiota presente en los hábitats naturales de Histoplasma capsulatum: un estudio integral en Guerrero, México
Full Text Available The mycobiota present in natural habitats of Histoplasma capsulatum was determined in samples of bat guano, poultry droppings, and intestinal contents of bats. The following fungi were isolated: 1 from bat guano: the ascomycetes Aphanoascus fulvescens, Gymnascella citrina, Gymnoascus dankaliensis, and Chaetomidium fimeti; the mitosporic fungi Aspergillus flavo-furcatis, A. terreus, A. terreus var. aureus, Penicillium spp., Malbranchea aurantiaca, and Sporothrix sp.; and the yeasts Candida catenulata, C. ciferrii, C. famata var. flareri, C. guilliermondii var. guilliermondii, and Rhodotorula spp. 2 from poultry droppings: the coelomycete Phoma sp.; and the yeasts C. albicans, C. catenulata, C. ciferrii, C. famata var. flareri, C. tropicalis, Cryptococcus albidus, Trichosporon moniliiforme, and Trichosporon spp. 3 from the intestinal contents of insectivorous, hematophagous, nectarivorous, and frugivorous bats: Ch. fimeti; the mitosporic fungi Aspergillus candidus, A. flavo-furcatis, A. sulphureus, A. sydowii, A. terreus, A. versicolor, Aspergillus sp., M. aurantiaca, Gliomastix murorum, and Scopulariopsis sp.; and C. famata var. flareri, C. lipolytica, Cr. albidus, and Trichosporon spp. Most of the species found are first records for these substrata and environments in Mexico. The coexistence with H. capsulatum was demonstrated by high specific antibody titers in ELISA serological method, using sera from BALB/c mice previously inoculated with the supernatant of the different samples studied.Se determinó la micobiota presente en diferentes hábitats naturales de Histoplasma capsulatum, como guano de murciélago, excretas de aves de corral, y contenido intestinal de murciélagos. Se aislaron: 1 de guano: los ascomicetes Aphanoascus fulvescens, Gymnascella citrina, Gymnoascus dankaliensis, y Chaetomidium fimeti; los hongos mitospóricos Aspergillus flavo-furcatis, A. terreus, A. terreus var. aureus, Penicillium spp., Malbranchea aurantiaca, y
We describe a rare case of multiple skeletal lesions and a pleural effusion owing to Histoplasma capsulatum infection in a 16-year-old immunocompetent girl residing in a non-endemic region. Of note is that she had a lesion within a thoracic vertebra. Following an extensive literature search, we found that vertebral ...
Mudawi, Hatim M.; Baraka, Omer Z.; El-Hassan, Ahmed M.; El-Amin, Elwaleed M.
Histoplasmosis is a fungal infection caused by Histoplasma capsulatum. In the normal individual, both disseminated histoplasmosis and symptomatic adrenal histoplasmosis are rare. Herein, we describe the case of a 50-year-old gentleman residing in western Sudan who presented with 7-month history of generalized body weakness, easy fatigue and frequent attacks of vomiting and diarrhea. Physical examination and laboratory investigations confirmed the diagnosis of Addison's disease due to histoplasma capsulatum var duboisii infection of the adrenal glands. He was treated with intravenous hydrocortisone, followed by oral prednisolone and itraconazole. (author)
Osborne, B M
Two cases of a lobular, necrotizing granulomatous process causing a unilateral painful breast mass mimicking carcinoma are presented for comparison. While the morphologic appearance in each case was that of lobular granulomatous mastitis, the etiologic agent in one case appeared to be Histoplasma capsulatum, based on Grocott methenamine silver staining, and represents the second reported case of histoplasmosis involving only breast parenchyma. Awareness of the rare entity, granulomatous mastitis, is important for the pathologist because the definitive diagnosis is made microscopically. Thorough evaluation of the breast tissue is essential for its management and should eventually contribute to the clarification of its etiology.
Fernández Andreu, C Carlos Manuel; Díaz Suárez, Luis Alberto; Ilnait Zaragozi, María Teresa; Aragonés López, Carlos; Martínez Machín, Gerardo; Perurena Lancha, Mayda R
culture collections are responsible for providing the microbial resources for development of biological sciences. Storage in distilled water is one of the easiest and least expensive method for long-term fungal preservation. to evaluate the usefulness of this preservation method in fungal culture of Histoplasma and Cryptococcus. the preservation condition of the highest biological risk species from Histoplasma y Cryptococcus genera, included in the fungal culture collection of "Pedro Kouri" Institute of Tropical Medicine in Havana, was evaluated in this study. One hundred and two strains stored in distilled water, 92% of which had been preserved for more than 10 years, were analyzed. the percentages of recovered strains from H. capsulatum, C. neoformans and C. gattii were 64.3%; 79.1% and 100% respectively. This method of preservation proved to be satisfactory for fungal culture in labs with limited financial resources. A web-based database with interesting information about the collection was made. The importance of strict compliance with the biosafety measures in these collections, particularly with high risk pathogens. preservation of fungal cultures in distilled water is a very useful method for laboratories with limited resources. Culture collections should be assumed as an essential activity in order to solve increasing challenges in the development of biomedical sciences.
Libert, Diane; Procop, Gary W; Ansari, Mohammad Q
Serum and urine antigen (SAg, UAg) detection are common tests for Histoplasma capsulatum. UAg detection is more widely used and reportedly has a higher sensitivity. We investigated whether SAg detection contributes meaningfully to the initial evaluation of patients with suspected histoplasmosis. We reviewed 20,285 UAg and 1,426 SAg tests ordered from 1997 to 2016 and analyzed paired UAg and SAg tests completed on the same patient within 1 week. We determined the positivity rate for each test. Of 601 paired specimens, 542 were concurrent negatives and 48 were concurrent positives (98% agreement). Medical records were available for eight of 11 pairs with discrepant results. UAg was falsely positive in six instances, truly positive once, and falsely negative once. These findings support using a single antigen detection test, rather than both UAg and SAg, as an initial screen for suspected histoplasmosis. This aligns with the current practice of most physicians.
Brunker, Jill D; Hoover, John P
A mixed breed dog treated for ehrlichiosis and systemic histoplasmosis developed a refractory thrombocytopenia. When an abdominal mass was detected, exploratory laparotomy and biopsies confirmed lymphoma, which on immunohistochemical stains was determined to be of B-cell origin. Conceivably, the B-cell lymphoma in this dog was associated with chronic inflammation from ehrlichiosis, histoplasmosis, or both.
Taján, Juan; Espasa, Mateu; Sala, Montserrat; Navarro, Marta; Font, Bernat; González-Martín, Julián; Segura, Ferran
Mycobacterium sherrisii is a new species of opportunistic, slow-growing, non-tuberculous Mycobacterium closely related to Mycobacterium simiae that can currently be identified with the sequence of 16S rARN gene and the heat-shock protein 65. Few cases of patients infected by this Mycobacterium have been reported and all of them were associated with human immunodeficiency virus or other immunosuppressive conditions. Clinical management is complex, because there is not a clear correlation between the in vitro antibiotic susceptibility testing and the patient's clinical outcome. PMID:23419367
Bosshardt, Charles Robert; Gnann, John; Lodhia, Nilesh
A 53-year-old man with Crohn's disease treated with adalimumab was hospitalised with abdominal pain, fatigue, fever and chills. CT scan of the abdomen showed chronic thickening of the terminal ileum and cecum and new-onset ascites. Further studies revealed weakly positive urine and serum histoplasma antigen. Laparoscopy revealed metastatic caking of the omentum and abdominal wall; peritoneal biopsy demonstrated organisms morphologically consistent with Histoplasma capsulatum No dissemination outside of the peritoneal cavity was evident. The patient completed 2 weeks of liposomal amphotericin B followed by oral itraconazole for 1 year. Adalimumab therapy was held for 10 weeks, then restarted. Presenting symptoms resolved following initiation of antifungal therapy. Follow-up MRI of his abdomen demonstrated resolution of ascites. To our knowledge, this is the first reported case of histoplasmosis presenting as peritonitis in a patient with Crohn's disease receiving antitumour necrosis factor-alpha (TNF-α) therapy. Many clinicians are aware that patients receiving anti-TNF-α therapy are at increased risk for histoplasmosis, but may fail to consider the diagnosis in the absence of lung involvement. © BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.
van Griensven, Johan; Mengesha, Bewketu; Mekonnen, Tigist; Fikre, Helina; Takele, Yegnasew; Adem, Emebet; Mohammed, Rezika; Ritmeijer, Koert; Vogt, Florian; Adriaensen, Wim; Diro, Ermias
Background: Biomarkers predicting the risk of VL treatment failure and relapse in VL/HIV coinfected patients are needed. Nested within a two-site clinical trial in Ethiopia (2011-2015), we conducted an exploratory study to assess whether (1) levels of Leishmania antigenuria measured at VL diagnosis were associated with initial treatment failure and (2) levels of Leishmania antigenuria at the end of treatment (parasitologically-confirmed cure) were associated with subsequent relapse. Methods: Leishmania antigenuria at VL diagnosis and cure was determined using KAtex urine antigen test and graded as negative (0), weak/moderate (grade 1+/2+) or strongly-positive (3+). Logistic regression and Kaplan-Meier methods were used to assess the association between antigenuria and (1) initial treatment failure, and (2) relapse over the 12 months after cure, respectively. Results: The analysis to predict initial treatment failure included sixty-three coinfected adults [median age: 30 years interquartile range (IQR) 27-35], median CD4 count: 56 cells/μL (IQR 38-113). KAtex results at VL diagnosis were negative in 11 (17%), weak/moderate in 17 (27%) and strongly-positive in 35 (36%). Twenty (32%) patients had parasitologically-confirmed treatment failure, with a risk of failure of 9% (1/11) with KAtex-negative results, 0% (0/17) for KAtex 1+/2+ and 54% (19/35) for KAtex 3+ results. Compared to KAtex-negative patients, KAtex 3+ patients were at increased risk of treatment failure [odds ratio 11.9 (95% CI 1.4-103.0); P : 0.025]. Forty-four patients were included in the analysis to predict relapse [median age: 31 years (IQR 28-35), median CD4 count: 116 cells/μL (IQR 95-181)]. When achieving VL cure, KAtex results were negative in 19 (43%), weak/moderate (1+/2+) in 10 (23%), and strongly positive (3+) in 15 patients (34%). Over the subsequent 12 months, eight out of 44 patients (18%) relapsed. The predicted 1-year relapse risk was 6% for KAtex-negative results, 14% for KAtex 1
Full Text Available Penicillium capsulatum is a rare Penicillium species used in paper manufacturing, but recently it has been reported to cause invasive infection. To research the pathogenicity of the clinical Penicillium strain, we sequenced the genomes and transcriptome of the clinical and environmental strains of P. capsulatum. Comparative analyses of these two P. capsulatum strains and close related strains belonging to Eurotiales were performed. The assembled genome sizes of P. capsulatum are approximately 34.4 Mbp in length and encode 11,080 predicted genes. The different isolates of P. capsulatum are highly similar, with the exception of several unique genes, INDELs or SNP in the genes coding for glycosyl hydrolases, amino acid transporters and circumsporozoite protein. A phylogenomic analysis was performed based on the whole genome data of 38 strains belonging to Eurotiales. By comparing the whole genome sequences and the virulence-related genes from 20 important related species, including fungal pathogens and non-human pathogens belonging to Eurotiales, we found meaningful pathogenicity characteristics between P. capsulatum and its closely related species. Our research indicated that P. capsulatum may be a neglected opportunistic pathogen. This study is beneficial for mycologists, geneticists and epidemiologists to achieve a deeper understanding of the genetic basis of the role of P. capsulatum as a newly reported fungal pathogen.
long on the human skin surface. ... It produces septicaemia with serious lung and brain damage in the newborn, ... aches, tiredness and lack ofappetite, and lost IQ kg in weight. In ... globulin, complement and auto-antibody levels and full blood.
Kaitlin Benedict, CDC epidemiologist, discusses Histoplasma capsulatum infection. Created: 3/24/2016 by National Center for Emerging and Zoonotic Infectious Diseases (NCEZID). Date Released: 3/24/2016.
T P Thankappan
Full Text Available An unusual case of Histoplasma Capsulatum infection with cutaneous nodules, a feature of African histoplasmosis and granulomatous lesions, a manifestation of classical histoplasmosis is being reported.
Cordeiro, Rossana de Aguiar; e Silva, Kylvia Rocha de Castro; Brilhante, Raimunda Sâmia Nogueira; Moura, Francisco Bergson Pinheiro; Duarte, Naylê Francelino Holanda; Marques, Francisca Jakelyne de Farias; Cordeiro, Rebecca de Aguiar; Filho, Renato Evando Moreira; de Araújo, Roberto Wagner Bezerra; Bandeira, Tereza de Jesus Pinheiro Gomes; Rocha, Marcos Fábio Gadelha; Sidrim, José Júlio Costa
To analyze the eco-epidemiologic aspects of Histoplasma capsulatum in Brazil, we tested 83 bats for this fungus. Although H. capsulatum was not isolated, Coccidioides posadasii was recovered from Carollia perspicillata bat lungs. Immunologic studies detected coccidioidal antibodies and antigens in Glossophaga soricina and Desmodus rotundus bats.
Cordeiro, Rossana de Aguiar; Rocha de Castro e Silva, Kylvia; Brilhante, Raimunda Sâmia Nogueira; Moura, Francisco Bergson Pinheiro; Duarte, Naylê Francelino Holanda; Marques, Francisca Jakelyne de Farias; Cordeiro, Rebecca de Aguiar; Filho, Renato Evando Moreira; Bezerra de Araújo, Roberto Wagner; Bandeira, Tereza de Jesus Pinheiro Gomes; Rocha, Marcos Fábio Gadelha; Sidrim, José Júlio Costa
To analyze the eco-epidemiologic aspects of Histoplasma capsulatum in Brazil, we tested 83 bats for this fungus. Although H. capsulatum was not isolated, Coccidioides posadasii was recovered from Carollia perspicillata bat lungs. Immunologic studies detected coccidioidal antibodies and antigens in Glossophaga soricina and Desmodus rotundus bats.
Histoplasmosis skin test ... health care provider cleans an area of your skin, usually the forearm. An allergen is injected just below the cleaned skin surface. An allergen is a substance that causes ...
Full Text Available A 60-year-old immunocompetent lady with disseminated primary cutaneous histoplasmosis is reported. Histology showed a granulomatous skin infiltrate with numerous intracellular PAS positive rounded yeast cells within macrophages. Culture on Sabouraud′s dextrose agar yielded a typical cottony white colony characteristic of Histoplasma capsulatum. Treatment with itraconazole showed an excellent response.
Ongkosuwito, J.V.; Kortbeek, L.M.; Lelij, van der A.; Molicka, E.; Kijlstra, A.; Smet, de M.D.; Suttrop-Schulten, M.S.A.
Aim. To investigate whether presumed ocular histoplasmosis syndrome in the Netherlands is caused by Histoplasma capsulatum and whether other risk factors might play a role in the pathogenesis of this syndrome. Methods. 23 patients were clinically diagnosed as having presumed ocular histoplasmosis
This report describes the first case of surgical site infection due to Histoplasma capsulatum. A 4 year-old presented with recurrent thoracotomy surgical site infection (SSI) requiring multiple debridements until the correct diagnosis was performed. This case illustrates the critical role of histopathology in early recognition of ...
Komaid, Aida van Gelderen de; Duran, Estela; Kestelman, Isabel Borges de
The present work was undertaken to obtain epidemiological data on the extent and distribution of Histoplasma capsulatum var. capsulatum and Paracoccidiodes brasiliensis diseases in the Vipos, La Toma and Choromoro areas. Skin test surveys with histoplasmin and paracoccidioidin were carried out in the permanent human population of those localities. Mycological sputum studies and serological tests were performed to skin test reactors to determine if there were signs or symptoms of active mycotic disease. La Toma and Choromoro are highly prevalent areas of histoplasmosis ( > 30% the histoplasmin positive individuals) whereas Vipos can be relatively considered a highly prevalent area (between 20-30% the histoplasmin reactors) according to the normally accepted range used to define an endemic disease . Early Histoplasma capsulatum infection ( < 10 years old) is reported for Vipos and Choromoro. La Toma has the highest rate of previous exposure to P. brasiliensis detected in the studied area (10.2%). Vipos residents are not infected with P. brasiliensis
Full Text Available Histoplasmosis, a systemic mycosis caused by the dimorphic fungus Histoplasma capsulatum var capsulatum and Histoplasma capsulatum var duboisii is endemic to many parts of the world. The clinical manifestations range from acute or chronic pulmonary infection to a progressive disseminated disease. After initial exposure to the fungus, the infection is self-limited and restricted to the lungs in 99% of healthy individuals. The remaining 1%, however, progress to either disseminated or chronic disease involving the lungs, liver, spleen, lymph nodes, bone marrow or rarely, the skin and mucous membranes. Mucocutaneous histoplasmosis is frequently reported in patients with acquired immune deficiency syndrome (AIDS, but it is rare in immunocompetent hosts. A 60-year-old male presented with asymptomatic swelling of the hard palate and crusted papules and nodules over the extremities, face and trunk. Clinically, the diagnoses of cutaneous cryptococcosis versus histoplasmosis was considered in this patient. A chest X-ray revealed hilar lymphadenopathy. Enzyme-linked immunosorbent assay (ELISA for human immunodeficiency virus (HIV was nonreactive. Skin biopsy revealed multiple tiny intracellular round yeast forms with a halo in the mid-dermis. Culture of the skin biopsy in Sabouraud′s dextrose agar showed colonies of Histoplasma capsulatum. Despite an investigation including no evidence of underlying immunosuppression was found, he was started on IV amphotericin-B (0.5 mg/kg/day. However, the patient succumbed to his disease 2 days after presentation. We report a rare case of disseminated cutaneous histoplasmosis in an immunocompetent individual.
da Silva, Roberto Moreira; da Silva Neto, João Ricardo; Santos, Carla Silvana; Cruz, Kátia Santana; Frickmann, Hagen; Poppert, Sven; Koshikene, Daniela; de Souza, João Vicente Braga
Fluorescence in situ hybridization (FISH) has been shown to be useful for the detection of Candida and Cryptococcus species in blood culture materials. FISH procedures for the detection of Histoplasma capsulatum var. capsulatum have not been reported so far. This study describes the development and evaluation of fluorescently labeled rRNA-targeting FISH probes to detect and identify H. capsulatum in blood cultures. All three analyzed H. capsulatum reference strains and clinical isolates showed positive signals with the newly designed specific oligonucleotide probes for H. capsulatum, whereas negative reactions were observed for all three nontarget yeast species and the two nontarget bacteria. The assay was also successfully applied for detections of H. capsulatum cells in pre-incubated blood culture samples of patients with clinical suspicion of histoplasmosis (n = 33). The described FISH-based assay was shown to be easy to apply, sensitive, and specific (compared to polymerase chain reaction) for the detection and identification of H. capsulatum in this proof-of-principle analysis. Larger multicentric assessments are recommended for a thorough diagnostic evaluation of the procedure. © The Author 2014. Published by Oxford University Press on behalf of The International Society for Human and Animal Mycology. All rights reserved. For permissions, please e-mail: email@example.com.
Full Text Available Histoplasmosis, a fungal disease caused by Histoplasma capsulatum, is endemic in North and South America. Except few scattered cases, the disease is considered to be a non-entity in India. Furthermore, disseminated histoplasmosis is rare in the immunocompetent individuals. We report an adolescent boy presenting as middle lobe consolidation which did not respond to antibiotics. His condition deteriorated with the development of mediastinal lymphadenopathy, pleural effusion and hepatosplenomegaly. A diagnosis of progressive disseminated histoplasmosis was established by his clinical findings as well as bronchoscopic biopsy, transbronchial needle aspiration cytology and bronchoalveolar lavage culture demonstrating Histoplasma capsulatum. The case represents a unique example of progressive disseminated histoplasmosis in an immunocompetent individual in India.
Full Text Available Human immunodeficiency virus (HIV-associated immune reconstitution inflammatory syndrome has been reported in association with tuberculosis, herpes zoster (shingles, Cryptococcus neoformans, Kaposi′s sarcoma, Pneumocystis pneumonia, hepatitis B virus, hepatitis C virus, herpes simplex virus, Histoplasma capsulatum, human papillomavirus, and Cytomegalovirus. However, it has never been documented with giardiasis. We present a 7-year-old HIV infected girl who developed diarrhea and shock following the initiation of antiretroviral therapy, and her stool showed the presence of giardiasis.
Tavares Junior, Wilson Campos; Madureira, Marcus Magalhaes; Andrade, Diego Correa de; Guimaraes, Silvana Mangeon Meireles; Queiroz, Leonardo Campos; Avila, Renata Eliane de; Lambertucci, Jose Roberto
Histoplasmosis is a disease caused by inhalation of the fungus Histoplasma capsulatum. In rare cases the disease affects immunocompetent individuals. Disseminated and severe disease is seen in immunocompromised patients. We report a case of a 45 year old immunocompromised patient presenting with weight loss and abdominal pain. Chest x-ray and computerized tomography examinations showed interstitial infiltrate and diffuse micro nodules. The initial diagnosis was miliary tuberculosis. However, the definitive diagnosis of miliary histoplasmosis was made later on. (author)
Tavares Junior, Wilson Campos; Madureira, Marcus Magalhaes; Andrade, Diego Correa de; Guimaraes, Silvana Mangeon Meireles; Queiroz, Leonardo Campos [Minas Gerais Univ., Belo Horizonte, MG (Brazil). Hospital das Clinicas. Dept. de Radiologia e Diagnostico por Imagem]. E-mail: firstname.lastname@example.org; Avila, Renata Eliane de [Minas Gerais Univ., Belo Horizonte, MG (Brazil). Hospital das Clinicas. Servico de Doencas Infecciosas e Parasitarias; Lambertucci, Jose Roberto [Minas Gerais Univ., Belo Horizonte, MG (Brazil). Faculdade de Medicina. Clinica Medica
Histoplasmosis is a disease caused by inhalation of the fungus Histoplasma capsulatum. In rare cases the disease affects immunocompetent individuals. Disseminated and severe disease is seen in immunocompromised patients. We report a case of a 45 year old immunocompromised patient presenting with weight loss and abdominal pain. Chest x-ray and computerized tomography examinations showed interstitial infiltrate and diffuse micro nodules. The initial diagnosis was miliary tuberculosis. However, the definitive diagnosis of miliary histoplasmosis was made later on. (author)
Full Text Available Miliary histoplasmosis is a rare presentation that may mimic miliary tuberculosis. We report a case of miliary histoplasmosis in a 52-year-old male who was being treated with hydroxychloroquine, methotrexate, and sulfasalazine for his rheumatoid arthritis and presented to the emergency department with shortness of breath and fevers. Computed tomography (CT chest revealed miliary pulmonary nodules. Urine Histoplasma antigen and serum Histoplasma antigen were negative; however, Coccidioides immitis complement immunofixation assay and Coccidioides IgM were positive. The patient was initiated on treatment for pulmonary coccidioidomycosis and immunosuppression was held. However, a few days later, Histoplasma capsulatum was isolated from cultures from bronchoscopy. This case highlights the difficulty in diagnosing histoplasmosis in immunocompromised patients and the importance of having a broad differential diagnosis for miliary pulmonary nodules. Tissue culture and histopathology remain the gold standard for the diagnosis of histoplasmosis. Further research needs to be conducted to determine the optimal duration of histoplasmosis treatment in immunocompromised patients.
Identification of the source of histoplasmosis infection in two captive maras (Dolichotis patagonum from the same colony by using molecular and immunologic assays Identificación de la fuente de infección de histoplasmosis de dos maras (Dolichotis patagonum cautivas procedentes de la misma colonia, utilizando ensayos moleculares e inmunológicos
M. R. Reyes-Montes
Full Text Available Histoplasma capsulatum was isolated from the spleen of a first infected mara (Dolichotis patagonum and from a second mara's liver and adrenal gland, both in the same colony at the Africam Safari, Puebla, Mexico. Studies of H. capsulatum isolates, using nested-PCR of a 100-kDa protein coding gene (Hcp100 fragment and a two-primer RAPDPCR method, suggest that these isolates were spreading in the environment of the maras' enclosure. By using a Dot- ELISA method, sera from mice inoculated with three homogenates of soil samples from the maras' enclosed space developed positive brown spot reactions to a purified H. capsulatum antigen, which identified the probable source of the maras' infection.Histoplasma capsulatum fue aislado del bazo de una primera mara (Dolichotis patagonum infectada y del hígado y la glándula suprarrenal de un segundo ejemplar, ambos de la misma colonia en el Africam Safari, Puebla, México. Los estudios de los aislamientos de H. capsulatum mediante PCR anidada para un fragmento del gen Hcp100 que codifica una proteína de 100 kDa y RAPD-PCR empleando doble iniciador sugieren que estos aislamientos estaban dispersos en el ambiente del refugio de las maras. Los sueros de ratones inoculados con tres homogenatos de muestras de suelo del refugio desarrollaron reacciones positivas a un antígeno purificado de H. capsulatum (manchas color castaño oscuro por el método de Dot-ELISA; con lo cual se identificó la probable fuente de infección de las maras.
Frías-De-León, María Guadalupe; Ramírez-Bárcenas, José Antonio; Rodríguez-Arellanes, Gabriela; Velasco-Castrejón, Oscar; Taylor, Maria Lucia; Reyes-Montes, María Del Rocío
Histoplasmosis is considered the most important systemic mycosis in Mexico, and its diagnosis requires fast and reliable methodologies. The present study evaluated the usefulness of PCR using Hcp100 and 1281-1283 (220) molecular markers in detecting Histoplasma capsulatum in occupational and recreational outbreaks. Seven clinical serum samples of infected individuals from three different histoplasmosis outbreaks were processed by enzyme-linked immunosorbent assay (ELISA) to titre anti-H. capsulatum antibodies and to extract DNA. Fourteen environmental samples were also processed for H. capsulatum isolation and DNA extraction. Both clinical and environmental DNA samples were analysed by PCR with Hcp100 and 1281-1283 (220) markers. Antibodies to H. capsulatum were detected by ELISA in all serum samples using specific antigens, and in six of these samples, the PCR products of both molecular markers were amplified. Four environmental samples amplified one of the two markers, but only one sample amplified both markers and an isolate of H. capsulatum was cultured from this sample. All PCR products were sequenced, and the sequences for each marker were analysed using the Basic Local Alignment Search Tool (BLASTn), which revealed 95-98 and 98-100 % similarities with the reference sequences deposited in the GenBank for Hcp100 and 1281-1283 (220) , respectively. Both molecular markers proved to be useful in studying histoplasmosis outbreaks because they are matched for pathogen detection in either clinical or environmental samples.
Full Text Available A review of 12 histoplasmosis outbreaks that occurred in the Colombian Andean region, are presented. According to their location, 3 were detected in each of the following states: Tolima, Caldas and Antioquia and 1 each in Cundinamarca, Boyacá and Risaralda. In 9 of the outbreaks it was possible to trace the following activities which led to the infection: visits to bat-inhabited caves, removing debris incide a hollowed tree, demolition of an old house, use of contaminated lime for fertilization, handling chickenmanure fettilised soil and the severe pruning of coffee trees. Histoplasma capsulatum var. capsulatum was isolated from environmental samples in 5 of the 8 outbreaks where it was feasible to obtain material for culture and animal inoculation. It was found that 332 persons had been in contact with the various infectious sources, including the 11 index cases (2 outbreaks had the same index case. All of them were studied by means of immunological tests designed to detect antibodies; based on the findings of reactive tests, al1 the index cases and 140 (42% of those exposed had antibodies indicative of infection by the fungus. The above cases reveal the importance of histoplasmosis in immunocompetent individuals who, for occupational or recreational reasons, are exposed to infectious aerosols generated when disturbing the natural habitat of H. capsulatum var. capsulatum.
Ana Carolina Alves de Paula e Silva
Full Text Available This work aims to demonstrate that the gallic acid structure modification to the decyl gallate (G14 compound contributed to increase the antifungal activity against several species of pathogenic fungi, mainly, Candida spp., Cryptococcus spp., Paracoccidioides spp., and Histoplasma capsulatum, according to standardized microdilution method described by Clinical Laboratory Standard Institute (CLSI documents. Moreover this compound has a particularly good selectivity index value, which makes it an excellent candidate for broad-spectrum antifungal prototype and encourages the continuation of subsequent studies for the discovery of its mechanism of action.
Mitchell, M; Stark, D R
The clinical features of 24 cases of disseminated canine histoplasmosis are presented. The enteric form predominated and the age at presentation was from five months to ten years. The principal clinical findings were chronic diarrhea, weight loss, pyrexia and anemia.A premortem diagnosis was reached in 20 cases, by demonstrating Histoplasma capsulatum organisms in peripheral blood smears, rectal scrapings or surgical biopsies. Five of seven dogs treated with amphotericin B were released in asymptomatic condition. Four of these cases relapsed six to 15 months following therapy. The overall mortality rate was 80%.
Harman, Mustafa; Sayarlioglu, Mehmet; Arslan, Halil; Ayakta, Hayati; Harman, Ece
We present CT, MRI and venography findings in 13-year boy with mediastinal fibrosis and superior vena cava (SVC) thrombosis associated with Behcet's disease. Fibrosing mediastinitis is an excessive fibrotic reaction that occurs in the mediastinum and may lead to compression of mediastinal structures (especially vascular). This condition is usually idiopathic, though many (and perhaps most) cases in the USA are thought to be caused by an abnormal immunologic response to Histoplasma capsulatum infection. SVC syndrome secondary to extrinsic compression by mediastinal fibrosis combined with Behcet's disease has rarely been described. Radiological investigations of this syndrome are necessary to avoid a useless anticoagulant therapy
Full Text Available Objetivo: Detectar por serología la presencia de micosis de localización pulmonar (Paracoccidioides brasiliensis, Aspergillus sp. e Histoplasma capsulatum, en pacientes con síntomas de enfermedad respiratoria crónica. Diseño: Estudio transversal. Lugar: Alto Huallaga (selva de los departamentos de Huánuco y San Martín, Perú. Pacientes: Se incluyó personas procedentes de seis distritos (Rupa Rupa, Tocache, Uchiza, Santa Lucia, Aucayacu y Puerto Inca - Sungaro con diagnóstico de enfermedad respiratoria crónica baja, tres episodios o más de bronquitis al año y/o tos con expectoración por más de tres meses y en quienes se descartó tuberculosis pulmonar mediante baciloscopia directa. Intervenciones: Por cada persona se llenó una ficha clínica-epidemiológica durante abril a septiembre de 2004, seguido de la toma de una muestra de suero (10 mL para las pruebas de inmunodifusión para Histoplasma capsulatum, Paraccocidiodes brasiliensis, Aspergilus sp, y Aspergillus fumigatus. Principales medidas de resultados: Seroprevalencia de micosis a Histoplasma capsulatum, Aspergilosis spp. y Paracoccidioides brasiliensis. Resultados: De 640 casos, 327 (51,1% fueron de sexo masculino, edad promedio 37,1 años y tiempo de enfermedad de 7,4 meses. La seroprevalencia de micosis fue 1,7% (11/640: 4 Histoplasma capsulatum y 7 Aspergilosis spp. No se obtuvo casos positivos de Paracoccidioides brasiliensis y, en los casos positivos, solo se encontró asociación con 'baja de peso' (p = 0,004. Conclusión: Si bien la frecuencia micoserológica obtenida fue baja, se sugiere en esta zona endémica considerar a las micosis dentro del diagnóstico diferencial de casos con enfermedades respiratorias crónicas bajas, así como la utilización de técnicas de inmunodifusión para el diagnóstico de estas etiologías.
Carlos Manuel Fernandez Andreu
Full Text Available El propósito del presente trabajo es reportar el aislamiento de Histoplasma capsulation, agente etiológico de la histoplasmosis, a partir del suelo de lugares habitados por murciélagos y gallinas en la Isla de la Juventud, Cuba. El hongo fue cultivado también a partir de los órganos de cuatro especies de murciélagos capturados en cuevas. La identificación de H. capsulatum se realizó mediante la conversión de la fase miceliana a levadura y por el test de exoantígenos. Se señala el valor epidemiológico de estos hallazgos en cuevas de gran importancia arqueológica, espeleológica y turística, así como el riesgo potencial que representan para la salud humana. Los autores concluyen con recomendaciones para evitar la infección por H. capsulatum en aquellas personas que por determinadas razones tengan que estar en contacto con estos ambientes contaminados.The purpose of this work is to report the isolation of Histoplasma capsulatum, etiologic agent of histoplasmosis, from soil in sites inhabited by bats and chicken in the Island of Youth, Cuba. The fungus was cultured from four species of cavedwelling bats too. The identification of H. capsulatum was done by mycelial to yeast conversion and exoantigen test. It is pointed out the epidemiological value of some of these isolations in caves of great importance from the archeologic, speleologic or touristic point of view; and the potential risk that they represent to human health. The authors conclude with some recommendation to prevent the infection with H. capsultatum in people who have to keep in contact with those environments.
Raselli, C; Reinhart, W H; Fleisch, F
A 24-year-old woman (student of biology) was part of a study group in Uganda. She developed fever and headache, which was empirically treated as malaria. After she had returned to Switzerland, a chest x-ray showed bilateral miliary nodular infiltrates. In assumption of an atypical pneumonia, she was treated with levofloxacin, although without success. On admission, she was in a bad general condition and was markedly dyspneic. Rales were heard over both lungs. CRP, liver enzymes and LDH were elevated. A lung function test revealed a marked impairment of the diffusion capacity. The chest x-ray showed a progression of the lung infiltrates. The informal medical data exchange among the group members by a virtual social network abbreviated our diagnostic workup substantially, since we heard that histoplasmosis had been assumed in another group member. It turned out that the affected persons had visited a colony of bats living in a cave inside the trunk of a tree. Antibodies against Histoplasma capsulatum were positive. We began a treatment with itraconazole. The condition improved gradually; chest x-ray and lung function normalized after the 8 week treatment. Histoplasmosis with such a severe course is rare in immunocompetent humans, which indicates that the inoculum must have been very high. Soil contaminated with bats guano favours the proliferation of Histoplasma capsulatum. Our case is also an illustration of how the widespread use of electronic media can sometimes facilitate our work. © Georg Thieme Verlag KG Stuttgart · New York.
Associação da rifampicina à anfotericina B no tratamento da paracoccidioidomicose: resultados em três pacientes tratados Association of Amphotericin B and Rifampicin in the treatment of paracoccidioidomycosis. Report of efficacy in three cases
Full Text Available Trabalhos experimentais demonstraram que a anfotericina B, desorganizando funcionalmente a membrana celular fúngica, permite a penetração da rifampicina no citoplasma e sua conseqüente ação contra Histoplasma capsulatum, Blastomyces dermatitidis e Candida albicans. Com metade das doses habituais' de anfotericina B associada à rifampicina conseguem-se melhores resultados do que com a anfotericina B isoladamente em doses plenas. Os Autores discutem as possíveis aplicações desta associação no tratamento da paracoccidioidomi-cose e apresentam 3 casos desta micose em que a inatividade clínica e micológica só foi obtida após o emprego combinado destas drogas.Experimental data have shown that low concentration of amphotericin B disrupts of the fungal cellular membranes, enhancing entrance of rifampicin into citoplasm, where it acts specifically as an antifungal agent against Histoplasma capsulatum, Blastomyces dermatitidis and Candida albicans. Amphotericin B in half dosage combined with rifampicin is more effective than when used alone in full dosage. The Authors discuss the possible indications of this association in the therapy of paracoccidioidomycosis, and report its efficacy in three cases of this disease only controlled after its use.
Histoplasmosis in Africa has markedly increased since the advent of the HIV/AIDS epidemic but is under-recognised. Pulmonary histoplasmosis may be misdiagnosed as tuberculosis (TB). In the last six decades (1952–2017), 470 cases of histoplasmosis have been reported. HIV-infected patients accounted for 38% (178) of the cases. West Africa had the highest number of recorded cases with 179; the majority (162 cases) were caused by Histoplasma capsulatum var. dubuosii (Hcd). From the Southern African region, 150 cases have been reported, and the majority (119) were caused by H. capsulatum var. capsulatum (Hcc). There have been 12 histoplasmin skin test surveys with rates of 0% to 35% positivity. Most cases of Hcd presented as localised lesions in immunocompetent persons; however, it was disseminated in AIDS patients. Rapid diagnosis of histoplasmosis in Africa is only currently possible using microscopy; antigen testing and PCR are not available in most of Africa. Treatment requires amphotericin B and itraconazole, both of which are not licensed or available in several parts of Africa. PMID:29346384
Raimunda Sâmia Nogueira Brilhante
Full Text Available Abstract This study aimed to evaluate the in vitro antifungal activity of terpinen-4-ol, tyrosol, and β-lapachone against strains of Coccidioides posadasii in filamentous phase (n = 22 and Histoplasma capsulatum in both filamentous (n = 40 and yeast phases (n = 13, using the broth dilution methods as described by the Clinical and Laboratory Standards Institute, to determine the minimum inhibitory concentration (MIC and minimum fungicidal concentration (MFC of these compounds. The mechanisms of action of these compounds were also investigated by analyzing their effect on cell membrane permeability and ergosterol synthesis. The MIC and MFCf these compounds against C. posadasii, mycelial H. capsulatum, and yeast-like H. capsulatum, were in the following ranges: 350-5720 µg/mL, 20-2860 µg/mL, and 40-1420 µg/mL, respectively for terpinen-4-ol; 250-4000 µg/mL, 30-2000 µg/mL, and 10-1000 µg/mL, respectively, for tyrosol; and 0.48-7.8 µg/mL, 0.25-16 µg/mL, and 0.125-4 µg/mL, respectively for β-lapachone. These compounds showed a decrease in MIC when the samples were subjected to osmotic stress, suggesting that the compounds acted on the fungal membrane. All the compounds were able to reduce the ergosterol content of the fungal strains. Finally, tyrosol was able to cause a leakage of intracellular molecules.
Grover, S.B.; Midha, N.; Gupta, M.; Sharma, U.; Talib, V.H.
The clinical manifestations of chronic disseminated histoplasmosis are non-specific and resemble those of other chronic infections and malignancies. We report the radiographic, sonographic and contrast-enhanced CT appearances of histoplasmosis in an adult male with non-insulin dependent diabetes mellitus, who was HIV negative and presented with weight loss and pyrexia. Imaging studies simulated tuberculosis with mediastinal lymphadenopathy, bilateral fibrotic lung lesions, hepatomegaly and bilateral hypoattenuating adrenal enlargement, without clinical or laboratory evidence of hypoadrenalism. Computed tomography-guided fine-needle aspiration biopsy of adrenal glands revealed Histoplasma capsulatum. We report our experience to increase awareness of the imaging spectrum of disseminated histoplasmosis and its similarity to tuberculosis as, with increasing incidence of AIDS, the chances of these infections are likely to increase. Moreover, awareness of this entity is important because it is known that untreated disseminated histoplasmosis is fatal Copyright (2005) Blackwell Publishing Asia Pty Ltd
Cragg, John; Clayton, Yvonne M.
In Jersey 166 fresh and 122 dried seagull droppings were obtained and studied locally and in London for the presence of bacteria and fungi of potentially pathogenic nature. There were no salmonella or shigella bacteria isolated from the two groups but there was a high proportion of Candida albicans obtained from the fresh material (21·7%) and only 1·6% from the dry faeces. Cryptococcus neoformans and Histoplasma capsulatum were not found in either the dry or fresh droppings. The normal bacterial and fungal flora of the seagull was established and it is considered that the C. albicans in fresh gull droppings would not materially increase albicans infections in man. PMID:5104846
Gomes Ferreira, O; Vieira Fernandes, A; Sebastião Borges, A; Simão Ferreira, M; Mota Loyola, A
Amongst the main opportunistic diseases that affect the HIV-positive patient, histoplasmosis is found. This systemic mycosis caused by the fungus Histoplasma capsulatum has the capacity to disseminate from the lung to the skin and oral mucosa. Oral lesions of histoplasmosis can be found with ulcerated or nodular aspect, being always very painful and infiltrating the mucosa. When they are present in the mouth, they strongly indicate the presence of some kind of immunosuppression. This study shows the disease's evolution in an HIV-positive patient, who presented several ulcerated lesions in the oral cavity and facial skin. The symptomatology and clinical aspects of the lesions were not specific for the disease, and due to this, the diagnosis was obtained by cytological smear and oral biopsy. The results of the exams defined the disseminated picture of the infection. The treatment plan involved the use of amphotericin B for the lesions' remission, and, following this, itraconazole was administered in the maintenance phase.
KUROKAWA Cilmery Suemi
Full Text Available Pathogenic fungi that cause systemic mycoses retain several factors which allow their growth in adverse conditions provided by the host, leading to the establishment of the parasitic relationship and contributing to disease development. These factors are known as virulence factors which favor the infection process and the pathogenesis of the mycoses. The present study evaluates the virulence factors of pathogenic fungi such as Blastomyces dermatitidis, Coccidioides immitis, Cryptococcus neoformans, Histoplasma capsulatum and Paracoccidioides brasiliensis in terms of thermotolerance, dimorphism, capsule or cell wall components as well as enzyme production. Virulence factors favor fungal adhesion, colonization, dissemination and the ability to survive in hostile environments and elude the immune response mechanisms of the host. Both the virulence factors presented by different fungi and the defense mechanisms provided by the host require action and interaction of complex processes whose knowledge allows a better understanding of the pathogenesis of systemic mycoses.
Nancy A. Rihana
Full Text Available Background. Histoplasma capsulatum is the most common endemic mycosis in the United States and is a frequent cause of opportunistic infection in immunodeficient hosts. Histoplasmosis is most often self-limiting and goes unrecognized in the immunocompetent population but can progress to disseminated histoplasmosis in patients with an impaired immune system. Liver involvement as a part of disseminated histoplasmosis which usually originates in the lung is well known. However, extrapulmonary hepatic histoplasmosis as a primary manifestation is extremely rare. Case Presentation. We report a rare case of histoplasmosis that presented as persistent fever and abnormal liver function tests in a 66-year-old female with rheumatoid arthritis, receiving infliximab. Conclusion. Emphasizing histoplasmosis as a major cause of acute granulomatous hepatitis and fever of unknown origin in cell mediated immunodeficient population, this case highlights the need for high index of suspicion and the importance of prompt diagnosis since any delay of treatment can be life threatening in this population.
Rihana, Nancy A; Kandula, Manasa; Velez, Ana; Dahal, Kumud; O'Neill, Edward B
Background. Histoplasma capsulatum is the most common endemic mycosis in the United States and is a frequent cause of opportunistic infection in immunodeficient hosts. Histoplasmosis is most often self-limiting and goes unrecognized in the immunocompetent population but can progress to disseminated histoplasmosis in patients with an impaired immune system. Liver involvement as a part of disseminated histoplasmosis which usually originates in the lung is well known. However, extrapulmonary hepatic histoplasmosis as a primary manifestation is extremely rare. Case Presentation. We report a rare case of histoplasmosis that presented as persistent fever and abnormal liver function tests in a 66-year-old female with rheumatoid arthritis, receiving infliximab. Conclusion. Emphasizing histoplasmosis as a major cause of acute granulomatous hepatitis and fever of unknown origin in cell mediated immunodeficient population, this case highlights the need for high index of suspicion and the importance of prompt diagnosis since any delay of treatment can be life threatening in this population.
Llanos, Elkin; Ojeda, Paulina
Histoplasmosis is an acquired mycotic disease produced by the histoplasma capsulatum very frequent in Colombia, primarily affecting lungs. The pathogenesis of the histoplasmosis is similar to the one of tuberculosis. From the clinical point of view, this disease has several manifestations including the primary acute and chronic pulmonary forms. Histoplasmoma pulmonary disseminated histoplasmosis, mediastinal compromise due to granulomatosis and fibrosis, as well as ocular histoplasmosis. A clinical case of a 33-year old man is presented who consults for dry coughing of one year of evolution, without any other symptomatology, with a normal chest x-ray and after several studies including chest cat and fiber-bronchoscopy. A pulmonary histoplasmosis was determined by histopathology
Full Text Available A teenage girl was evaluated for recurrent right pneumonia. The evaluation revealed a calcified mediastinal mass that compressed the right intermediate and middle lobar bronchi, as well as the right pulmonary artery and veins. The clinical picture together with imaging studies and borderline positive serology testing suggested a diagnosis of fibrosing mediastinitis associated with histoplasmosis. This rare condition is characterized by the local proliferation of invasive fibrous tissue within the mediastinum due to a hyperimmune reaction to Histoplasma capsulatum. Antifungal and anti-inflammatory therapies are usually ineffective, and surgical intervention contains a high morbidity risk. Palliative surgery and stenting of the compressed airway have been suggested. In the past, the prognosis was thought to be poor, but recent studies demonstrate a more positive outcome. Our patient had been radiologically and functionally stable under follow-up for over thirteen years and has married and delivered two healthy children, both following an uneventful pregnancy.
Alexandra I. Medeiros
Full Text Available Histoplasma capsulatum (Hc induces a pulmonary disease in which leukotrienes promote activation and recruitment of effectors cells. It is also well-recognized that leukotriene B4 (LTB4 and platelet-activating factor (PAF induce leukocyte recruitment to inflammatory sites. We investigated the impact of pulmonary Hc infection on PMN migration to a remote inflammatory site. Our results show that pulmonary Hc infection impairs LTB4- or PAF-stimulated PMN recruitment to air pouch. Yet, remote inflammation did not modify PMN numbers in the bronchoalveolar lavage fluid (BALF of Hc-infected mice. Interestingly, the concomitant administration of PAF and LTB4 receptor antagonists inhibited PMN recruitment to both BALF and the remote site, demonstrating cooperation between both mediators. Along that line, our results show that PAF-elicited PMN chemotaxis was abrogated in 5-lipoxygenase-deficient animals. These results suggest caution in the indiscriminate use of anti-inflammatory drugs during infectious diseases.
Calanni, Liliana María; Pérez, Rufina Ana; Brasili, Susana; Schmidt, Norma Graciela; Iovannitti, Cristina Adela; Zuiani, María Fernanda; Negroni, Ricardo; Finquelievich, Jorge; Canteros, Cristina Elena
In Argentina, there are no reports of autochthonous cases of histoplasmosis in the southern regions of the country. To report a histoplasmosis outbreak in Zapala town, Province of Neuquén, Patagonia Argentina. We evaluated the clinical and epidemiological characteristics of 5 patients involved in the outbreak. Environmental studies were conducted to determine the source of infection. The genetic profile of Histoplasma capsulatum strains isolated from the index case (IC) were compared with clinical isolates from Argentinean patients not related to the outbreak, using RAPD-PCR with primers 1281-1283. The patients were residents of Zapala, and had not visited other geographical areas before. All patients had an influenza-like syndrome, and X-ray revealed disseminated micronodular images throughout the lung parenchyma. The IC needed specific antifungal therapy; the remaining 4 patients had mild symptoms, and did not require therapy. All of them had a good clinical outcome. Strains of H. capsulatum isolated from blood culture and lung biopsy of the IC showed a genetic profile different from other strains analyzed. The presence of the fungus in the environment was demonstrated by the detection of anti-Histoplasma antibodies in BALB/c mice inoculated with soil obtained in a culvert where workers had dug up earth after a landslide. This outbreak suggests the histoplasmosis endemic area is under the 38° S parallel. Patients from Neuquén, Patagonia Argentina, with compatible symptoms of histoplasmosis should be tested, regardless of their travel or exposure history. Copyright © 2012 Revista Iberoamericana de Micología. Published by Elsevier Espana. All rights reserved.
Miguel Abidon Aidé
Full Text Available Histoplasmose é uma micose sistêmica causada por um pequeno fungo, Histoplasma capsulatum var. capsulatum, cujo habitat é o solo rico em excrementos de pássaros e morcegos. A incidência da histoplasmose é mundial. No Brasil, a doença incide em todas as regiões; porém, o estado do Rio de Janeiro é responsável pelo maior número de microepidemias descritas até hoje. A infecção humana ocorre pela inalação de esporos do H. capsulatum. A forma clínica mais freqüente é a assintomática. Na histoplasmose aguda ou epidêmica, os sintomas são febre alta, tosse, astenia, dor retroesternal, acompanhados de aumento dos linfonodos cervicais, fígado e do baço. Os achados radiológicos mais frequentes são o infiltrado reticulonodular difuso em ambos os pulmões, associados a linfonodomegalias hílares e mediastinais. Na forma pulmonar crônica, o quadro clínico e radiológico é idêntico ao da tuberculose pulmonar do adulto. O diagnóstico da histoplasmose é feito pela identificação do fungo ou crescimento em cultura de escarro ou de material obtido por fibrobroncoscopia. A histopatologia identifica o fungo dentro e fora do macrófago em meio à lesão granulomatosa com ou sem necrose caseosa. A imunodifusão em duplo gel de ágar é o teste sorológico mais fácil e disponível para o diagnóstico imunológico. As formas agudas com sintomas prolongados, as formas disseminadas e a forma pulmonar crônica requerem tratamento. A droga de escolha é o itraconazol.Histoplasmosis is systemic mycosis caused by a small fungus, Histoplasma capsulatum var. capsulatum, whose natural habitat is soil contaminated by bat or bird excrement. The incidence of histoplasmosis is worldwide. In Brazil, the disease is found in all regions; however, the state of Rio de Janeiro is responsible for most of the microepidemics described. Human infection occurs when airborne spores of H. capsulatum are inhaled. The most common clinical presentation is
Roberto Alonso Jiménez
Full Text Available Se informa un brote de histoplasmosis ocurrido en los integrantes de una familia y que comprometió a cuatro personas, dos mujeres, una niña y un hombre. El caso índice consultó por sintomatología respiratoria grave, de comienzo súbito, que requirió hospitalización. En los otros casos, la infección cursó de manera asintomática pero se puso en evidencia por la reactividad en las pruebas serológicas con histoplasmina. La búsqueda de una fuente común de contagio llevó a sospechar que era la tierra de un vivero que se había utilizado como fertilizante de las plantas caseras. Las suspensiones de las tierras de las macetas sirvieron para inocular ratones BALB/c, de cuyos órganos fue posible aislar el agente etiológico, Histoplasma capsulatum var. capsulatum. Si bien la histoplasmosis es más frecuente en ciertas ocupaciones y es propia de áreas rurales, las epidemias y los brotes son ahora comunes en áreas urbanas debido a actividades como la urbanización masiva, la tala de árboles, las demoliciones y el uso de tierras enriquecidas con abonos orgánicos (gallinaza, guano. Se llama la atención sobre el peligro que representa esta última actividad.
Murray, P R
Although the detection of fungemia has been improved by the use of vented or biphasic blood culture bottles, the best recovery and earliest detection have been reported in the Isolator lysis-centrifugation system. It was recently demonstrated that improved detection of both bacteria and fungi was accomplished by mechanically agitating blood culture bottles for the first 24 h of incubation. In this study the detection of fungemia by use of the Isolator system was compared with that of an agitated biphasic system. A total of 182 fungi were isolated from blood specimens inoculated into both culture systems. No difference in the overall recovery of fungi or individual species of yeasts was observed between the two systems. However, all seven isolates of Histoplasma capsulatum were recovered in the Isolator system only. The time required to detect fungemia with each of the two systems was also compared. No statistically significant difference was observed. From the data collected during this 18-month study, it can be concluded that the overall recovery and time of detection of yeasts are equivalent in the lysis-centrifugation system and the agitated biphasic blood culture system. The lysis-centrifugation system is still superior for the detection of filamentous fungi such as H. capsulatum. PMID:1993772
Boyce, Kylie J; Andrianopoulos, Alex
The ability of pathogenic fungi to switch between a multicellular hyphal and unicellular yeast growth form is a tightly regulated process known as dimorphic switching. Dimorphic switching requires the fungus to sense and respond to the host environment and is essential for pathogenicity. This review will focus on the role of dimorphism in fungi commonly called thermally dimorphic fungi, which switch to a yeast growth form during infection. This group of phylogenetically diverse ascomycetes includes Talaromyces marneffei (recently renamed from Penicillium marneffei), Blastomyces dermatitidis (teleomorph Ajellomyces dermatitidis), Coccidioides species (C. immitis and C. posadasii), Histoplasma capsulatum (teleomorph Ajellomyces capsulatum), Paracoccidioides species (P. brasiliensis and P. lutzii) and Sporothrix schenckii (teleomorph Ophiostoma schenckii). This review will explore both the signalling pathways regulating the morphological transition and the transcriptional responses necessary for intracellular growth. The physiological requirements of yeast cells during infection will also be discussed, highlighting recent advances in the understanding of the role of iron and calcium acquisition during infection. © FEMS 2015. All rights reserved. For permissions, please e-mail: email@example.com.
Horacio F. Rodrigo
Full Text Available El síndrome de Sjögren es una enfermedad autoinmune caracterizada por disminución de las secreciones de las glándulas exocrinas; puede presentar también diversas alteraciones hemáticas, entre ellas linfopenia. Presentamos el caso de un varón de 28 años que consultó por cefalea de un mes de evolución a la que se agregaron en las últimas 48 horas vómitos y fiebre. Presentaba lesiones en piel de tronco y cara; no tenía rigidez de nuca. Se demostró infección por Histoplasma capsulatum var. capsulatum en piel y líquido cefalorraquídeo, linfopenia, anticuerpos anti Ro-SSA positivos, baja concentración del trazador en centellograma de glándulas salivales e infiltración linfocitaria en glándulas salivales, lo que permitió confirmar al diagnóstico de síndrome de Sjögren. El tratamiento con anfotericina liposomal e itraconazol mejoró el cuadro clínico. Comunicamos este caso para referir que una infección oportunista, como la histoplasmosis diseminada, puede ser una forma poco común de presentación del síndrome de Sjögren.
Secatto, Adriana; Soares, Elyara Maria; Locachevic, Gisele Aparecida; Assis, Patricia Aparecida; Paula-Silva, Francisco Wanderlei Garcia; Serezani, Carlos Henrique; de Medeiros, Alexandra Ivo; Faccioli, Lúcia Helena
The bioactive lipid mediator leukotriene B4 (LTB4) greatly enhances phagocyte antimicrobial functions against a myriad of pathogens. In murine histoplasmosis, inhibition of the LT-generating enzyme 5-lypoxigenase (5-LO) increases the susceptibility of the host to infection. In this study, we investigated whether murine resistance or susceptibility to Histoplasma capsulatum infection is associated with leukotriene production and an enhancement of in vivo and/or in vitro antimicrobial effector function. We show that susceptible C57BL/6 mice exhibit a higher fungal burden in the lung and spleen, increased mortality, lower expression levels of 5-LO and leukotriene B4 receptor 1 (BLT1) and decreased LTB4 production compared to the resistant 129/Sv mice. Moreover, we demonstrate that endogenous and exogenous LTs are required for the optimal phagocytosis of H. capsulatum by macrophages from both murine strains, although C57BL/6 macrophages are more sensitive to the effects of LTB4 than 129/Sv macrophages. Therefore, our results provide novel evidence that LTB4 production and BLT1 signaling are required for a histoplasmosis-resistant phenotype. PMID:24465479
Verma, A H; Bueter, C L; Rothenberg, M E; Deepe, G S
Eosinophils contribute to type II immune responses in helminth infections and allergic diseases; however, their influence on intracellular pathogens is less clear. We previously reported that CCR2 -/- mice exposed to the intracellular fungal pathogen Histoplasma capsulatum exhibit dampened immunity caused by an early exaggerated interleukin (IL)-4 response. We sought to identify the cellular source promulgating IL-4 in infected mutant animals. Eosinophils were the principal instigators of non-protective IL-4 and depleting this granulocyte population improved fungal clearance in CCR2 -/- animals. The deleterious impact of eosinophilia on mycosis was also recapitulated in transgenic animals overexpressing eosinophils. Mechanistic examination of IL-4 induction revealed that phagocytosis of H. capsulatum via the pattern recognition receptor complement receptor (CR) 3 triggered the heightened IL-4 response in murine eosinophils. This phenomenon was conserved in human eosinophils; exposure of cells to the fungal pathogen elicited a robust IL-4 response. Thus, our findings elucidate a detrimental attribute of eosinophil biology in fungal infections that could potentially trigger a collapse in host defenses by instigating type II immunity.
Verma, Akash H.; Bueter, Chelsea L.; Rothenberg, Marc E.; Deepe, George S.
Eosinophils contribute to type II immune responses in helminth infections and allergic diseases, however, their influence on intracellular pathogens is less clear. We previously reported that CCR2−/− mice exposed to the intracellular fungal pathogen Histoplasma capsulatum exhibit dampened immunity caused by an early exaggerated IL-4 response. We sought to identify the cellular source promulgating interleukin (IL)-4 in infected mutant animals. Eosinophils were the principal instigators of non-protective IL-4 and depleting this granulocyte population improved fungal clearance in CCR2−/− animals. The deleterious impact of eosinophilia on mycosis was also recapitulated in transgenic animals overexpressing eosinophils. Mechanistic examination of IL-4 induction revealed that phagocytosis of H. capsulatum via the pattern recognition receptor complement receptor (CR) 3 triggered the heightened IL-4 response in murine eosinophils. This phenomenon was conserved in human eosinophils; exposure of cells to the fungal pathogen elicited a robust IL-4 response. Thus, our findings elucidate a detrimental attribute of eosinophil biology in fungal infections that could potentially trigger a collapse in host defenses by instigating type II immunity. PMID:27049063
Drouhet, E; Dupont, B
Forty-eight cases of deep mycoses were studied and treated with ketoconazole, each with in vitro evaluation of the minimum inhibitory concentrations (MIC) of the causative fungi, in vivo pharmacokinetic, clinical, and mycologic evaluations, several months to two years after the treatment was stopped. Excellent results were obtained in six cases of chronic mucocutaneous candidiasis, with restoration of immunologic disturbances; 23 cases of systemic candidiasis, including new aspects of heroin addicts with cutaneous, ocular, or osteoarticular manifestations; eight cases of histoplasmosis, five due to Histoplasma capsulatum and three to Histoplasma duboisii, with cure in seven and remission in one; one case of African blastomycosis (Blastomyces dermatitidis); three cases of mycetoma, two due to Monosporium apiospermum, one due to a dematiacious fungus; three cases of entomophthoromycosis with cure; one case of fungal arthritis, due to new hyphomycete similar to M. apiospermum, pathogenic for laboratory animals; one case of Drechslera longirostrata causing vertebral arthritis, following a fungal endocarditis and cured by combination of ketoconazole with amphotericin B, each agent alone being ineffective; and other deep mycoses.
Mshana Stephen E
Full Text Available Abstract Introduction Severe histoplasmosis is known to be among the AIDS-defining opportunistic infections affecting patients with very low CD4 cell counts in histoplasmosis-endemic areas. Histoplasma capsulatum var. duboisii is common in West and Central Africa, where it occurs in both HIV/AIDS and non-HIV patients. Few cases of life-threatening histoplasmosis in immune-competent individuals have been reported worldwide. Case report We describe a case of pulmonary histoplasmosis diagnosed on the basis of autopsy and histological investigations. A 15-year old East African immune-competent boy with a history of smear-positive tuberculosis and a two-year history of rock cutting presented to our hospital with chronic productive cough, fever, and massive unilateral consolidation. At the time of presentation to our hospital, this patient was empirically treated for recurrent tuberculosis without success, and he died on the seventh day after admission. The autopsy revealed a huge granulomatous lesion with caseation, but no acid-fast bacilli were detected on several Ziehl-Neelsen stains. However, periodic acid-Schiff staining was positive, and the histological examination revealed features suggestive of Histoplasma yeast cells. Conclusion Severe pulmonary histoplasmosis should be considered in evaluating immune-competent patients with risk factors for the disease who present with pulmonary symptoms mimicking tuberculosis.
Will, D W; Hasegawa, C M; Kawauchi, Tadanaga; Murashima, Shoichi
A case is presented of isolated renal histoplasmosis in a Nagasaki woman who died of pulmonary tuberculosis following massive x-ray therapy for squamous carcinoma of the mouth. No primary pulmonary lesion was identified. While the patient's history includes a 40-year residence in Malaysia and a brief internment in New Delhi where a few cases of histoplasmosis have been reported, she had been in Japan for 16 years prior to her death. In view of the presently-known absence of viability of Histoplasma in old primary foci, it was concluded that the infection was acquired in Japan and represents the first case of Histoplasma capsulatum infection reported from Japan (37 references, 5 figures). A second case is presented of a 15-year-old Japanese girl with a clinical history and postmortem findings of a subacute necrotizing encephalomyelopathy is reported. The patient's parents were consanguinous and a similar disease was also present in one sibling. This case and those available in the literature indicate that a severe peripheral neuropathy associated frequently with secondary degeneration of the dorsal white columns of the spinal cord constitutes an integral part of the disorder. The presence of peripheral neuropathy reminiscent of that due to deficiency of thiamine and pantothenic acid, frequent familial occurrence of the disorder and consanguinity in some of the parents give support to the speculation of previous investigators that the disease may represent an inborn error of metabolism especially of pyruvate metabolism. 11 references, 15 figures, 1 table.
M.A. den Bakker (Michael); N.N.T. Goemaere (Natascha); J.A. Severin (Juliëtte); J.L. Nouwen (Jan); P.C.M.S. Verhagen (Paul)
textabstractA 56-year-old female, originally from Suriname, with an otherwise unremarkable previous medical history was found to have a renal mass highly suspicious for renal cancer for which a nephrectomy was performed. Within the kidney, a tumourous mass was found which, on histological
Marcos C. de Almeida
Full Text Available Efusões pleurais surgem raramente em associação com a histoplasmose capsu-lata, ocorrendo em geral nas formas agudas da doença. Relatamos e discutimos um caso clínico em que um histoplasmoma subpleural acompanhou-se de dor pleurítica, hidrotórax e pleurite fibrosante.
Full Text Available INTRODUÇÃO: A histoplasmose pulmonar aguda depende da inalação de uma grande quantidade de propágulos fúngicos por um paciente hígido. O tempo de exposição determina a gravidade da doença. Uma epidemia é influenciada por fatores que afetam o crescimento e a transmissão do Histoplasma capsulatum var. capsulatum na natureza. OBJETIVO: Identificar os aspectos epidemiológicos e clínico-laboratoriais dos pacientes com histoplasmose pulmonar aguda no Rio Grande do Sul e compará-los com as microepidemias relatadas no Brasil. MÉTODO: Foram revisados 212 prontuários clínicos de pacientes com histoplasmose dos arquivos do Laboratório de Micologia do Complexo Hospitalar Santa Casa de Porto Alegre (RS num período de 25 anos (1977-2002. Foram identificados e incluídos no estudo os casos de histoplasmose pulmonar aguda com cultivo positivo e/ou achado histopatológico compatível. As microepidemias foram diagnosticadas com a comprovação de um caso ou evidência soromicológica com história clínica compatível. Foram revisadas as microepidemias publicadas no Brasil. RESULTADOS: Dezoito de um total de 212 pacientes (8,5% foram incluídos no trabalho. A idade variou de 8 a 63 anos (média de 35,4; mediana de 34,5, e 67% eram do sexo masculino. A história epidemiológica foi sugestiva em 11 pacientes (61%. O tipo primário de histoplasmose pulmonar aguda foi o mais freqüente (17; 95%. Houve predomínio de casos isolados. CONCLUSÃO: O reconhecimento de casos isolados e a presença de microepidemias demonstram a abundância do H. capsulatum no solo, e juntamente com a ocorrência de todas as formas da doença, confirmam o Rio Grande do Sul como hiperendêmico para histoplasmose.BACKGROUND: Acute pulmonary histoplasmosis is a respiratory infection occurring when an otherwise healthy individual inhales a large quantity of fungal propagules. Length of exposure determines disease severity. An epidemic is influenced by factors affecting the
Miguel Ángel Castro-Jiménez
Full Text Available Objetivos. Identificar las micosis oportunistas que afectan a los pacientes con VIH/sida, y determinar sus características demográficas, socioeconómicas y su relación con el número de células T CD4+. Métodos. Se trata de un estudio descriptivo de serie de casos basado en los participantes de un estudio diseñado para determinar el tipo y la frecuencia de las enfermedades oportunistas en pacientes con VIH/sida. Un caso se definió como un paciente con VIH/sida a quien se le diagnosticó una micosis oportunista, entre octubre de 2007 y mayo de 2010. Los pacientes elegibles estaban siendo tratados en dos instituciones médicas de Bogotá. Se recolectaron muestras respiratorias, de líquido cefalorraquídeo, de sangre y de raspado de lesión orofaríngea, para determinar la presencia de Histoplasma capsulatum, Paracoccidioides brasiliensis, Cryptococcus neoformans o Candida spp. Se utilizaron proporciones para resumir las variables cualitativas y medianas para las cuantitativas. Resultados. En 33 (9,8 % pacientes con VIH/sida del estudio base (n=336, se diagnosticó una o más de las micosis evaluadas. El 75 % tenía entre 23 y 42 años. La frecuencia de estas infecciones fueron: H. capsulatum (n=1; 3,0 %, P. brasiliensis (n=1; 3,0 %, C. neoformans (n=25; 75,8 %, y Cándida spp. (n=7; 21,2 %. Los valores medianos de células T CD4+ fueron de 176 o menos, independientemente de sus manifestaciones clínicas. Conclusión. Se necesitan estudios adicionales para identificar los factores que podrían estar determinando la presencia de las micosis oportunistas en estos pacientes.Objectives: To identify the opportunistic fungal infections affecting patients with HIV/AIDS, to determine their demographic and socioeconomic characteristics and the number of CD4+ T cells. Materials and methods: This is a descriptive case series study based on a major study aimed at determining the type and frequency of opportunistic diseases in HIV/AIDS patients. A case
Full Text Available OBJETIVO: Aislar e identificar hongos en diferentes especímenes de pacientes inmunocomprometidos, atendidos en un hospital de la Ciudad de México, y determinar su asociación con micosis. MATERIAL Y MÉTODOS: Se realizó un estudio de tipo observacional transversal en pacientes del Hospital Regional General Ignacio Zaragoza, de junio de 1999 a mayo de 2000. De 108 pacientes se procesaron 268 especímenes para estudio micológico que incluyó examen directo, frotis, cultivos y microcultivos en medios específicos además de pruebas bioquímicas. La mayoría de pacientes tenía diagnóstico clínico de tuberculosis pulmonar y de síndrome de inmunodeficiencia adquirida. RESULTADOS: Se obtuvieron 183 aislamientos de levaduras y 66 de hongos filamentosos. Se diagnosticaron 45 micosis que en su mayoría correspondieron a candidosis pulmonar (32 casos. Las especies de Candida más frecuentes asociadas a patología fueron Candida albicans y C parapsilosis. Se obtuvieron cinco aislamientos de Cryptococcus neoformans variedad neoformans, uno de C albidus, tres de Histoplasma capsulatum y uno de Geotrichum candidum, asociados a infección micótica. CONCLUSIONES: El 41.6% de los pacientes estudiados presentaron una micosis asociada principalmente a síndrome de inmunodeficiencia adquirida y a tuberculosis pulmonar.OBJECTIVE: To isolate and identify the fungi in specimens collected from immunocompromised patients seen in Mexico City hospital, and to assess their association with mycosis. MATERIAL AND METHODS: A total of 268 specimens from 108 patients were processed for mycological study, including direct examination, smears, cultures, and microcultures in specific media, in addition to biochemical tests. Most of the patients had been diagnosed with pulmonary tuberculosis and Acquired Immunodeficiency Syndrome (AIDS. RESULTS: One hundred and eighty-three yeasts and 66 mycelial fungi were isolated. Forty-five mycoses were diagnosed; the most frequent
Full Text Available Se describe un brote de histoplasmosis que afectó a 6 cadetes de la Fuerza Aérea Argentina, sin antecedentes patológicos previos. Todos consultaron por problemas respiratorios después de haber limpiado un hangar. En ese recinto se encontraron abundantes deyecciones de animales, presuntamente de palomas y murciélagos. Los pacientes sufrieron fiebre, mialgias, taquipnea y tos no productiva. Las radiografías y tomografías de tórax mostraron imágenes pulmonares micronodulares, engrosamiento de los tabiques interalveolares y adenopatías hiliares. Todos tuvieron una evolución favorable y no requirieron tratamiento antifúngico. Las pruebas de inmunodifusión y contrainmunoelectroforesis con antígenos de Histoplasma capsulatum fueron positivas, al igual que las intradermorreacciones con histoplasmina. Se recogieron 5 muestras de tierra del lugar, las que fueron inoculadas por vía intraperitoneal a 20 hámsteres. De los cultivos de hígado y bazo de dichos animales se consiguió aislar la fase micelial de H. capsulatum. La cepa aislada se comparó con las obtenidas de 12 pacientes argentinos utilizando perfiles genéticos y se observó un clado único con más de 96% de similitud, lo que confirma la homogeneidad de las cepas argentinas. Si bien la histoplasmosis es endémica en la Pampa húmeda, este es el primer brote totalmente documentado al sur del paralelo 34°.An histoplasmosis outbreak affecting 6 previously healthy Air Force cadets is herein presented. The patients suffered from fever and respiratory symptoms after having cleaned an abandoned hangar soiled with pigeons and bat droppings. They all presented fever, myalgia, tachypnea, and nonproductive cough. Chest X-ray and CT scan studies showed disseminated reticulonodular images affecting both lungs. Hiliar adenomegalies were also observed. All patients achieved a favourable outcome without antifungal treatment. Both serologic tests searching for specificic antibodies
Rocha, D C; Duarte, M I; Pagliari, C; de Oliveira, M S
Because the mycosis incidence has increased a lot with the appearing of AIDS, the Immunohistochemistry study among fungus shows the importance of fast methods for their identification that have advantage of been a durable method in comparison with immunofluorescence and the possibility of making retrospective studies in material embedded in paraffin. The Immunohistochemistry reaction with Histoplasma capsulatum, Pneumocystis carinii; and Criptococcus neoformans antibodies were sensitive, specifics, and intensely positive in all the cases previously diagnosed as Histoplasmosis, Pneumocystosis and Cryptococcosis, without cross-reaction with other fungus; while the anti-Candida albicans antibody showed weak positiveness in four Histoplasmosis cases, in one of Paracoccidioidomycosis cases and Sporotrichosis case; and the reactions with the antibody anti-P. brasiliensis were intensely positive in all the Paracoccidioidomycosis cases and weakly positive in two Histoplasmosis and two of the four Candidiasis cases. The previous identification of each fungi on tissue sample was made by Grocott method. This preliminary study showed that it is necessary to use other kinds of antibody and fungus, in order to get more details about the possible occurrence of cross-reactions. We suggest the use of new antibodies, with new standardizations in order to find the best titles for each reaction and eliminate the cross-reactions.
Loughan, Ashlee R; Perna, Robert; Hertza, Jeremy
Histoplasmosis is a rare disease caused by inhalation of the fungus Histoplasma capsulatum. It can spread via cerebral circulation to the central nervous system as a manifestation of a disseminated infection; particularly in patients with immune suppression, which can result in isolated ring-enhancing lesions and inflammation in the brain. Of the reported disseminated histoplasmosis cases (approximately 1 in 2000 per year), only 5-20% have evidence of central nervous system involvement. This paper reviews a single case study of a 57-year-old female diagnosed with disseminated CNS histoplasmosis. Patient's complaints included reduced short-term memory, word-finding problems, and difficulty organizing, making decisions, getting lost while driving, recalling names, retaining information while reading, and slowed processing speed. There was also a history of mild depression and anxiety. Direct testing revealed deficits in multiple cognitive domains including complex attention, processing speed, semantic fluency, visual scanning, motor speed, set-shifting, naming, nonverbal memory, and verbal memory. Neuropsychological deficits suggest cortical and subcortical brain dysfunction, including anterior, temporal, and mesial-temporal regions. This case illustrates the need for neuropsychologists to understand histoplasmosis, the related pathophysiology, and the neuropsychological impact; particularly with the potential for delayed progression.
Navascués, Ana; Rodríguez, Irene; Repáraz, Jesús; Salvo, Soledad; Gil-Setas, Alberto; Martínez Peñuela, José María
Histoplasmosis is a fungal infection caused by the dimorphic fungi Histoplasma capsulatum. Its incidence in Spain has increased in recent years, mainly due to the increased presence of immigrants from Latin America and increased travel to the continent for tourism and cooperation. Our aim was to review the clinical characteristics of cases of histoplasmosis diagnosed in our hospital during the last six years. We diagnosed 4 cases from 4 patients from South America, 3 of whom were HIV positive and 1 diagnosed with dermatomyositis was treated with immunosuppressive drugs. The laboratory diagnosis was carried out by histological and microbiological study, by culture and specific PCR directly on the sample. As it is an imported infection there needs to be a high level of suspicion and a detailed history taken to get a diagnosis. This infection requires a differential diagnosis between febrile syndrome in immunosuppressed patients, both HIV positive and immunosuppressive therapy, which originate from endemic areas, or who have a history of staying in them. Copyright © 2010 Revista Iberoamericana de Micología. Published by Elsevier Espana. All rights reserved.
Paulo E Marchiori
Full Text Available OBJECTIVES: This study was undertaken to characterize the neuroinfection profile in a tertiary neurological ward. INTRODUCTION: Neuroinfection is a worldwide concern and bacterial meningitis, tetanus and cerebral malaria have been reported as the commonest causes in developing countries. METHODS: From 1999 to 2007, all patients admitted to the Neurology Ward of Hospital das Clínicas, São Paulo University School of Medicine because of neuroinfection had their medical records reviewed. Age, gender, immunological status, neurological syndrome at presentation, infectious agent and clinical outcome were recorded. RESULTS: Three hundred and seventy four cases of neuroinfectious diseases accounted for 4.2% of ward admissions and the identification of infectious agent was successful in 81% of cases. Mean age was 40.5 + 13.4 years, 63.8% were male, 19.7% were immunocompromised patients and meningoencephalitis was the most common clinical presentation despite infectious agent. Viruses and bacteria were equally responsible for 29.4% of neuroinfectious diseases; parasitic, fungal and prion infections accounted for 28%, 9.6% and 3.5% respectively. Human immunodeficiency virus (HIV, herpes simplex virus 1 (HSV1, Mycobacterium tuberculosis, Treponema pallidum, Taenia solium, Schistosoma mansoni, Cryptococcus neoformans and Histoplasma capsulatum were the more common infectious pathogens in the patients. Infection mortality rate was 14.2%, of which 62.3% occurred in immunocompetent patients. CONCLUSION: Our institution appeared to share some results with developed and developing countries. Comparison with literature may be considered as quality control to health assistance.
Zarnowski, Robert; Woods, Jon P.
In this study, extracellular glutathione-dependent ferric reductase (GSH-FeR) activities in different dimorphic zoopathogenic fungal species were characterized. Supernatants from Blastomyces dermatitidis, Histoplasma capsulatum, Paracoccidioides brasiliensis and Sporothrix schenckii strains grown in their yeast form were able to reduce iron enzymically with glutathione as a cofactor. Some variations in the level of reduction were noted amongst the strains. This activity was stable in acidic, neutral and slightly alkaline environments and was inhibited when trivalent aluminium and gallium ions were present. Using zymography, single bands of GSH-FeRs with apparent molecular masses varying from 430 to 460 kDa were identified in all strains. The same molecular mass range was determined by size exclusion chromatography. These data demonstrate that dimorphic zoopathogenic fungi produce and secrete a family of similar GSH-FeRs that may be involved in the acquisition and utilization of iron. Siderophore production by these and other fungi has sometimes been considered to provide a full explanation of iron acquisition in these organisms. Our work reveals an additional common mechanism that may be biologically and pathogenically important. Furthermore, while some characteristics of these enzymes such as extracellular location, cofactor utilization and large size are not individually unique, when considered together and shared across a range of fungi, they represent an important novel physiological feature. PMID:16000713
Full Text Available El hallazgo de masas adrenales detectadas mediante técnicas ecográficas o tomográficas solicitadas por algún otro motivo, y por ello incidentales, constituye un nuevo desafío diagnóstico. El paciente que presentamos se encontraba asintomático y no refería antecedentes patológicos. Una ecografía mostró agrandamiento de la glándula suprarrenal derecha, que medía 66 por 33mm. La tomografía computada mostró agrandamiento irregular de ambas suprarrenales. Se descartaron neoplasias extra-adrenales y tumores hiperfuncionantes. Se realizó una biopsia guiada por tomografía, y el estudio histopatológico informó Histoplasma capsulatum. El paciente vivía en una zona endémica para esta enfermedad y, por exposición laboral, tenía contacto diario con excremento de aves. La histoplasmosis es una causa infrecuente de masas adrenales bilaterales en el huesped inmu-nocompetente.
Full Text Available Abstract Background A prospective observational study was done to describe nonbacterial pulmonary complications in hospitalized patients with human immunodeficiency virus (HIV infection. Methods The study included 1,225 consecutive hospital admissions of 599 HIV-infected patients treated from April 1995 through March 1998. Data included demographics, risk factors for HIV infection, Acute Physiology and Chronic Health Evaluation (APACHE II score, pulmonary complications, CD4+ lymphocyte count, hospital stay and case-fatality rate. Results Patient age (mean ± SD was 38.2 ± 8.9 years, 62% were men, and 84% were African American. The median APACHE II score was 14, and median CD4+ lymphocyte count was 60/μL. Pulmonary complications were Pneumocystis carinii pneumonia (85 in 78 patients, Mycobacterium avium complex (51 in 38, Mycobacterium tuberculosis (40 in 35, Mycobacterium gordonae (11 in 11, Mycobacterium kansasii (10 in 9, Cytomegalovirus (10 in 10, Nocardia asteroides (3 in 3, fungus ball (2 in 2, respiratory syncytial virus (1, herpes simplex virus (1, Histoplasma capsulatum (1, lymphoma (3 in 3, bronchogenic carcinoma (2 in 2, and Kaposi sarcoma (1. The case-fatality rate of patients was 11% with Pneumocystis carinii pneumonia; 5%, Mycobacterium tuberculosis; 6%, Mycobacterium avium complex; and 7%, noninfectious pulmonary complications. Conclusion Most pulmonary complications in hospitalized patients with HIV are from Pneumocystis and mycobacterial infection.
Samayoa, Blanca; Roy, Monika; Cleveland, Angela Ahlquist; Medina, Narda; Lau-Bonilla, Dalia; Scheel, Christina M; Gomez, Beatriz L; Chiller, Tom; Arathoon, Eduardo
Histoplasmosis is one of the most common and deadly opportunistic infections among persons living with human immunodeficiency virus (HIV)/acquired immune deficiency syndrome in Latin America, but due to limited diagnostic capacity in this region, few data on the burden and clinical characteristics of this disease exist. Between 2005 and 2009, we enrolled patients ≥ 18 years of age with suspected histoplasmosis at a hospital-based HIV clinic in Guatemala City. A case of suspected histoplasmosis was defined as a person presenting with at least three of five clinical or radiologic criteria. A confirmed case of histoplasmosis was defined as a person with a positive culture or urine antigen test for Histoplasma capsulatum . Demographic and clinical data were also collected and analyzed. Of 263 enrolled as suspected cases of histoplasmosis, 101 (38.4%) were confirmed cases. Median time to diagnosis was 15 days after presentation (interquartile range [IQR] = 5-23). Crude overall mortality was 43.6%; median survival time was 19 days (IQR = 4-69). Mycobacterial infection was diagnosed in 70 (26.6%) cases; 26 (25.7%) histoplasmosis cases were coinfected with mycobacteria. High mortality and short survival time after initial symptoms were observed in patients with histoplasmosis. Mycobacterial coinfection diagnoses were frequent, highlighting the importance of pursuing diagnoses for both diseases.
Santiago, Axel Rodolfo; Hernández, Betsy; Rodríguez, Marina; Romero, Hilda
The purpose of this work was to compare the efficacy of blood culture conventional method vs. a modified lysis/centrifugation technique. Out of 450 blood specimens received in one year, 100 where chosen for this comparative study: 60 from patients with AIDS, 15 from leukemic patients, ten from febrile neutropenic patients, five from patients with respiratory infections, five from diabetics and five from septicemic patients. The specimens were processed, simultaneously, according to the above mentioned methodologies with daily inspections searching for fungal growth in order to obtain the final identification of the causative agent. The number (40) of isolates recovered was the same using both methods, which included; 18 Candida albicans (45%), ten Candida spp. (25%), ten Histoplasma capsulatum (25%), and two Cryptococcus neoformans (5%). When the fungal growth time was compared by both methods, growth was more rapid when using the modified lysis/centrifugation technique than when using the conventional method. Statistical analysis revealed a significant difference (pcentrifugation technique showed to be more efficacious than the conventional one, and therefore the implementation of this methodology is highly recommended for the isolation of fungi from blood.
Dixon, D M; Casadevall, A; Klein, B; Mendoza, L; Travassos, L; Deepe, G S
Vaccine approaches to infectious diseases are widely applied and appreciated. Disciplines such as bacteriology and virology have a rich history of successful vaccine development. The complexity of eukaryotic systems presents additional challenges to the development of vaccines against them. These challenges are being met in the fields of parasitology, and are being revisited for application in oncology. Vaccine opportunities exist in medical mycology. The National Institute of Allergy and Infectious Diseases has held a series of workshops in medical mycology where the need to develop vaccines for fungal diseases was noted and where important opportunities were discussed. Major advances in vaccinology and the technology of antigen preparation and delivery have increased feasibility and heightened interest. The recent epidemic of coccidioidomycosis in the American Southwest has demonstrated the need for developing a vaccine as an effective preventive measure for those living in and for those who subsequently move into regions with the endemic mycoses. The XIIth Congress of the International Society for Human and Animal Mycology included a symposium that summarized new vaccination strategies for selected fungi: Candida albicans, Coccidioides immitis, and Trichophyton verrucosum. The goal of the present summary is to provide representative examples of continuing efforts relating to vaccine development within the medical mycological community highlighting Blastomyces dermatidis, Cryptococcus neoformans, Histoplasma capsulatum, Paracoccidioides brasiliensis, and Pythiumn insidiosum.
Morphological changes in the digestive system of 322 necropsies of patients with acquired immune deficiency syndrome: comparison of findings pre- and post-HAART (Highly Active Antiretroviral Therapy).
Guimarães, Lucinda Calheiros; Silva, Ana Cristina Araújo Lemos da; Micheletti, Adilha Misson Rua; Moura, Everton Nunes Melo; Silva-Vergara, Mario Léon; Tostes, Sebastião; Adad, Sheila Jorge
Involvement of the digestive system in AIDS pathologies or injuries is frequent. Aiming at comparing the frequency, the importance that these lesions have for death and the survival time in patients using or not using HAART, we studied 322 necropsies classified as follows: Group A - without antiretroviral drugs (185 cases); B - one or two antiretroviral drugs or HAART for less than six months (83 cases); C - HAART for six months or longer (54 cases). In the overall analysis of the digestive system, changes were present in 73.6% of cases. The most frequent was Candida infection (22.7%), followed by cytomegalovirus (19.2%), Histoplasma capsulatum (6.5%), mycobacteria (5.6%), and Toxoplasma gondii (4.3%). T. gondii infection was more frequent in group A compared with group C, and cytomegalovirus (CMV) was more frequent in group A compared with groups B and C (p digestive system infections are still frequent, even with the use of HAART. However, the average survival time in group C was more than three times greater than the one in group A and nearly double that of group B, demonstrating the clear benefit of this therapy.
Full Text Available Human immunodeficiency virus infection is the first major pandemic of the 20th century. At present, almost 10 million people are known to be infected with this virus, and it is estimated that by the year 2000, approximately 40 million people will be infected. Transmission of this deadly infection is predominantly by sexual contact. Individuals infected with this virus pass through several predictable stages with progressive decrease in circulating CD4+ T cells. During the advanced stage, these patients develop various opportunistic infections or malignancies, or both. It is this advanced stage that was first recognized as AIDS, which has a 100% mortality rate. The opportunistic organisms that can involve the eye in patients with AIDS include cytomegalovirus, herpes zoster, Toxoplasma gondii, Mycobacterium tuberculosis, Cryptococcus neoformans, Mycobacterium avium-intracellulare, Pneumocystis carinii, Histoplasma capsulatum, Candida, and others. Intraocular lesions from these agents often represent disseminated infections. Visual morbidity occurs secondary to retinitis due to cytomegalovirus, herpes zoster, or Toxoplasma gondii. Anti-viral agents such as ganciclovir or foscarnet are effective against cytomegalovirus infection. The role of the ophthalmologist in the diagnosis and management of AIDS is becoming increasingly important. Not only does the eye reflect systemic disease, but ocular involvement may often precede systemic manifestations. In the AIDS patient, the ophthalmologist thus has an opportunity to make not only a slight-saving, but also life-saving diagnosis of disseminated opportunistic infections.
Full Text Available Collaboration between heterogeneous pattern recognition receptors (PRRs leading to synergistic coordination of immune response is important for the host to fight against invading pathogens. Although complement receptor 3 (CR3 and Dectin-1 are major PRRs to detect fungi, crosstalk between these two receptors in antifungal immunity is largely undefined. Here we took advantage of Histoplasma capsulatum which is known to interact with both CR3 and Dectin-1 and specific particulate ligands to study the collaboration of CR3 and Dectin-1 in macrophage cytokine response. By employing Micro-Western Array (MWA, genetic approach, and pharmacological inhibitors, we demonstrated that CR3 and Dectin-1 act collaboratively to trigger macrophage TNF and IL-6 response through signaling integration at Syk kinase, allowing subsequent enhanced activation of Syk-JNK-AP-1 pathway. Upon engagement, CR3 and Dectin-1 colocalize and form clusters on lipid raft microdomains which serve as a platform facilitating their cooperation in signaling activation and cytokine production. Furthermore, in vivo studies showed that CR3 and Dectin-1 cooperatively participate in host defense against disseminated histoplasmosis and instruct adaptive immune response. Taken together, our findings define the mechanism of receptor crosstalk between CR3 and Dectin-1 and demonstrate the importance of their collaboration in host defense against fungal infection.
Nimrichter, Leonardo; de Souza, Marcio M; Del Poeta, Maurizio; Nosanchuk, Joshua D; Joffe, Luna; Tavares, Patricia de M; Rodrigues, Marcio L
Classic cell wall components of fungi comprise the polysaccharides glucans and chitin, in association with glycoproteins and pigments. During the last decade, however, system biology approaches clearly demonstrated that the composition of fungal cell walls include atypical molecules historically associated with intracellular or membrane locations. Elucidation of mechanisms by which many fungal molecules are exported to the extracellular space suggested that these atypical components are transitorily located to the cell wall. The presence of extracellular vesicles (EVs) at the fungal cell wall and in culture supernatants of distinct pathogenic species suggested a highly functional mechanism of molecular export in these organisms. Thus, the passage of EVs through fungal cell walls suggests remarkable molecular diversity and, consequently, a potentially variable influence on the host antifungal response. On the basis of information derived from the proteomic characterization of fungal EVs from the yeasts Cryptoccocus neoformans and Candida albicans and the dimorphic fungi Histoplasma capsulatum and Paracoccidioides brasiliensis, our manuscript is focused on the clear view that the fungal cell wall is much more complex than previously thought.
Lucinda Calheiros Guimarães
Full Text Available ABSTRACT Involvement of the digestive system in AIDS pathologies or injuries is frequent. Aiming at comparing the frequency, the importance that these lesions have for death and the survival time in patients using or not using HAART, we studied 322 necropsies classified as follows: Group A - without antiretroviral drugs (185 cases; B - one or two antiretroviral drugs or HAART for less than six months (83 cases; C - HAART for six months or longer (54 cases. In the overall analysis of the digestive system, changes were present in 73.6% of cases. The most frequent was Candida infection (22.7%, followed by cytomegalovirus (19.2%, Histoplasma capsulatum (6.5%, mycobacteria (5.6%, and Toxoplasma gondii (4.3%. T. gondii infection was more frequent in group A compared with group C, and cytomegalovirus (CMV was more frequent in group A compared with groups B and C (p < 0.05; 2.2% of the deaths were due to gastrointestinal bleeding. Regarding the segments, only in the large intestine, and only cytomegalovirus, were more frequent in group A compared with group C. We conclude that digestive system infections are still frequent, even with the use of HAART. However, the average survival time in group C was more than three times greater than the one in group A and nearly double that of group B, demonstrating the clear benefit of this therapy.
Full Text Available OBJETIVO: Aislar e identificar hongos en diferentes especímenes de pacientes inmunocomprometidos, atendidos en un hospital de la Ciudad de México, y determinar su asociación con micosis. MATERIAL Y MÉTODOS: Se realizó un estudio de tipo observacional transversal en pacientes del Hospital Regional General Ignacio Zaragoza, de junio de 1999 a mayo de 2000. De 108 pacientes se procesaron 268 especímenes para estudio micológico que incluyó examen directo, frotis, cultivos y microcultivos en medios específicos además de pruebas bioquímicas. La mayoría de pacientes tenía diagnóstico clínico de tuberculosis pulmonar y de síndrome de inmunodeficiencia adquirida. RESULTADOS: Se obtuvieron 183 aislamientos de levaduras y 66 de hongos filamentosos. Se diagnosticaron 45 micosis que en su mayoría correspondieron a candidosis pulmonar (32 casos. Las especies de Candida más frecuentes asociadas a patología fueron Candida albicans y C parapsilosis. Se obtuvieron cinco aislamientos de Cryptococcus neoformans variedad neoformans, uno de C albidus, tres de Histoplasma capsulatum y uno de Geotrichum candidum, asociados a infección micótica. CONCLUSIONES: El 41.6% de los pacientes estudiados presentaron una micosis asociada principalmente a síndrome de inmunodeficiencia adquirida y a tuberculosis pulmonar.
Rivian Christina Lopes Faiolla
Full Text Available Introduction The distribution of infection by Histoplasma capsulatum in Brazil is heterogeneous, and the number of cases affecting immunocompetent individuals is relatively small. This study reports the epidemiological and clinical data regarding histoplasmosis in non-immunosuppressed individuals. Methods The study included only the immunocompetent patients with histoplasmosis who were diagnosed between 1970 and 2012 at a university hospital located in Ribeirão Preto, State of São Paulo, Brazil. Clinical and epidemiological data were collected retrospectively from the patient records. Results Of the 123 patients analyzed, 95 had an active disease that manifested in the different clinical forms of histoplasmosis. Men were the predominant gender, and most patients resided in the Northeast of the State of São Paulo and in the nearby municipalities of the State of Minas Gerais. The risk factors for acquiring histoplasmosis and prolonged contact in a rural environment were recorded in 43.9% and 82.9% of cases, respectively. Smoking, alcoholism, and comorbidity rates were high among the patients with the chronic pulmonary and subacute/chronic disseminated forms of histoplasmosis. Many patients achieved clinical cure spontaneously, but 58.9% required antifungals; the disease lethality rate was 5.3%. Conclusions Immunocompetent individuals manifested the diverse clinical forms of histoplasmosis over a period of 4 decades, revealing an additional endemic area of this fungal disease in the Brazilian Southeast.
Rodríguez-Cerdeira, C; Arenas, R; Moreno-Coutiño, G; Vásquez, E; Fernández, R; Chang, P
Histoplasmosis is a systemic infection caused by the dimorphic fungus Histoplasma capsulatum. In immunocompromised patients, primary pulmonary infection can spread to the skin and meninges. Clinical manifestations appear in patients with a CD4(+) lymphocyte count of less than 150 cells/μL. Coccidioidomycosis is a systemic mycosis caused by Coccidioides immitis and Coccidioides posadasii. It can present as diffuse pulmonary disease or as a disseminated form primarily affecting the central nervous system, the bones, and the skin. Cryptococcosis is caused by Cryptococcus neoformans (var. neoformans and var. grubii) and Cryptococcus gattii, which are members of the Cryptococcus species complex and have 5 serotypes: A, B, C, D, and AD. It is a common opportunistic infection in patients with human immunodeficiency virus (HIV)/AIDS, even those receiving antiretroviral therapy. Histopathologic examination and culture of samples from any suspicious lesions are essential for the correct diagnosis of systemic fungal infections in patients with HIV/AIDS. Copyright © 2011 Elsevier España, S.L. and AEDV. All rights reserved.
Full Text Available La histoplasmosis es una afección polifacética producida por el hongo dimorfo Histoplasma capsulatum, cuyas esporas son inhaladas y llegan al pulmón, órgano primario de infección. La forma meníngea, considerada como una de las manifestaciones más graves de esta micosis, suele presentarse en individuos con alteraciones en la inmunidad celular: pacientes con síndrome de inmunodeficiencia humana adquirida, con lupus eritematoso sistémico o con trasplante de órgano sólido, así como en lactantes, debido a su inmadurez inmunológica. La forma de presentación más usual es de resolución espontánea y se observa en individuos inmunocompetentes que se han expuesto a altas concentraciones de conidias y fragmentos miceliares del hongo. En estas personas, la afección se manifiesta por trastornos pulmonares y por la posterior diseminación a otros órganos y sistemas. Se presenta un caso de histoplasmosis del sistema nervioso central en un niño inmunocompetente.
A. I. Toranzo
Full Text Available Se evaluó el uso de sangre entera para el diagnóstico molecular de histoplasmosis utilizando un método artesanal de extracción de ADN fúngico y una PCR anidada que amplifica una porción del gen HcP100 específica de Histoplasma capsulatum. La sangre entera se trató con liticasa, enzima lisante de Trichoderma harzianum y proteinasa K, seguido de una extracción fenólica. Este tratamiento permitió una lisis completa de las células, mostró buen rendimiento en la obtención de ADN y posibilitó la detección de la banda de 210 pb específica de H. capsulatum en la PCR anidada. El límite de detección fue de 0,25-1 levaduras/ml de sangre. El método se evaluó en 31 muestras de sangre de 19 pacientes con diagnóstico microbiológico de histoplasmosis, en 21 muestras de pacientes con otras micosis o infecciones por micobacterias y en 30 controles sanos. La PCR fue positiva en sangre para 17/19 pacientes con histoplasmosis (14/15 inmunocomprometidos y 3/4 sin inmunocompromiso aparente. Las muestras de sangre de los 30 controles sanos y de 20 pacientes con otras patologías fueron negativas, sólo hubo un falso positivo correspondiente a un paciente con infección por Mycobacterium avium-intracellulare. El método presentó 89% de sensibilidad y 96% de especificidad para el diagnóstico de histoplasmosis en sangre entera.To assess the value of using whole blood samples for the molecular diagnosis of histoplasmosis, we applied an in-house DNA extraction method and a nested PCR targeting a 210 bp specific segment of the Histoplasma capsulatum HcP100 gene. A whole blood volume of 2.5-3 milliliters was centrifuged and the cellular pellet was treated with Trichoderma harzianum lyticase and proteinase K prior to applying a conventional phenol DNA extraction. This procedure allowed complete cell lysis, high DNA yield and specific amplification. The PCR detection limit was 0.25-1 yeast cells/ml of blood sample. The method was assessed on 31 blood
Negroni, Ricardo; Messina, Fernando; Arechavala, Alicia; Santiso, Gabriela; Bianchi, Mario
Classic histoplasmosis is a systemic endemic mycosis due to Histoplasma capsulatum var. capsulatum. A significant reduction in the morbidity and mortality of AIDS-related histoplasmosis has been observed since the introduction of highly active antiretroviral therapy (HAART) and secondary antifungal prophylaxis. The aim of this study was to determine the current state of prognosis and treatment response of HIV-positive patients with histoplasmosis in the Francisco J. Muñiz Infectious Diseases Hospital in Buenos Aires City. A retrospective study was conducted using the demographic, clinical, immunological and treatment data of 80 patients suffering from AIDS-related histoplasmosis. Of the 80 cases studied 65 were male, the median age was 36 years, with 73.7% of the patients being drug addicts, 82.5% of the patients was not receiving HAART at diagnosis, and 58.7% of the cases had less than 50 CD4+ cells/μl at the beginning of the treatment. The initial phase of treatment consisted of intravenous amphotericin B and/or oral itraconazole for 3 months, with 78.7% of the cases showing a good clinical response. Only 26/63 patients who were discharged from hospital continued with the follow-up of the HAART, secondary prophylaxis with itraconazole or amphotericin B. Secondary prophylaxis was stopped after more than one year of HAART if the patients were asymptomatic, had two CD 4 + cell counts greater than 150cells/μl, and undetectable viral loads. No relapses were observed during a two-year follow up after prophylaxis was stopped. The treatment of histoplasmosis in HIV-positive patients was effective in 78.8% of the cases. The combination of HAART and secondary antifungal prophylaxis is safe, well tolerated, and effective. The low adherence of patients to HAART and the lack of laboratory kits for rapid histoplasmosis diagnosis should be addressed in the future. The usefulness of primary antifungal prophylaxis for cryptococcosis and histoplasmosis HIV-positive patients
Full Text Available El objetivo fue revisar la encefalitis en niños y adolescentes, su etiología, manifestaciones clínicas, fisiopatología, métodos diagnósticos y tratamiento, enfatizando las manifestaciones neuropsiquiátricas de la encefalitis durante una epidemia de influenza. La encefalitis se considera una inflamación del sistema nervioso central (SNC que compromete el cerebro. Se manifiesta usualmente por cefaleas, fiebre y trastorno del estado de conciencia. Puede además manifestarse por convulsiones, cambios en la personalidad y manifestaciones obsesivas (síntomas neuropsiquiátricos. Las manifestaciones dependerán del tipo de virus y las células afectadas. La encefalitis puede ser causada por una gran variedad de agentes infecciosos incluyendo virus, bacterias, hongos y parásitos. Causas virales de encefalitis incluyen herpesvirus, arbovirus, rabia y enterovirus. Casos establecidos de bacterias incluyen Borrelia burgdorferi y rickettsia y el Mycoplasma neumoniae, al cual se atribuyen varios casos de encefalitis. Otros agentes como el hongo Coccidioides immitis e Histoplasma capsulatum pueden también generarla. Más de 100 agentes se han asociado a encefalitis. El diagnóstico de encefalitis constituye un reto para el clínico, y su etiología infecciosa usualmente se identifica entre el 40% al 70% de casos. El diagnóstico se hace con absoluta certeza sólo con una biopsia cerebral. La epidemiología depende de ciertos factores como la edad, la localización geográfica, la época del año, las condiciones climáticas y la inmunocompetencia del huésped. El tratamiento temprano puede disminuir el riesgo de muerte y las secuelas. Describimos cuatro pacientes con encefalitis y manifestaciones neuropsiquiátricas durante una epidemia de influenza, con el fin de alertar sobre esta asociación.The aim is to review the encephalitis in infants and adolescents as well as its etiology, clinical manifestation, epidemiology, physiopathology, diagnostic
Klein, B.S.; Jones, J.M.
No well-defined Blastomyces-specific antigens are currently available. We used sodium dodecyl sulfate-polyacrylamide gel electrophoresis and immunoblotting to identify immunologically active molecules in the cell wall of B. dermatitidis. A major immunoreactive 120-kD protein (WI-1) was present in all five strains studied and comprised 5% of the protein in the cell wall extract obtained after freezing and thawing yeast cells. WI-1 was recognized by serum from all 10 patients with blastomycosis but by none of those from 5 patients with histoplasmosis. It was purified by electroelution, radiolabeled with 125I, and incorporated into a radioimmunoassay (RIA) for serodiagnosis of blastomycosis. Antibody to WI-1 was detected in 58 (85%) of 68 patients with blastomycosis (geometric mean titer, 1:2,981), in two (3%) of 73 patients with histoplasmosis, coccidioidomycosis, sporotrichosis, or candidiasis (titers, 1:86 and 1:91) and in none of 44 healthy persons. WI-1 was shown to be a surface molecule abundant on B. dermatitidis yeasts that were indirectly stained with serum from a rabbit immunized with WI-1. Approximately 0.93 pg of WI-1 or 4.7 x 10(6) WI-1 molecules were found on the surface of an individual yeast using an antigen-inhibition RIA; none was found on Histoplasma capsulatum or Candida albicans yeasts. We conclude that WI-1 is a novel, immunologically active surface molecule on the invasive form of B. dermatitidis and that WI-1 can be used to reliably detect antibody and study the immunopathogenesis of blastomycosis
Fiorillo, S.P.; Diefenthal, H.C.; Goodman, P.C.; Ramadhani, H.O.; Njau, B.N.; Morrissey, A.B.; Maro, V.P.; Saganda, W.; Kinabo, G.D.; Mwako, M.S.; Bartlett, J.A.
Aim: To describe chest radiographic abnormalities and assess their usefulness for predicting causes of fever in a resource-limited setting. Materials and methods: Febrile patients were enrolled in Moshi, Tanzania, and chest radiographs were evaluated by radiologists in Tanzania and the United States. Radiologists were blinded to the results of extensive laboratory evaluations to determine the cause of fever. Results: Of 870 febrile patients, 515 (59.2%) had a chest radiograph available; including 268 (66.5%) of the adolescents and adults, the remainder were infants and children. One hundred and nineteen (44.4%) adults and 51 (20.6%) children were human immunodeficiency virus (HIV)-infected. Among adults, radiographic abnormalities were present in 139 (51.9%), including 77 (28.7%) with homogeneous and heterogeneous lung opacities, 26 (9.7%) with lung nodules, 25 (9.3%) with pleural effusion, 23 (8.6%) with cardiomegaly, and 13 (4.9%) with lymphadenopathy. Among children, radiographic abnormalities were present in 87 (35.2%), including 76 (30.8%) with homogeneous and heterogeneous lung opacities and six (2.4%) with lymphadenopathy. Among adolescents and adults, the presence of opacities was predictive of Streptococcus pneumoniae and Coxiella burnetii, whereas the presence of pulmonary nodules was predictive of Histoplasma capsulatum and Cryptococcus neoformans. Conclusions: Chest radiograph abnormalities among febrile inpatients are common in northern Tanzania. Chest radiography is a useful adjunct for establishing an aetiologic diagnosis of febrile illness and may provide useful information for patient management, in particular for pneumococcal disease, Q fever, and fungal infections
Luciano Nery Tencate
Full Text Available Os morcegos são hospedeiros de uma rica diversidade de microrganismos. Muitos trabalhos apontam uma estreita ligação entre quirópteros e fungos com potencial patogênico, principalmente por habitarem ambientes como cavernas, grutas e ocos de árvores, favoráveis à manutenção e propagação dos fungos. O objetivo do trabalho foi estudar a microbiota fúngica gastrintestinal de morcegos. Das 98 amostras pertencentes a 11 espécies de morcegos procedentes de 15 cidades estudadas, 20% são da espécie Carollia perspicillata, 19% Artibeus lituratus, 17% Molossus rufus, 13% Glossophaga soricina, 9% Nyctinomops macrotis, 8% Molossus molossus, 7% Desmodus rotundus, 2% Lasiurus ega, e 1% Eptesicus furinalis, Myotis nigricans e Tadarida brasiliensis. O gênero Aspergillus sp. foi isolado de 29% das amostras, seguidos por 6% Microsporum sp. e Penicillium sp., 4% Tricophyton sp. e zigomicetos e 2% Fusarium sp. Das espécies de leveduras, 14% foram de Rhodotorula sp., 10% Candida sp. e 2% Cryptococcus sp., 22% dos isolados permaneceram sem identificação. Todos os 82 cultivos de vísceras foram negativos para Histoplasma capsulatum. Houve associação estatística significativa entre os resultados do cultivo microbiológico e as espécies de morcegos (p < 0,05. Concluímos que os morcegos podem atuar como agentes veiculadores de fungos com potencial patogênico, entretanto outros trabalhos devem ser realizados a fim de estabelecer estratégias que permitam identificar os principais fatores correlacionados com o crescimento e a disseminação dos microrganismos na natureza e qual a implicação dos quirópteros no ciclo epidemiológico.
Pamela P. Lee
Full Text Available The global burden of fungal diseases has been increasing, as a result of the expanding number of susceptible individuals including people living with human immunodeficiency virus (HIV, hematopoietic stem cell or organ transplant recipients, patients with malignancies or immunological conditions receiving immunosuppressive treatment, premature neonates, and the elderly. Opportunistic fungal pathogens such as Aspergillus, Candida, Cryptococcus, Rhizopus, and Pneumocystis jiroveci are distributed worldwide and constitute the majority of invasive fungal infections (IFIs. Dimorphic fungi such as Histoplasma capsulatum, Coccidioides spp., Paracoccidioides spp., Blastomyces dermatiditis, Sporothrix schenckii, Talaromyces (Penicillium marneffei, and Emmonsia spp. are geographically restricted to their respective habitats and cause endemic mycoses. Disseminated histoplasmosis, coccidioidomycosis, and T. marneffei infection are recognized as acquired immunodeficiency syndrome (AIDS-defining conditions, while the rest also cause high rate of morbidities and mortalities in patients with HIV infection and other immunocompromised conditions. In the past decade, a growing number of monogenic immunodeficiency disorders causing increased susceptibility to fungal infections have been discovered. In particular, defects of the IL-12/IFN-γ pathway and T-helper 17-mediated response are associated with increased susceptibility to endemic mycoses. In this review, we put together the various forms of endemic mycoses on the map and take a journey around the world to examine how cellular and molecular defects of the immune system predispose to invasive endemic fungal infections, including primary immunodeficiencies, individuals with autoantibodies against interferon-γ, and those receiving biologic response modifiers. Though rare, these conditions provide importance insights to host defense mechanisms against endemic fungi, which can only be appreciated in unique
Klein, B.S.; Jones, J.M.
No well-defined Blastomyces-specific antigens are currently available. We used sodium dodecyl sulfate-polyacrylamide gel electrophoresis and immunoblotting to identify immunologically active molecules in the cell wall of B. dermatitidis. A major immunoreactive 120-kD protein (WI-1) was present in all five strains studied and comprised 5% of the protein in the cell wall extract obtained after freezing and thawing yeast cells. WI-1 was recognized by serum from all 10 patients with blastomycosis but by none of those from 5 patients with histoplasmosis. It was purified by electroelution, radiolabeled with 125I, and incorporated into a radioimmunoassay (RIA) for serodiagnosis of blastomycosis. Antibody to WI-1 was detected in 58 (85%) of 68 patients with blastomycosis (geometric mean titer, 1:2,981), in two (3%) of 73 patients with histoplasmosis, coccidioidomycosis, sporotrichosis, or candidiasis (titers, 1:86 and 1:91) and in none of 44 healthy persons. WI-1 was shown to be a surface molecule abundant on B. dermatitidis yeasts that were indirectly stained with serum from a rabbit immunized with WI-1. Approximately 0.93 pg of WI-1 or 4.7 x 10(6) WI-1 molecules were found on the surface of an individual yeast using an antigen-inhibition RIA; none was found on Histoplasma capsulatum or Candida albicans yeasts. We conclude that WI-1 is a novel, immunologically active surface molecule on the invasive form of B. dermatitidis and that WI-1 can be used to reliably detect antibody and study the immunopathogenesis of blastomycosis.
Full Text Available La histoplasmosis diseminada (HD compromete la piel y la mucosa oronasofaríngea con alta frecuencia. Entre 1.800 enfermos con sida, 19 presentaron HD, todos con compromiso cutáneo o mucocutáneo. Las lesiones cutáneas fueron máculas, pápulas umbilicadas o escamocostrosas, nódulos y úlceras, en tanto que 42% de los pacientes presentaron ulceras orales. Las biopsias mostraron dermatitis perivasculares superficiales y profundas, nodulares y difusas, foliculitis pustulosa o vasculitis con PMN y leucocitoclasia, con cantidades variables del hongo, fagocitado por macrófagos. En 5 biopsias, Histoplasma ca~sulatums e vio dentro de los nervios cutáneos que estaban rodeados de inflamación variable o tenían perinervio desflecado y estaban invadidos por macrófagos con el hongo. Los principales diagnósticos diferenciales histológicos son: vasculitis leucocitoclásica, criptococosis, aftas, paracoccidioidomicosis y leishmaniasis difusa. Los clínicos, laboratoristas y patólogos deben tener en mente la HD en toda úlcera oral o erupción máculo-papular cutánea de pacientes con sida, pues el diagnóstico rápido de la micosis conduce a un tratamiento oportuno y eficaz, que controla la enfermedad. La biopsia es un procedimiento de diagnóstico rápido, seguro y confiable. H. capsulatum es capaz de invadir los nervios cutáneos.
Gloria Velásquez Uribe
Full Text Available Introducción: la histoplasmosis es una micosis endémica en nuestro país y una complicación relativamente frecuente de los pacientes con sida. El objetivo del estudio era identificar las características clínicas, epidemiológicas y los factores de riesgo asociados a la mortalidad en pacientes con sida coinfectados con histoplasmosis. Materiales y métodos: se realizó un estudio de cohorte retrospectivo en el Hospital Universitario San Vicente de Paúl, en Medellín, con 1177 pacientes con VIH atendidos en un programa especializado de sida. Se identificaron los pacientes con histoplasmosis confirmada por aislamiento del hongo, o identificaci&oacut compatibles con Histoplasma capsulatum, mediante microscopía. Se analizaron variables demográficas, clínicas, de laboratorio, comorbilidad, tratamiento recibido y mortalidad. Resultados: La histoplasmosis afectó a 44 de 709 pacientes con sida (6,2%. Entre éstos, el 95,4% tuvo fiebre, el 54,5% enfermedad diseminada e;n de levaduras intracelulares y el 61,3% compromiso pulmonar. El cultivo fue positivo en el 89,3% y la histopatología en el 93,3%. Se encontró tuberculosis concomitante en el 15,9% y neumocistosis en el 11,4%. La mortalidad fue del 22,7%. El riesgo de morir fue mayor en pacientes con formas diseminadas (todas las muertes ocurrieron en sujetos con este tipo de compromiso, disnea (RR 13; IC95% 1,8-93,8, hipotensión (RR 4,5; IC95% 1,6-13,1, deshidrogenasa láctica (DHL >2 veces (RR 5,2; IC95% 1,2-22,5, y fue menor en quienes recibieron Anfotericina B (RR 0,3; IC95% 0,1-0,8. Discusión: en la región, la histoplasmosis es frecuente en pacientes con sida, y el rendimiento diagnóstico de las técnicas de rutina para H. capsulatum es alto, por lo que deben solicitarse en cualquier caso compatible. Demostrar la comorbilidad sida-histoplasmosis no descarta otras infecciones oportunistas. Los pacientes con formas diseminadas, disnea, hipotensión y DHL alta tienen mayor riesgo de muerte
Penk, A; Pittrow, L
With the increased use of artificial implants the management of related infections has become an important challenge. Normally an infected implant would be removed. In many cases this might be contraindicated and drug treatment remains as the only alternative. As microbiological eradication is often impossible, especially in fungal infections at artificial implants (FIAI) long-term suppressive therapy might be required. The objective of this study was to determine the therapeutic value of fluconazole (F) in the management of FIAI. Clinical data of 56 patients (pts) with proven or suspected fungal infections and artificial implants (FIAI) subsequently treated with F were analyzed retrospectively. FIAI caused by species with intrinsic resistance to F have been excluded from the study. The following implants were involved: prosthetic valve endocarditis (PVE) 25 pts (44.6%), intraocular lenses (IL) 9 pts (16.1%), ventriculoperitoneal shunts (VPS) 6 pts (10.7%), knee prostheses (KP) 5 pts (8.9%), biliary stents (BS) 4 pts (7.1 %), venous access devices (VAS) 3 pts (5.4%), urinary stents (US) 2 pts (3.6%), breast implant and pacemaker 1 patient (1.8%) each. Underlying diseases were valve insufficiency (in PVE), cataract surgery (in IL), prematurity in newborns (in VPS), arthrosis (in KP), biliary obstruction (in BS), cystic fibrosis (in VAS), and obstructive renal calculi (in US). Candida species (C. spp.) were the most frequently detected causative agents with C. parapsilosis as the leading cause (n = 19; 33.9%). Furthermore C. albicans (n = 15; 26.8%), C. spp. and fungi not further specified (n = 8; 14.3%), C. tropicalis (n = 3; 5.4%), C. glabrata (n = 3; 5.4%), and C. lusitaniae (n = 1; 1.8%) were identified. Acremonium kiliense has been detected in 4 pts (7.1%), Cryptococcus neoformans in 2 pts (3.6 %). Histoplasma capsulatum was identified in 1 patient (1.8%). The maximum duration of treatment with F was lifelong with a maximum recorded duration of 4,5 years. The
Martins Natalia F
Full Text Available Abstract Background The prevalence of invasive fungal infections (IFIs has increased steadily worldwide in the last few decades. Particularly, there has been a global rise in the number of infections among immunosuppressed people. These patients present severe clinical forms of the infections, which are commonly fatal, and they are more susceptible to opportunistic fungal infections than non-immunocompromised people. IFIs have historically been associated with high morbidity and mortality, partly because of the limitations of available antifungal therapies, including side effects, toxicities, drug interactions and antifungal resistance. Thus, the search for alternative therapies and/or the development of more specific drugs is a challenge that needs to be met. Genomics has created new ways of examining genes, which open new strategies for drug development and control of human diseases. Results In silico analyses and manual mining selected initially 57 potential drug targets, based on 55 genes experimentally confirmed as essential for Candida albicans or Aspergillus fumigatus and other 2 genes (kre2 and erg6 relevant for fungal survival within the host. Orthologs for those 57 potential targets were also identified in eight human fungal pathogens (C. albicans, A. fumigatus, Blastomyces dermatitidis, Paracoccidioides brasiliensis, Paracoccidioides lutzii, Coccidioides immitis, Cryptococcus neoformans and Histoplasma capsulatum. Of those, 10 genes were present in all pathogenic fungi analyzed and absent in the human genome. We focused on four candidates: trr1 that encodes for thioredoxin reductase, rim8 that encodes for a protein involved in the proteolytic activation of a transcriptional factor in response to alkaline pH, kre2 that encodes for α-1,2-mannosyltransferase and erg6 that encodes for Δ(24-sterol C-methyltransferase. Conclusions Our data show that the comparative genomics analysis of eight fungal pathogens enabled the identification of
Hegg, E. L.; Yang, H.; Gandhi, H.; McQuarters, A.; Lehnert, N.; Ostrom, N. E.
Nitrous oxide (N2O) is both a powerful greenhouse gas and a key participant in ozone destruction. Microbial activity accounts for over 70% of the N2O produced annually, and the atmospheric concentration of N2O continues to rise. Because the fungal and bacterial denitrification pathways are major contributors to microbial N2O production, understanding the mechanism by which NO is reduced to N2O will contribute to both N2O source tracing and quantification. Our strategy utilizes stable isotopes to probe the enzymatic mechanism of microbial N2O production. Although the use of stable isotopes to study enzyme mechanisms is not new, our approach is distinct in that we employ both measurements of isotopic preferences of purified enzyme and DFT calculations, thereby providing a synergistic combination of experimental and computational approaches. We analyzed δ18O, δ15Nα (central N atom in N2O), and δ15Nβ (terminal N atom) of N2O produced by purified fungal cytochrome P450 nitric oxide reductase (P450nor) from Histoplasma capsulatum as well as bacterial cytochrome c dependent nitric oxide reductase (cNOR) from Paracoccus denitrificans. P450nor exhibits an inverse kinetic isotope effect for Nβ (KIE = 0.9651) but a normal isotope effect for both Nα (KIE = 1.0127) and the oxygen atom (KIE = 1.0264). These results suggest a mechanism where NO binds to the ferric heme in the P450nor active site and becomes Nβ. Analysis of the NO-binding step indicated a greater difference in zero point energy in the transition state than the ground state, resulting in the inverse KIE observed for Nβ. Following protonation and rearrangement, it is speculated that this complex forms a FeIV-NHOH- species as a key intermediate. Our data are consistent with the second NO (which becomes Nα and O in the N2O product) attacking the FeIV-NHOH- species to generate a FeIII-N2O2H2 complex that enzymatically (as opposed to abiotically) breaks down to release N2O. Conversely, our preliminary data
Yang, H.; Gandhi, H.; Kreuzer, H. W.; Moran, J.; Hill, E. A.; McQuarters, A.; Lehnert, N.; Ostrom, N. E.; Hegg, E. L.
Stable isotopes can provide considerable insight into enzymatic mechanisms and fluxes in various biological processes. In our studies, we used stable isotopes to characterize both enzyme-catalyzed H2 and N2O production. H2 is a potential alternative clean energy source and also a key metabolite in many microbial communities. Biological H2 production is generally catalyzed by hydrogenases, enzymes that combine protons and electrons to produce H2 under anaerobic conditions. In our study, H isotopes and fractionation factors (α) were used to characterize two types of hydrogenases: [FeFe]- and [NiFe]-hydrogenases. Due to differences in the active site, the α associated with H2 production for [FeFe]- and [NiFe]-hydrogenases separated into two distinct clusters (αFeFe > αNiFe). The calculated kinetic isotope effects indicate that hydrogenase-catalyzed H2 production has a preference for light isotopes, consistent with the relative bond strengths of O-H and H-H bonds. Interestingly, the isotope effects associated with H2 consumption and H2-H2O exchange reactions were also characterized, but in this case no specific difference was observed between the different enzymes. N2O is a potent greenhouse gas with a global warming potential 300 times that of CO2, and the concentration of N2O is currently increasing at a rate of ~0.25% per year. Thus far, bacterial and fungal denitrification processes have been identified as two of the major sources of biologically generated N2O. In this study, we measured the δ15N, δ18O, δ15Nα (central N atom in N2O), and δ15Nβ (terminal N atom in N2O) of N2O generated by purified fungal P450 nitric oxide reductase (P450nor) from Histoplasma capsulatum. We observed normal isotope effects for δ18O and δ15Nα, and inverse isotope effects for bulk δ15N (the average of Nα and Nβ) and δ15Nβ. The observed isotope effects have been used in conjunction with DFT calculations to provide important insight into the mechanism of P450nor. Similar
Dec 2, 2009 ... Histoplasmosis, caused by two varieties of dimorphic fungi, Histoplasma ... from asymptomatic primary infection to disseminated disease in immunocompromised .... Addison's disease) tongue, gingivae, buccal mucosa,.
O’Donovan, Brian D.; Gelfand, Jeffrey M.; Sample, Hannah A.; Chow, Felicia C.; Betjemann, John P.; Shah, Maulik P.; Richie, Megan B.; Gorman, Mark P.; Hajj-Ali, Rula A.; Calabrese, Leonard H.; Zorn, Kelsey C.; Chow, Eric D.; Greenlee, John E.; Blum, Jonathan H.; Green, Gary; Khan, Lillian M.; Banerji, Debarko; Langelier, Charles; Bryson-Cahn, Chloe; Harrington, Whitney; Lingappa, Jairam R.; Shanbhag, Niraj M.; Green, Ari J.; Brew, Bruce J.; Soldatos, Ariane; Strnad, Luke; Doernberg, Sarah B.; Jay, Cheryl A.; Douglas, Vanja; Josephson, S. Andrew; DeRisi, Joseph L.
, Aspergillus oryzae, Histoplasma capsulatum, and Candida dubliniensis) were identified among the 7 participants by using mNGS. Evaluating mNGS data with a weighted z score–based scoring algorithm reduced the reported microbial taxa by a mean of 87% (range, 41%-99%) when taxa with a combined score of 0 or less were removed, effectively separating bona fide pathogen sequences from spurious environmental sequences so that, in each case, the causative pathogen was found within the top 2 scoring microbes identified using the algorithm. Conclusions and Relevance Diverse microbial pathogens were identified by mNGS in the CSF of patients with diagnostically challenging subacute or chronic meningitis, including a case of subarachnoid neurocysticercosis that defied diagnosis for 1 year, the first reported case of CNS vasculitis caused by Aspergillus oryzae, and the fourth reported case of C dubliniensis meningitis. Prioritizing metagenomic data with a scoring algorithm greatly clarified data interpretation and highlighted the problem of attributing biological significance to organisms present in control samples used for metagenomic sequencing studies. PMID:29710329
Simon F Dufresne
Full Text Available Mortality associated with invasive aspergillosis (IA remains high, partly because of delayed diagnosis. Detection of microbial exoantigens, released in serum and other body fluids during infection, may help timely diagnosis. In course of IA, Aspergillus galactomannan (GM, a well established polysaccharide biomarker, is released in body fluids including urine. Urine is an abundant, safely collected specimen, well-suited for point-of-care (POC testing, which could play an increasing role in screening for early disease. Our main objective was to demonstrate GM antigenuria as a clinically relevant biological phenomenon in IA and establish proof-of-concept that it could be translated to POC diagnosis. Utilizing a novel IgM monoclonal antibody (MAb476 that recognizes GM-like antigens from Aspergillus and other molds, we demonstrated antigenuria in an experimental animal IA model (guinea pig, as well as in human patients. In addition, we investigated the chemical nature of the urinary excreted antigen in human samples, characterized antigen detection in urine by immunoassays, described a putative assay inhibitor in urine, and indicated means of alleviation of the inhibition. We also designed and used a lateral flow immunochromatographic assay to detect urinary excreted antigen in a limited number of IA patient urine samples. In this study, we establish that POC diagnosis of IA based on urinary GM detection is feasible. Prospective studies will be necessary to establish the performance characteristics of an optimized device and define its optimal clinical use.
Reynolds, Daniel J; Andersen, Carl A; Hoskote, Sumedh S; Lee, Hee Eun; Raghunathan, Aditya; Kalra, Sanjay; Limper, Andrew H
A 19-year-old male with a history of idiopathic panuveitis, currently taking methotrexate and infliximab, presented to our institution with 6 weeks of cough, dyspnoea and fevers. He had failed outpatient antimicrobial therapy. Computerised tomography (CT) of the chest revealed the presence of a lobar pneumonia and he was treated with broad spectrum antibiotics, which did not improve his symptoms. Bronchoalveolar lavage was performed with a transbronchial lung biopsy because of the diagnostic uncertainty of the patient's presentation. Pathology revealed non-budding yeasts, consistent with Pneumocystis Serological and urine studies were positive for both Histoplasma and Blastomyces The diagnosis of Histoplasma pneumonia was made because of the presentation being inconsistent with Pneumocystis pneumonia, and serology, urine and pathology testing being more consistent with Histoplasma The patient was treated with oral itraconazole and was doing well at follow-up 12 weeks after hospitalisation. © Royal College of Physicians 2016. All rights reserved.
In vitro, sensitivity of Macrophomina phaseolina (Tassi) Goid determined through inhibition zone technique to various antagonistic fungi viz., Aspergillus niger, Aspergillus flavus, Trichoderma viride, Trichoderma harzianum and Penicillium capsulatum amended into PDA medium. All the antagonists reduced the colony ...
Full Text Available Resource availability is one of the main factors determining the ecological dynamics of populations or species. Fluctuations in resource availability can increase or decrease the intensity of resource competition. Resource availability and competition can also cause evolutionary changes in life-history traits. We studied how community structure and resource fluctuations affect the evolution of fitness related traits using a two-species bacterial model system. Replicated populations of Serratia marcescens (copiotroph and Novosphingobium capsulatum (oligotroph were reared alone or together in environments with intergenerational, pulsed resource renewal. The comparison of ancestral and evolved bacterial clones with 1 or 13 weeks history in pulsed resource environment revealed species-specific changes in life-history traits. Co-evolution with S. marcescens caused N. capsulatum clones to grow faster. The evolved S. marcescens clones had higher survival and slower growth rate then their ancestor. The survival increased in all treatments after one week, and thereafter continued to increase only in the S. marcescens monocultures that experienced large resource pulses. Though adaptive radiation is often reported in evolution studies with bacteria, clonal variation increased only in N. capsulatum growth rate. Our results suggest that S. marcescens adapted to the resource renewal cycle whereas N. capsulatum was more affected by the interspecific competition. Our results exemplify species-specific evolutionary response to both competition and environmental variation.
Fungal sinusitis is a known cause of persistent or chronic sinusitis. Various authors have reported various fungal organisms such as aspergillus species, candida species and phycomycetes but not histoplasma duboisii as the cause of fungal sinusitis. A rare case of facial deformity secondary to invasive fungal infection by ...
Fabricia Salvador Bezerra
Full Text Available SUMMARY Background. Disseminated histoplasmosis is common in AIDS patients with advanced immunosuppression in Ceará, Northeastern Brazil. The goal of this study was to determine the prevalence of Histoplasma infection in patients with HIV/AIDS living in Fortaleza, the capital of Ceará. Methods. Intradermal tests with histoplasmin (mycelial phase were performed in 161 HIV patients with CD4 ≥ 350 cells/mm 3 . Evidence of recent illness was evaluated with immunodiffusion (ID tests in 76 of these individuals. Results. A total of 11.8% of patients reacted to histoplasmin and 2.63% had ID test positive to Histoplasma. The presence of mango trees (Mangifera indica in the patient neighborhood (OR = 2.870; 95% CI = 1.081-7.617; p = 0.040 and past activity involving soil (OR = 2.834; 95% CI = 1.045-7.687; p = 0.045 or visits to a farm (OR = 3.869; 95% CI = 1.189-12.591; p = 0.033 were significantly associated with Histoplasma infection. Conclusions. Patients with HIV living in Fortaleza have an expressive prevalence of infection with Histoplasma.
Rai, Mahendra; Ingle, Avinash P; Gade, Aniket K; Duarte, Marta Cristina Teixeira; Duran, Nelson
The authors report extracellular mycosynthesis of silver nanoparticles (AgNPs) by Phoma capsulatum, Phoma putaminum and Phoma citri. The AgNPs thus synthesised were characterised by UV-visible spectrophotometer, Fourier transform infrared spectroscopy, Nanosight LM20 and transmission electron microscopy, which confirmed the synthesis of mostly spherical and polydisperse nanoparticles capped with proteins. The size of AgNPs was found in the range of 10-80 , 5-80 and 5-90 nm with an average size of 31.85, 25.43 and 23.29 nm by P. capsulatum, P. putaminum and P. citri, respectively. Further, potential antimicrobial activity was reported against Aspergillus niger, Candida albicans, Salmonella choleraesuis, Pseudomonas aeruginosa, Staphylococcus aureus and Escherichia coli. The lowest minimal inhibitory concentration (MIC) (0.85 µg/ml) was reported for AgNPs synthesised from P. citri against S. choleraesuis. However, AgNPs synthesised from P. capsulatum showed the highest MIC (10.62 µg/ml) against S. choleraesuis, P. aeruginosa and E. coli (clinical isolate). The same MIC values (10.62 µg/ml) were also reported against P. aeruginosa and both clinical and standard isolates of E. coli for AgNPs synthesised from P. citri. It was also observed that all the silver nanoparticles showed remarkable antifungal and antibacterial activity against these tested pathogens as compared with the commercially available antifungal and antibacterial agents.
Caceres, Diego H.; Zuluaga, Alejandra; Arango-Bustamante, Karen; de Bedout, Catalina; Tobón, Ángela Maria; Restrepo, Ángela; Gómez, Beatriz L.; Cano, Luz Elena; González, Ángel
Histoplasmosis causes a significant mortality, especially persons living with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) from developing countries where access to both appropriate diagnostic methods and antiretroviral therapy are limited. A total of 81 physicians assigned to 17 Colombian departments (states) received training in the clinical, epidemiological, and diagnostic aspects of histoplasmosis. Once this training was received and during the period of October 2009–November 2012, these physicians sent biological samples for immunodiagnostic, mycological, and molecular tests from their patients with suspicion of histoplasmosis. A total of 1,536 samples from 768 patients were evaluated. Of the 768 patients studied, 463 (60%) were HIV positive, 214 (28%) HIV negative, and in 91 (12%) this diagnosis was unknown, and 538 (70%) were males. The 1,536 specimens studied comprised 722 sera, 439 blood samples, and 241 urines, which were tested by immunodiffusion (ID), culture, and antigenuria, respectively; in addition, 134 specimens were tested by performing a molecular assay. Histoplasmosis was diagnosed in 133 patients (17%). After the training, we observed more diagnoses from 27 to 44 cases per year. In this study, a significantly increased number of histoplasmosis cases reported by year were observed after implementing an educational training program. PMID:26123961
Wheat, Joseph; Myint, Thein; Guo, Ying; Kemmer, Phebe; Hage, Chadi; Terry, Colin; Azar, Marwan M; Riddell, James; Ender, Peter; Chen, Sharon; Shehab, Kareem; Cleveland, Kerry; Esguerra, Eden; Johnson, James; Wright, Patty; Douglas, Vanja; Vergidis, Pascalis; Ooi, Winnie; Baddley, John; Bamberger, David; Khairy, Raed; Vikram, Holenarasipur R; Jenny-Avital, Elizabeth; Sivasubramanian, Geetha; Bowlware, Karen; Pahud, Barbara; Sarria, Juan; Tsai, Townson; Assi, Maha; Mocherla, Satish; Prakash, Vidhya; Allen, David; Passaretti, Catherine; Huprikar, Shirish; Anderson, Albert
Central nervous system (CNS) involvement occurs in 5 to 10% of individuals with disseminated histoplasmosis. Most experience has been derived from small single center case series, or case report literature reviews. Therefore, a larger study of central nervous system (CNS) histoplasmosis is needed in order to guide the approach to diagnosis, and treatment.A convenience sample of 77 patients with histoplasmosis infection of the CNS was evaluated. Data was collected that focused on recognition of infection, diagnostic techniques, and outcomes of treatment.Twenty nine percent of patients were not immunosuppressed. Histoplasma antigen, or anti-Histoplasma antibodies were detected in the cerebrospinal fluid (CSF) in 75% of patients. One year survival was 75% among patients treated initially with amphotericin B, and was highest with liposomal, or deoxycholate formulations. Mortality was higher in immunocompromised patients, and patients 54 years of age, or older. Six percent of patients relapsed, all of whom had the acquired immunodeficiency syndrome (AIDS), and were poorly adherent with treatment.While CNS histoplasmosis occurred most often in immunocompromised individuals, a significant proportion of patients were previously, healthy. The diagnosis can be established by antigen, and antibody testing of the CSF, and serum, and antigen testing of the urine in most patients. Treatment with liposomal amphotericin B (AMB-L) for at least 1 month; followed by itraconazole for at least 1 year, results in survival among the majority of individuals. Patients should be followed for relapse for at least 1 year, after stopping therapy.
Castro-Sesquen, Yagahira E.; Gilman, Robert H.; Mejia, Carolina; Clark, Daniel E.; Choi, Jeong; Reimer-McAtee, Melissa J.; Castro, Rosario; Valencia-Ayala, Edward; Flores, Jorge; Bowman, Natalie; Castillo-Neyra, Ricardo; Torrico, Faustino; Liotta, Lance; Bern, Caryn; Luchini, Alessandra
Background Early diagnosis of reactivated Chagas disease in HIV patients could be lifesaving. In Latin America, the diagnosis is made by microscopical detection of the T. cruzi parasite in the blood; a diagnostic test that lacks sensitivity. This study evaluates if levels of T. cruzi antigens in urine, determined by Chunap (Chagas urine nanoparticle test), are correlated with parasitemia levels in T. cruzi/HIV co-infected patients. Methodology/Principal Findings T. cruzi antigens in urine of HIV patients (N = 55: 31 T. cruzi infected and 24 T. cruzi serology negative) were concentrated using hydrogel particles and quantified by Western Blot and a calibration curve. Reactivation of Chagas disease was defined by the observation of parasites in blood by microscopy. Parasitemia levels in patients with serology positive for Chagas disease were classified as follows: High parasitemia or reactivation of Chagas disease (detectable parasitemia by microscopy), moderate parasitemia (undetectable by microscopy but detectable by qPCR), and negative parasitemia (undetectable by microscopy and qPCR). The percentage of positive results detected by Chunap was: 100% (7/7) in cases of reactivation, 91.7% (11/12) in cases of moderate parasitemia, and 41.7% (5/12) in cases of negative parasitemia. Chunap specificity was found to be 91.7%. Linear regression analysis demonstrated a direct relationship between parasitemia levels and urine T. cruzi antigen concentrations (p 105 pg was chosen to determine patients with reactivation of Chagas disease (7/7). Antigenuria levels were 36.08 times (95% CI: 7.28 to 64.88) higher in patients with CD4+ lymphocyte counts below 200/mL (p = 0.016). No significant differences were found in HIV loads and CD8+ lymphocyte counts. Conclusion Chunap shows potential for early detection of Chagas reactivation. With appropriate adaptation, this diagnostic test can be used to monitor Chagas disease status in T. cruzi/HIV co-infected patients. PMID:26919324
Full Text Available It is not known whether rainfall increases the risk of sporadic cases of Legionella pneumonia. We sought to test this hypothesis in a prospective observational cohort study of non-immunosuppressed adults hospitalized for community-acquired pneumonia (1995-2011. Cases with Legionella pneumonia were compared with those with non-Legionella pneumonia. Using daily rainfall data obtained from the regional meteorological service we examined patterns of rainfall over the days prior to admission in each study group. Of 4168 patients, 231 (5.5% had Legionella pneumonia. The diagnosis was based on one or more of the following: sputum (41 cases, antigenuria (206 and serology (98. Daily rainfall average was 0.556 liters/m(2 in the Legionella pneumonia group vs. 0.328 liters/m(2 for non-Legionella pneumonia cases (p = 0.04. A ROC curve was plotted to compare the incidence of Legionella pneumonia and the weighted median rainfall. The cut-off point was 0.42 (AUC 0.54. Patients who were admitted to hospital with a prior weighted median rainfall higher than 0.42 were more likely to have Legionella pneumonia (OR 1.35; 95% CI 1.02-1.78; p = .03. Spearman Rho correlations revealed a relationship between Legionella pneumonia and rainfall average during each two-week reporting period (0.14; p = 0.003. No relationship was found between rainfall average and non-Legionella pneumonia cases (-0.06; p = 0.24. As a conclusion, rainfall is a significant risk factor for sporadic Legionella pneumonia. Physicians should carefully consider Legionella pneumonia when selecting diagnostic tests and antimicrobial therapy for patients presenting with CAP after periods of rainfall.
Essig, Andreas; von Baum, Heike; Gonser, Theodor; Haerter, Georg; Lück, Christian
An explosive outbreak of Legionnaires' disease with 64 reported cases occurred in Ulm/Neu-Ulm in the South of Germany in December 2009/January 2010 caused by Legionella (L.) pneumophila serogroup 1, monoclonal (mAb) subtype Knoxville, sequence type (ST) 62. Here we present the clinical microbiological results from 51 patients who were diagnosed at the University hospital of Ulm, the results of the environmental investigations and of molecular typing of patients and environmental strains. All 50 patients from whom urine specimens were available were positive for L. pneumophila antigen when an enzyme-linked immunosorbent assay (EIA) was used following concentration of those urine samples that tested initially negative. The sensitivity of the BinaxNow rapid immunographic assay (ICA), after 15 min reading and after 60 min reading were 70% and 84%, respectively. Direct typing confirmed the monoclonal subtype Knoxville in 5 out of 8 concentrated urine samples. Real time PCR testing of respiratory tract specimens for L. pneumophila was positive in 15 out of 25 (60%) patients. Direct nested sequence based typing (nSBT) in some of these samples allowed partial confirmation of ST62. L. pneumophila serogroup 1, monoclonal subtype Knoxville ST62, defined as the epidemic strain was isolated from 8 out of 31 outbreak patients (26%) and from one cooling tower confirming it as the most likely source of the outbreak. While rapid detection of Legionella antigenuria was crucial for the recognition and management of the outbreak, culture and molecular typing of the strains from patients and environmental specimens was the clue for the rapid identification of the source of infection. Copyright © 2016 Elsevier GmbH. All rights reserved.
Takeuchi, M; Hamana, K; Hiraishi, A
Phylogenetic analyses of 16S rRNA gene sequences by distance matrix and parsimony methods indicated that the currently known species of the genus Sphingomonas can be divided into four clusters. Some chemotaxonomic and phenotypic differences were noted among these clusters. Three new genera, Sphingobium, Novosphingobium and Sphingopyxis, are proposed in addition to the genus Sphingomonas sensu stricto. The genus Sphingobium is proposed to accommodate Sphingomonas chlorophenolica, Sphingomonas herbicidovorans and Sphingomonas yanoikuyae. The genus Novosphingobium is proposed for Sphingomonas aromaticivorans, Sphingomonas capsulata, Sphingomonas rosa, Sphingomonas stygia, Sphingomonas subarctica and Sphingomonas subterranea. Sphingomonas macrogoltabidus and Sphingomonas terrae are reclassified in the genus Sphingopyxis. The type species of Sphingobium, Novosphingobium and Sphingopyxis are Sphingobium yanoikuyae, Novosphingobium capsulatum and Sphingopyxis macrogoltabida, respectively.
Wootton, Susan H; Aguilera, Elizabeth; Salazar, Lucrecia; Hemmert, Andrew C; Hasbun, Rodrigo
Meningitis with a negative cerebrospinal (CSF) Gram stain represents a diagnostic and therapeutic challenge. The purpose of our study was to evaluate the performance of the BioFire FilmArray(®) Meningitis/Encephalitis (FA ME) panel in patients presenting with community-acquired meningitis with a negative Gram stain. CSF from 48 patients with community-acquired meningitis with a negative Gram stain admitted to four hospitals in Houston, TX underwent additional testing by the FA ME. FA ME results were compared to results obtained as part of routine evaluation. The panel detected pathogens not previously identified in 11 (22.9 %) of 48, but did not detect pathogens identified by standard technique (West Nile virus, Histoplasma) in 5 (15.2 %) patients. Rapid testing for the most common pathogens causing meningitis will aid in the diagnosis and treatment of patients with meningitis.
Vanzzini Zago, Virginia; Alcantara Castro, Marino; Naranjo Tackman, Ramon
This is a retrospective, and descriptive study about the support that the laboratory of microbiology aids can provide in the diagnosis of ocular infections in patients whom were attended a tertiary-care hospital in México City in a 10-year-time period. We describe the microbiological diagnosis in palpebral mycose; in keratitis caused by Fusarium, Aspergillus, Candida, and melanized fungi; endophthalmitis; one Histoplasma scleritis and one mucormycosis. Nowadays, ocular fungal infections are more often diagnosed, because there is more clinical suspicion and there are easy laboratory confirmations. Correct diagnosis is important because an early medical treatment gives a better prognosis for visual acuity. In some cases, fungal infections are misdiagnosed and the antifungal treatment is delayed. PMID:22518339
Leishmaniosis laríngea recidivante: un caso inusual en un paciente inmunocompetente tratado con corticoides Recidivant laryngeal leishmaniosis: an unusual case in an immunocompetent patient treated with corticosteroids
Full Text Available La leishmaniosis es una parasitosis de evolución crónica; en Argentina, sus agentes etiológicos principales pertenecen al complejo Leishmania (Viannia braziliensis, habitualmente asociado a lesiones cutáneas y mucocutáneas. Informamos en este trabajo un caso de leishmaniosis laríngea en un hombre de 29 años procedente de Jujuy, quien a raíz de múltiples subdiagnósticos portaba esta parasitosis desde hacía 20 años. En el año 2008 este paciente consulta por disfonía crónica y trastornos en las vías aéreas superiores, refiere que fue sometido a terapias con tuberculostáticos, antifúngicos y corticoides desde 2002. Diferentes biopsias y fibroscopías revelaron los siguientes diagnósticos: laringitis granulomatosa inespecífica, laringitis compatible con tuberculosis, laringitis compatible con histoplasmosis, linfoma Natural Killer extraganglionar a células pequeñas. Finalmente, estudios realizados en nuestro hospital demostraron la presencia de una laringe granulomatosa en toda su extensión, amastigotes intra y extracelulares de Leishmania spp., ausencia de formas compatibles con Micobacterias e Histoplasma, y laringitis crónica vinculable a Leishmania spp. El paciente realizó tratamiento con antimoniato de N-metil-glucamina y demostró una muy buena evolución clínica tras ser examinado 2 meses después. Si bien la leishmaniosis laríngea como lesión única no es la presentación prevalente de esta zoonosis, su estudio amerita especial atención en pacientes tratados con corticoides, pues esto evitará un diagnóstico tardío y las mayores consecuencias asociadas a la morbimortalidad propia de esta parasitosis.Leishmaniosis is a chronic parasitic disease, which in Argentina is mainly caused by protozoa belonging to the Leishmania (Viannia braziliensis complex, leading to cutaneous and mucosal pathologies. We report a rare case of laryngeal leishmaniosis in a 29 year-old man from Jujuy province, Argentina, who had been
Full Text Available En 1955 se realizó una encuesta entre 696 escolares de las zonas, urbana y rural de Tingo María para investigar la reacción histoplasmínica y tuberculínica en este grupo, con el objeto de conocer el grado de sensibilidad a la histoplasmina que pudiera existir en dicha área. Los resultados obtenidos han sido los siguientes: 1.- El 41.9 por ciento de escolares de la zona de Tingo María. han presentado positividad a la intradermo reacción a la histoplasmina. 2.- Entre el grupo que presentó reacción positiva a la histoplasmina, el 51.7 por ciento mostraron ser negativos a la tuberculina, la que constituye el 21.7 por ciento del total de niños. 3.- La proporción de niños sensibles a la histoplasmina está distribuída uniformemente en toda el área de Tingo María tanto urbana como rural. 4.- El tiempo de residencia en la zona ha demostrado influir en la positividad de la reacción histoplasmínica; esto es, que conforme se prolonga el tiempo de residencia, aumenta la proporción de niños histoplasmino positivos. 5.- Los escolares procedentes de los departamentos de San Martín y Huánuco (excluida la zona de Tingo María han mostrado tener los más altos porcentajes de positividad a la prueba. Hechos los cálculos estadísticos se concluye que estas dos áreas podrían ser también zonas contaminadas por el H. capsulatum. 6. No se ha demostrado en esta encuesta que la "Cueva de las Lechuzas" tenga una influencia mayor que el resto del área de Tingo María para adquirir la sensibilidad a la histoplasmina. Se sugiere realizar posteriores estudios que determinen hasta qué punto la mencionada cueva tiene valor como factor predominante en la epidemiología de la reacción a la histoplasmina. 7. Toda la zona cubierta por la encuesta parece estar contaminada por el H. capsulatum.
Full Text Available Neste trabalho são relatadas pesquisas parasitológicas e epiâemiológicas realizadas numa provável fonte de infecção de Histoplasmose da área rural do D. F. - Brasília, onde 14 pessoas contraíram a doença. Os estudos clínico, imunológico e radiológico foram anteriormente descritos. Os autores conseguiram isolar o H. capsulatum do solo da caverna e das vísceras e do sangue de morcegos (Phyllostomus hastatus hastatus, Pallas 1767 que nela habitavam. Resultaram negativas as tentativas de isolamento do fungo de animais sentinelas (cobaios, assim como não se obteve neles a viragem dos testes intradérmicos com histoplasmina. Em impressões de vísceras dos morcegos, constataram-se formas semelhantes as do T. gondii que posteriormente foram isoladas, em camundongos jovens, por inoculação de vísceras maceradas e sangue. Foram encontrados 2 ectoparasitos nos morcegos: Boophilus microplus e um díptero da família Streblidae. O ácaro albergava tripomastigotos do tipo cruzi, não sendo porém conseguido seu isolamento. No tubo digestivo dos quirópteros, foram retirados nematódeos (Histiostrongylus octaeantus e cestódeos do gênero Mathevotaenia. Foram capturados, em torno da entrada da caverna, 2 exemplares de Cercomys cunicularis apereoide não sendo examinados sob o ponto de vista parasitológico. Testes intradérmicos realizados em 826 habitantes da área resultaram positivos em 184 (22,27%. A gruta, fonte da infecção, está localizada em uma formação calcárea, pertencente à série Bambuí, acreditando-se, pelos aspectos tectônicos, ser da idade siluriana. No Brasil, o isolamento de H. capsulatum de solo, guanos de morcegos e vísceras de roedores já tinham sido realizados; contudo, esta foi a primeira vez que se conseguiu isolá-lo do solo de uma caverna, fonte de infecção, e das vísceras e sangue de morcegos. Os resultados obtidos com os testes intradérmicos com histoplasmina demonstraram a prevalência de
Full Text Available Background: All around the world exist more than thousand species of bats. In spite of some advantageous characteristics, mostly recognised in several insectivorous species, bats can transmit different kinds of microorganisms – the causes of infectious diseases. Microbial agents, recognised in connection with bats are: lyssavirus, Nipah virus, Hystoplasma capsulatum fungus, etc. In Europe there live about 28 species of bats. The most cases of European bat lyssaviruses (EBL1 and EBL2 were demonstrated in the Eptesicus serotinus species placed in Slovenia as well. We are presenting available data on rabies prevention. The rate of post-exposure treatment against rabies after the bite of bats in Slovenia is below 1% and is comparable with the remainder of Europe.Conclusions: In most European countries, including Slovenia, the bats are included in the lists of animal species protected by the law. In spite of that, the programs of investigations of bats, including the recognition and prevention of diseases transmitted by bats are implemented. We believe that such program should be prepared in Slovenia as well. We propose for that purposes the establishment of co-operation between the medical institutions, veterinarians, cave explorers associations, societies for bat protections and other interested institutions.
Gürkök, Sümeyra; Görmez, Arzu
Chitin, a linear polymer of β-1,4-N-acetylglucosamine units, is one of the most abundant biopolymers widely distributed in the marine and terrestrial environments. It is found as a structural component of insects, crustaceans and the cell walls of fungi. Chitinases, the enzymes degrading chitin by cleaving the β-(1-4) bond, have gained increased attention due to their wide range of biotechnological applications, especially for biocontrol of harmful insects and phytopathogenic fungi in agriculture. In the present study, 200 bacterial isolates from Western Anatolia Region of Turkey were screened for chitinolytic activity on agar media amended with colloidal chitin. Based on the chitin hydrolysis zone, 13 isolates were selected for further study. Bacterial isolates with the highest chitinase activity were identified as Acinetobacter calcoaceticus, Arthrobacter oxydans, Bacillus cereus, Bacillus megaterium, Brevibacillus reuszeri, Kocuria erythromyxa, Kocuria rosea, Novosphingobium capsulatum, Rhodococcus bratislaviensis, Rhodococcus fascians and Staphylococcus cohnii by MIS and BIOLOG systems. The next aims of the study are to compare the productivity of these bacteria quantitatively, to purify the enzyme from the most potent producer and to apply the pure enzyme for the fight against the phytopathogenic fungi and harmful insects.
Angela Noronha Passos
Full Text Available Several reports showed outbreaks of histoplasmosis acquired while bat-inhabited caves were visited by tourists, miners or researchers. We evaluated the performance of double immunodifusion (DI and immunoblotting (IB assays, employed for the histoplasmosis outbreak elucidation occurred in Vale do Paraíba, São Paulo. The existence of epidemiologic link, four patients with clinical signs suggestive of histoplasmosis and mycological confirmation has made that all 35 individuals involved to the cave visit were subjected to serological evaluation. By DI, we observed reactivity against H. capsulatum antigen in a single serum examined nearly 20 days after exposure to fungal propagules. On the other hand, IB showed reactivity against H and M fractions in 50% of samples evaluated. The analysis of the second sample batch, collected two months after the exposure showed that 96.7% were reactive by DI with antibodies titers ranging from 1 to 16 and 100% of reactivity against H and M fractions, by IB, suggesting an acute infection. The analysis of the overall agreement between the methods showed to be reasonable (κ = 0.37. This study confirms the importance and efficacy of more sensitive methodologies, such as IB assay, to early elucidation of disease, especially in cases of patients without mycological information.
Sang, Mee Kyung; Shrestha, Anupama; Kim, Du-Yeon; Park, Kyungseok; Pak, Chun Ho; Kim, Ki Deok
We previously developed a sequential screening procedure to select antagonistic bacterial strains against Phytophthora capsici in pepper plants. In this study, we used a modified screening procedure to select effective biocontrol strains against P. capsici; we evaluated the effect of selected strains on Phytophthora blight and anthracnose occurrence and fruit yield in pepper plants under field and plastic house conditions from 2007 to 2009. We selected four potential biocontrol strains (Pseudomonas otitidis YJR27, P. putida YJR92, Tsukamurella tyrosinosolvens YJR102, and Novosphingobium capsulatum YJR107) among 239 bacterial strains. In the 3-year field tests, all the selected strains significantly (P anthracnose incidence in at least one of the test years, but their biocontrol activities were variable. In addition, strains YJR27, YJR92, and YJR102, in certain harvests, increased pepper fruit numbers in field tests and red fruit weights in plastic house tests. Taken together, these results indicate that the screening procedure is rapid and reliable for the selection of potential biocontrol strains against P. capsici in pepper plants. In addition, these selected strains exhibited biocontrol activities against anthracnose, and some of the strains showed plant growth-promotion activities on pepper fruit.
Mohd Shawal Thakib Maidin; Sakinah Safari; Nur Aziemah Ghani; Sharifah Azura Syed Ibrahim; Shamsilawani Ahamed Bakeri; Mohamed Mazmira Mohd Masri; Siti Ramlah Ahmad Ali
Peat land has an important role in environmental sustainability which can be used for agricultural purposes. However, deforestation in the logged-over forest may disrupt the diversity of microbial population in peat soil. Therefore, this study focuses on the differences of microbial populations in Maludam primary forest and Cermat Ceria logged-over forest in Sarawak, Malaysia. The prokaryotic 16S rDNA region was amplified followed by denaturing gradient gel electrophoresis (16S PCR-DGGE) analysis. Berger-Parker and Shannon-Weaver Biodiversity Index showed that Maludam (0.11, 7.75) was more diverse compared to Cermat Ceria (0.19, 7.63). Sequence analysis showed that the bacterial community in Maludam and Cermat Ceria were dominated by unclassified bacteria, followed by Acidobacteria, Actinobacteria, Firmicutes and a-Proteobacteria. Based on the findings, the distinct species that can be found in Maludam were Acidobacterium capsulatum, Solibacter sp., Mycobacterium intracellulare, Rhodoplanes sp., Clostridia bacterium, Exiguobacterium sp. and Lysinibacillus fusiformis. While, the distinct species that can be found in Cermat Ceria were Telmatobacter, Mycobacterium tuberculosis and Bacillus tequilensis. Overall, the findings showed that microbial population in the logged-over forest are less diverse compared to primary forest. Higher prokaryotic diversity identified in the primary forest compared to logged-over forest showed that deforestation might cause prokaryotic population changes to both ecosystems. (author)
Köhler, Julia R; Hube, Bernhard; Puccia, Rosana; Casadevall, Arturo; Perfect, John R
Fungi must meet four criteria to infect humans: growth at human body temperatures, circumvention or penetration of surface barriers, lysis and absorption of tissue, and resistance to immune defenses, including elevated body temperatures. Morphogenesis between small round, detachable cells and long, connected cells is the mechanism by which fungi solve problems of locomotion around or through host barriers. Secretion of lytic enzymes, and uptake systems for the released nutrients, are necessary if a fungus is to nutritionally utilize human tissue. Last, the potent human immune system evolved in the interaction with potential fungal pathogens, so few fungi meet all four conditions for a healthy human host. Paradoxically, the advances of modern medicine have made millions of people newly susceptible to fungal infections by disrupting immune defenses. This article explores how different members of four fungal phyla use different strategies to fulfill the four criteria to infect humans: the Entomophthorales, the Mucorales, the Ascomycota, and the Basidiomycota. Unique traits confer human pathogenic potential on various important members of these phyla: pathogenic Onygenales comprising thermal dimorphs such as Histoplasma and Coccidioides ; the Cryptococcus spp. that infect immunocompromised as well as healthy humans; and important pathogens of immunocompromised patients- Candida , Pneumocystis , and Aspergillus spp. Also discussed are agents of neglected tropical diseases important in global health such as mycetoma and paracoccidiomycosis and common pathogens rarely implicated in serious illness such as dermatophytes. Commensalism is considered, as well as parasitism, in shaping genomes and physiological systems of hosts and fungi during evolution.
Li, Qiang; Zhao, Jian; Xiong, Chuan; Li, Xiaolin; Chen, Zuqin; Li, Ping; Huang, Wenli
The aim of this study was to investigate the effect of an ectomycorrhizal fungus (Tuber indicum) on the diversity of microbial communities associated with an indigenous tree, Pinus armandii, and the microbial communities in the surrounding ectomycorhizosphere soil. High-throughput sequencing was used to analyze the richness of microbial communities in the roots or rhizosphere of treatments with or without ectomycorrhizae. The results indicated that the bacterial diversity of ectomycorhizosphere soil was significantly lower compared with the control soil. Presumably, the dominance of truffle mycelia in ectomycorhizosphere soil (80.91%) and ectomycorrhizae (97.64%) was the main factor that resulted in lower diversity and abundance of endophytic pathogenic fungi, including Fusarium, Monographella, Ustilago and Rhizopus and other competitive mycorrhizal fungi, such as Amanita, Lactarius and Boletus. Bacterial genera Reyranena, Rhizomicrobium, Nordella, Pseudomonas and fungal genera, Cuphophyllus, Leucangium, Histoplasma were significantly more abundant in ectomycorrhizosphere soil and ectomycorrhizae. Hierarchical cluster analysis of the similarities between rhizosphere and ectomycorrhizosphere soil based on the soil properties differed significantly, indicating the mycorrhizal synthesis may have a feedback effect on soil properties. Meanwhile, some soil properties were significantly correlated with bacterial and fungal diversity in the rhizosphere or root tips. Overall, this work illustrates the interactive network that exists among ectomycorrhizal fungi, soil properties and microbial communities associated with the host plant and furthers our understanding of the ecology and cultivation of T. indicum. PMID:28410376
Full Text Available The aim of this study was to investigate the effect of an ectomycorrhizal fungus (Tuber indicum on the diversity of microbial communities associated with an indigenous tree, Pinus armandii, and the microbial communities in the surrounding ectomycorhizosphere soil. High-throughput sequencing was used to analyze the richness of microbial communities in the roots or rhizosphere of treatments with or without ectomycorrhizae. The results indicated that the bacterial diversity of ectomycorhizosphere soil was significantly lower compared with the control soil. Presumably, the dominance of truffle mycelia in ectomycorhizosphere soil (80.91% and ectomycorrhizae (97.64% was the main factor that resulted in lower diversity and abundance of endophytic pathogenic fungi, including Fusarium, Monographella, Ustilago and Rhizopus and other competitive mycorrhizal fungi, such as Amanita, Lactarius and Boletus. Bacterial genera Reyranena, Rhizomicrobium, Nordella, Pseudomonas and fungal genera, Cuphophyllus, Leucangium, Histoplasma were significantly more abundant in ectomycorrhizosphere soil and ectomycorrhizae. Hierarchical cluster analysis of the similarities between rhizosphere and ectomycorrhizosphere soil based on the soil properties differed significantly, indicating the mycorrhizal synthesis may have a feedback effect on soil properties. Meanwhile, some soil properties were significantly correlated with bacterial and fungal diversity in the rhizosphere or root tips. Overall, this work illustrates the interactive network that exists among ectomycorrhizal fungi, soil properties and microbial communities associated with the host plant and furthers our understanding of the ecology and cultivation of T. indicum.
Desai, Harsha B; Perkins, Philip L; Procop, Gary W
A 67-year-old man, with multiple skin lesions that appeared over 2 years, had biopsies that disclosed granulomatous dermatitis with associated small yeasts. The urinary antigen test results were negative for Histoplasma infection; cultures from the biopsies did not grow any fungi or other potential pathogens. The chest roentgenogram results were normal. Morphologic examination revealed features of a Malassezia species. Broad-range fungal polymerase chain reaction and DNA sequencing disclosed that the infecting fungus was Malassezia sympodialis , a lipid-dependent yeast. This report supports one other case report that Malassezia species may cause granulomatous dermatitis; in the previous case, the etiologic agent was Malassezia pachydermatis , a nonlipid-dependent species. We recommend the use of lipid-supplemented culture media for specimens from patients with granulomatous dermatitis because several Malassezia species are dependent on lipid; the absence of lipid supplementation in routine cultures likely explains the negative culture results for this patient. This, to our knowledge, is the first report of granulomatous dermatitis caused by M sympodialis.
Heckmann, M.; Uder, M.; Bautz, W.; Heinrich, M. [Erlangen-Nuernberg Univ., Erlangen (Germany). Inst. fuer Diagnostische Radiologie
The importance of fungal infection of the lung in immunocompromised patients has increased substantially during the last decades. Numerically the most patients are those with neutropenia, e.g. patients with malignancies or solid organ and stem cell transplantation, chemotherapy, corticosteroid use and HIV infection. Although fungal infections can occur in immunocompetent patients, their frequency in this population is rare. The clinical symptoms such as fever accompanied with non-productive cough are unspecific. In some patients progression to hypoxemia and dyspnea may occur rapidly. In spite of improved antifungal therapy morbidity and mortality of these infections are still high. Therefore an early and non-invasive diagnosis is very important. That is why CT and even better High-Resolution-CT (HR-CT) is a very important modality in examining immunocompromised patients with a probability of fungal infection. CT is everywhere available and, as a non-invasive method, able to give the relevant diagnose efficiently. This paper should give an overview about the radiologic findings and possible differential diagnosis of diverse pulmonary fungal infections in CT. Pneumonias caused by Aspergillus, Cryptococcus, Candida, Histoplasma, Mucor and Geotrichum capitatum are illustrated. (orig.)
Heckmann, M.; Uder, M.; Bautz, W.; Heinrich, M.
The importance of fungal infection of the lung in immunocompromised patients has increased substantially during the last decades. Numerically the most patients are those with neutropenia, e.g. patients with malignancies or solid organ and stem cell transplantation, chemotherapy, corticosteroid use and HIV infection. Although fungal infections can occur in immunocompetent patients, their frequency in this population is rare. The clinical symptoms such as fever accompanied with non-productive cough are unspecific. In some patients progression to hypoxemia and dyspnea may occur rapidly. In spite of improved antifungal therapy morbidity and mortality of these infections are still high. Therefore an early and non-invasive diagnosis is very important. That is why CT and even better High-Resolution-CT (HR-CT) is a very important modality in examining immunocompromised patients with a probability of fungal infection. CT is everywhere available and, as a non-invasive method, able to give the relevant diagnose efficiently. This paper should give an overview about the radiologic findings and possible differential diagnosis of diverse pulmonary fungal infections in CT. Pneumonias caused by Aspergillus, Cryptococcus, Candida, Histoplasma, Mucor and Geotrichum capitatum are illustrated. (orig.)
Riza Zainuddin Ahmad
Full Text Available Selakarang is a fungal disease attacking horses. Although the mortality rate is low, the morbidity is high leading to economic loss. The island of Sulawesi has about 151.000 horses and they are distributed in 5 provinces: North, Central, West, South, and South-East Sulawesi which potentially has endemic outbreaks caused by the Selakarang fungus, Histoplasma farciminosum. The disease might be endemic throughout Indonesia if the horse trading is not monitored. In Maros, South Sulawesi, the disease is found with symptoms in the form of nasal, cutan, and ocular symptoms. Ignorance of the appropriate authorities will increase the likelihood of spread of the disease. According to the Staatblad act produced in 1912 and the disease belonged to the zoonotic disease and when it is not well handled and properly managed, infection to human may occur. Prevention is better than treatment. In the future, we may propose to produce inactive vaccines and develop serological test to detect antigen and antibody in RIVS collaborating with other government agencies or private parties interested in this disease control.
Full Text Available Durante 5 años se estudiaron 117 pacientes con micosis sistémicas asociadas al SIDA: 74 criptococosis, 39 histoplasmosis y 4 con ambas enfermedades. Para el diagnóstico analizamos los siguientes materiales: escarificaciones de lesiones cutáneas o mucosas, aspirados de médula ósea, secreciones bronquiales, biopsias de diversos órganos, líquido cefalorraquídeo, hemocultivos y sueros para determinaciones serológicas. Fueron estudiadas en total 203 muestras de pacientes con histoplasmosis, el 46.3% de las mismas acusó la presencia de H. capsulatum. Las escarificaciones cutáneas exhibieron la mayor sensibilidad (94.7%, seguidas por las biopsias (80% y los mielocultivos (42.1%. La demostración de anticuerpos circulantes por medio de 3 pruebas serológicas y con de 2 antígenos específicos dio resultados positivos en el 45.4% de los pacientes. Se estudiaron en total 413 especímenes de pacientes con criptococosis, la confirmación diagnóstica fue posible en el 69% de las muestras. El mayor rendimiento se obtuvo con el LCR (89.5%, le seguieron en sensibilidad los hemocultivos (61.2%, las escarificaciones cutáneas (42.9% y los urocultivos (41.7%. La búsqueda de antígeno en los fluidos orgánicos fue positiva en casi todos los casos. La revisión que presentamos permitirá una búsqueda más racional y rápida de los métodos de diagnóstico en las micosis asociadas al SIDA.One hundred and seventeen patients suffering systemic mycosis and AIDS were studied during 5 years in the Muñiz Hospital of Buenos Aires City. Seventy four of them presented cryptococcosis, 39 histoplasmosis and 4 both mycoses. The following specimens were studied for the diagnosis: skin and mucous membrane scrapings, bone marrow aspirations, bronchial secretions, biopsies of different organs, cerebral spinal fluid and blood cultures. Sera were also collected for serologic tests. A total of 203 samples from patients with histoplasmosis were studied, 46.3% of them
Fabíola Maria Marques do Couto
Full Text Available INTRODUCTION: Fungemia corresponds to the isolation of fungi in the bloodstream and occurs mostly in immunosuppressed patients. The early diagnosis and treatment of these infections are relevant given the serious threat to the affected patients and possible spread to other organs, often becoming fatal. The growing number of fungemia associated with poor prognosis resulted in this research aiming to diagnose and assess the epidemiological aspects of hematogenous infections by fungi. METHODS: The study included 58 blood samples collected within a 1-year period, from patients at the Hospital das Clinicas, Federal University of Pernambuco, by venipuncture in vacuum tubes. Blood samples were processed for direct examination and culture and identification, conducted by observing the macroscopic and microscopic characteristics, as well as physiological characteristics when necessary. RESULTS: Eight (13.8% episodes of fungemia were identified, accounting for the total sample, and these pathogens were Candida, Histoplasma, Trichosporon, Cryptococcus, and a dematiaceous fungus. C. albicans was the prevalent species, accounting for 37.5% of the cases. Most affected patients were adult males. There was no predominance for any activity, and the risk of acquired immunodeficiency syndrome was the underlying pathology most often cited. CONCLUSIONS: The isolation of fungi considered as emergent species, such as C. membranifaciens and dematiaceous species, highlights the importance of epidemiological monitoring of cases of fungemia in immunocompromised patients, as the therapy of choice depends on the knowledge of the aethiological agent.INTRODUÇÃO: Fungemia corresponde ao isolamento de fungos na corrente sanguínea e ocorre, sobretudo, em pacientes imunossuprimidos. O diagnóstico e tratamento precoce destas infecções são relevantes diante da grave ameaça aos pacientes acometidos e possível disseminação via hematogênica para outros órgãos, tornando
Laguna-Torres Victor Alberto
Full Text Available As alterações anatomopatológicas renais foram estudadas em 119 casos de indivíduos com a síndrome da imunodeficiência humana adquirida (SIDA no Hospital Escola da Faculdade de Medicina do Triângulo Mineiro, Uberaba MG. A partir das amostras de rim fixadas em formol, foram confeccionadas lâminas e analisadas ao microscópio de luz. Dos 119 casos estudados, 67 tiveram diagnóstico de nefrite túbulo intersticial (NTI, sendo 18 inespecíficas, 2 xantogranulomatosas e encontrou-se agente infeccioso em 48: fungos em 28 (16 Cryptococcus sp, 9 Histoplasma sp, 1 Candida sp e 2 Paracoccidioides brasiliensis; bactérias em 18 (9 Mycobacterium sp; vírus em 6, Citomegalovírus. Em 43 havia necrose tubular aguda (NTA. Outros diagnósticos foram: nefrocalcinose (15,1% e hialinose arteriolar (22,7%. Encontrou-se também 2 casos com glomeruloesclerose segmentar focal (GESF e um caso de hiperplasia mesangial difusa. Houve predomínio da NTI, que pode ser devido às infecções oportunistas, predominando as fúngicas; a toxicidade por drogas ou ainda devido a possível ação direta do próprio vírus. A necrose tubular aguda (NTA, foi a segunda causa em freqüência, de acometimento renal da amostra. Concluiu-se que o envolvimento renal nos pacientes com SIDA apresenta um espectro variado de processos patológicos, principalmente relacionados com infecções oportunistas, o tratamento e os procedimentos para diagnósticos, e ainda as nefropatias associadas ao vírus da imunodeficiência humana (VIH.
Full Text Available Fibrosing mediastinitis (FM and IgG4-related disease (IgG4-RD are two fibroinflammatory disorders with potentially overlapping clinical and radiological features. In this paper, we looked for histopathologic features of IgG4-RD and enumerated infiltrating IgG4-positive plasma cells within mediastinal tissue biopsies from FM patients. We identified 15 consecutive FM surgical mediastinal tissue biopsies between 1985 and 2006. All patients satisfied the clinical and radiological diagnostic criteria for FM. All patients had either serological or radiological evidence of prior histoplasmosis or granulomatous disease, respectively. Formalin-fixed paraffin-embedded tissue sections of all patients were stained for H&E, IgG, and IgG4. Three samples met the predefined diagnostic criteria for IgG4-RD. In addition, characteristic histopathologic changes of IgG4-RD in the absence of diagnostic numbers of tissue infiltrating IgG4-positive plasma cells were seen in a number of additional cases (storiform cell-rich fibrosis in 11 cases, lymphoplasmacytic infiltrate in 7 cases, and obliterative phlebitis/arteritis in 2 cases. We conclude that up to one-third of histoplasmosis or granulomatous-disease-associated FM cases demonstrate histopathological features of IgG4-RD spectrum. Whether these changes occur as the host immune response against Histoplasma or represent a manifestation of IgG4-RD remains to be determined. Studies to prospectively identify these cases and evaluate their therapeutic responses to glucocorticoids and/or other immunosuppressive agents such as rituximab are warranted.
Duch Francisco Moretti
Full Text Available Na síndrome da imunodeficiência adquirida (AIDS pode-se verificar o acometimento da supra-renal por efeito citopático direto pelo HIV, por infecções oportunistas ou neoplasias. Estes achados poderiam variar de acordo com a procedência do paciente, devido às doenças peculiares à região. Neste trabalho avaliou-se o comprometimento da supra-renal em quatorze pacientes que morreram de AIDS no Hospital Escola, em Uberaba. Treze eram do sexo masculino e treze brancos. A idade foi de 29,9 ± 7,8 anos e o índice de massa corporal foi de 19 ± 4,1kg/m2. Os fragmentos de supra-renal obtidos nas necropsias foram analisados em microscópio de luz. Encontramos inflamação em 100% dos casos, identificando-se o agente etiológico em oito (58,1% casos. O Citomegalovírus foi identificado em sete casos, o Cryptococcus sp e o Herpes simplex em dois e o Histoplasma sp em um caso, estes achados são semelhantes aos da literatura. Em um caso, encontramos calcificação do parênquima e em outro, flebite da veia central. Em alguns casos que apresentavam lesão não foi possível identificar o agente etiológico, talvez em decorrência do efeito citopático direto pelo HIV ou devido a toxicidade das drogas utilizadas no tratamento da AIDS e das infecções oportunistas.
Labadie, Cécile; Ginies, Christian; Guinebretiere, Marie-Hélène; Renard, Catherine M G C; Cerutti, Céline; Carlin, Frédéric
Hydrosols are hydrodistillation products of aromatic plants. They contain less than 1g/L of dispersed essential oils giving organoleptic properties. Hydrosols are subjected to microbial proliferation. Reasons for spoilage have to be found in the nature of substrates supporting growth and of microbiological contaminants. The composition in essential oils and the microbiota of 22 hydrosol samples of Citrus aurantium L. ssp. amara L. (orange blossom), Rosa damascena Miller (rose D.), and Rosa centifolia L. (rose C.) flowers were analyzed to determine the factors responsible for decay. The median concentrations in essential oils were 677mg/L for orange blossom hydrosols, 205mg/L for rose D. hydrosols, and 116mg/L for rose C. hydrosols. The dry matter content of these hydrosols varied between 4.0mg/L and 702mg/L, and the carbohydrate content varied between 0.21mg/L and 0.38mg/L. These non-volatile compounds were likely carried over during distillation by a priming and foaming effect, and could be used as nutrients by microorganisms. A microbial proliferation at ambient temperature and also at 5°C has been observed in all studied hydrosols when stored in a non-sterile container. In contaminated hydrosols, maximal counts were about 7log 10 CFU/mL, while the French pharmacopeia recommends a maximal total bacterial count of 2log 10 CFU/mL. Neither yeast nor mold was detected. The isolated microbial population was composed of environmental Gram-negative bacteria, arranged in four major genera: Pseudomonas sp., Burkholderia cepacia complex, and presumably two new genera belonging to Acetobacteraceae and Rhodospirillaceae. Among those bacteria, Burkholderia vietnamiensis and Novosphingobium capsulatum were able to metabolize volatile compounds, such as geraniol to produce 6-methyl-5-hepten-2-one or geranic acid, or phenylethyl acetate to produce 2-phenylethanol. EO concentrations in hydrosols or cold storage are not sufficient to insure microbiological stability. Additional
Kulichevskaya, Irina S; Kostina, Lilia A; Valásková, Vendula; Rijpstra, W Irene C; Damsté, Jaap S Sinninghe; de Boer, Wietse; Dedysh, Svetlana N
Two strains of subdivision 1 Acidobacteria, a pink-pigmented bacterium KA1(T) and a colourless isolate WH120(T), were obtained from acidic Sphagnum peat and wood under decay by the white-rot fungus Hyploma fasciculare, respectively. Cells of these isolates were Gram-negative-staining, non-motile, short rods, which were covered by large polysaccharide capsules and occurred singly, in pairs, or in short chains. Strains KA1(T) and WH120(T) were strictly aerobic mesophiles that grew between 10 and 33 °C, with an optimum at 22-28 °C. Both isolates developed under acidic conditions, but strain WH120(T) was more acidophilic (pH growth range 3.5-6.4; optimum, 4.0-4.5) than strain KA1(T) (pH growth range 3.5-7.3; optimum , 5.0-5.5). The preferred growth substrates were sugars. In addition, the wood-derived isolate WH120(T) grew on oxalate, lactate and xylan, while the peat-inhabiting acidobacterium strain KA1(T) utilized galacturonate, glucuronate and pectin. The major fatty acids were iso-C(15:0) and iso-C(17:1)ω8c; the cells also contained significant amounts of 13,16-dimethyl octacosanedioic acid. The quinone was MK-8. The DNA G+C contents of strains KA1(T) and WH120(T) were 54.1 and 51.7 mol%, respectively. Strains KA1(T) and WH120(T) displayed 97.8% 16S rRNA gene sequence similarity to each other. The closest recognized relatives were Acidobacterium capsulatum and Telmatobacter bradus (93.4-94.3% 16S rRNA gene sequence similarity). These species differed from strains KA1(T) and WH120(T) by their ability to grow under anoxic conditions, the absence of capsules, presence of cell motility and differing fatty acid composition. Based on these differences, the two new isolates are proposed as representing a novel genus, Acidicapsa gen. nov., and two novel species. Acidicapsa borealis gen. nov., sp. nov. is the type species for the new genus with strain KA1(T) (=DSM 23886(T)=LMG 25897(T)=VKM B-2678(T)) as the type strain. The name Acidicapsa ligni sp. nov. is proposed for
Franco E. Montúfar-Andrade
Full Text Available Resumen Más de la mitad de los pacientes con infección por virus de inmunodeficiencia humana (VIH pueden tener compromiso pulmonar en el transcurso de su vida. Este puede ser multicausal y las infecciones oportunistas son las principales, sin embargo, las causas no infecciosas no son menos importantes. Objetivo: Describir las características del compromiso pulmonar en pacientes hospitalizados con infección por VIH. Metodología: Estudio descriptivo observacional. Resultados: Se incluyó a 63 pacientes, el 85,7% fueron hombres. La edad promedio fue 40,6 ± 12 años. El 21,4% tuvieron antecedente de promiscuidad sexual y 28,6% fueron hombres con sexo con hombres. Se identificó tabaquismo en 60,3%, alcoholismo en 52,4% y consumo de drogas en 20,6%. El 23,8% tuvo historia de tuberculosis. Al ingreso, el 79,4% tenía sida, el recuento promedio de CD4 fue 138,5 ± 17,7 células/mm3 y el 49,2% tenía CD4 < 100 células/mm3. Las principales comorbilidades fueron: enfermedad neoplásica 20,6%, diarrea crónica 19%, EPOC 6,3% y diabetes mellitus 3,2%. Los principales síntomas al ingreso fueron: respiratorios 66,7%, gastrointestinales 47,6% y neurológicos 34,9%. Los principales oportunistas documentados fueron Mycobacterium spp, H. capsulatum y P. jirovecii. El sarcoma de Kaposi, la enfermedad lifoproliferativa y la EPOC fueron causas de compromiso no infeccioso. Los principales hallazgos radiográficos fueron: infiltrados intersticiales (42,9%, compromiso pleural (23,8% y lesiones cavitarias (7,9%. El compromiso multilobar fue evidente en el 15,9%. Las principales complicaciones fueron falla respiratoria, disfunción orgánica múltiple y falla renal aguda. El 19% requirió ingreso a UCI y, de estos, el 83,3% necesitó ventilación mecánica. La estancia hospitalariapromedio fue de 18 ± 20 días y la mortalidad del 17,5%. Discusión: Las infecciones por oportunistas son las principales causas de compromiso pulmonar y, dentro de estas, las causadas
McCaig, A E.; Grayston, S J.; Prosser, J I.; Glover, L A.
The species composition of culturable bacteria in Scottish grassland soils was investigated using a combination of Biolog and 16S rDNA analysis for characterisation of isolates. The inclusion of a molecular approach allowed direct comparison of sequences from culturable bacteria with sequences obtained during analysis of DNA extracted directly from the same soil samples. Bacterial strains were isolated on Pseudomonas isolation agar (PIA), a selective medium, and on tryptone soya agar (TSA), a general laboratory medium. In total, 12 and 21 morphologically different bacterial cultures were isolated on PIA and TSA, respectively. Biolog and sequencing placed PIA isolates in the same taxonomic groups, the majority of cultures belonging to the Pseudomonas (sensu stricto) group. However, analysis of 16S rDNA sequences proved more efficient than Biolog for characterising TSA isolates due to limitations of the Microlog database for identifying environmental bacteria. In general, 16S rDNA sequences from TSA isolates showed high similarities to cultured species represented in sequence databases, although TSA-8 showed only 92.5% similarity to the nearest relative, Bacillus insolitus. In general, there was very little overlap between the culturable and uncultured bacterial communities, although two sequences, PIA-2 and TSA-13, showed >99% similarity to soil clones. A cloning step was included prior to sequence analysis of two isolates, TSA-5 and TSA-14, and analysis of several clones confirmed that these cultures comprised at least four and three sequence types, respectively. All isolate clones were most closely related to uncultured bacteria, with clone TSA-5.1 showing 99.8% similarity to a sequence amplified directly from the same soil sample. Interestingly, one clone, TSA-5.4, clustered within a novel group comprising only uncultured sequences. This group, which is associated with the novel, deep-branching Acidobacterium capsulatum lineage, also included clones isolated
Amr M.M. Abd-Elall
Full Text Available This study was conducted to determine the concentration and frequency distribution of certain airborne micro-organisms on cattle farms and their potential health hazards to farm workers. The samples (60 air samples and 240 hand and nasal swabs from cattle farm workers were collected from ten cattle farms (five dairy barns and five beef sheds located in the Sharkia Governorate of Egypt. Air samples were collected for microbiological examination in liquid media using an all-glass impinger whereas those for fungal examination were placed on agar plates using slit air samplers (aeroscopes. The results showed that the overall means of total culturable bacterial and fungal counts were lower in the air of dairy cattle barns than in beef cattle sheds. Identification of the isolated bacteria revealed the recovery of the following species (from dairy cattle barns versus beef cattle sheds: Staphylococcus epidermidis (26.7% vs 36.7%, S. saprophyticus (20% vs 33.3%, S. aureus (10% vs 16.7%, Enterococcus faecalis (23.3% vs 26.7%, Enterobacter agglomerans (23.3 vs 13.3%, Escherichia coli, (16.7% vs 26.7%, Klebsiella oxytoca, (10% vs 16.7%, K. pneumoniae (3.3% vs 0%, Proteus rettegri (6.7% vs 13.3%, P. mirabilis (10% vs 10%, P. vulgaris (3.3% vs 6.7%, Pseudomonas species (6.7% vs 16.7%, respectively. Mycological examination of air samples revealed the presence of Aspergillus fumigatus (46.7% vs 63.3%, A. niger (20% vs 36.7%, A. flavus (13.3% vs 26.7%, Penicillium citrinum (16.7% vs 23.3%, P. viridicatum (13.3% vs 6.7%, P. capsulatum (3.3% vs 0%, Cladosporium spp. (30% vs 56.7%, Alternaria spp. (13.3 vs 23.3%, Mucor spp. (6.7% vs 16.7%, Fusarium spp. (3.3% vs 10%, Absidia spp. (6.7% vs 10%, Curvilaria spp. (10% vs 3.3%, Rhizopus spp. (6.7% vs 13.3%, Scopulariopsis (3.3% vs 6.7%, Epicoccum spp. (0% vs 3.4% and yeast (13.3% vs 20%, respectively. In addition, microbiological examinations of farm workers revealed heavy contamination of their hands and noses with
Fibla, Juan J; Brunelli, Alessandro; Allen, Mark S; Wigle, Dennis; Shen, Robert; Nichols, Francis; Deschamps, Claude; Cassivi, Stephen D
In efforts to obtain complete results, current practice in surgical lung biopsy (LB) for interstitial lung disease (ILD) recommends sending lung tissue samples for bacterial, mycobacterial, fungal, and viral cultures. This study assesses the value of this practice by evaluating the microbiology findings obtained from LB for ILD and their associated costs. A total of 296 consecutive patients (140 women, 156 men, median age=61 years) underwent LB for ILD from 2002 to 2009. All had lung tissue sent for microbiology examination. Microbiology results and resultant changes in patient management were analyzed retrospectively. A cost analysis was performed based upon nominal hospital charges adjusted on current inflation rates. Cost data included cultures, stains, smears, direct fluorescent antibody studies, and microbiologist consulting fees. As many as 25 patients (8.4%) underwent open LB and 271 (91.6%) underwent thoracoscopic LB. A total of 592 specimens were assessed (range 1-4 per patient). The most common pathologic diagnoses were idiopathic pulmonary fibrosis in 122 (41.2%), cryptogenic organizing pneumonia in 31 (10.5%), and respiratory bronchiolitis ILD in 16 (5.4%). Microbiology testing was negative in 174 patients (58.8%). A total of 118 of 122 (96.7%) positive results were clinically considered to be contaminants and resulted in no change in clinical management. The most common contaminants were Propionibacterium acnes (38 patients; 31%) and Penicillium fungus (16 patients; 13%). In only four patients (1.4%), the organism cultured (Nocardia one, Histoplasma one, and Aspergillus fumigatus two) resulted in a change in clinical management. The cost of microbiology studies per specimen was $984 (€709), with a total cost for the study cohort being $582,000 (€420,000). The yield and impact on clinical management of microbiology specimens from LB for ILD is very low. Its routine use in LB is questionable. We suggest it should be limited to those cases of ILD with
Full Text Available OBJETIVOS: Descrever os aspectos clínicos, laboratoriais, radiológicos e anatomopatológicos encontrados em tecidos pulmonares de necrópsias de crianças com Aids e acometimento pulmonar. MÉTODOS: Foram revisados, retrospectivamente, prontuários, radiografias simples de tórax e laudos de necrópsias de 14 crianças com Aids e acometimento pulmonar. RESULTADOS: Oito casos eram do sexo masculino e seis do feminino. As idades variaram de três meses a nove anos, mediana de 1,2, sendo nove deles menores de dois anos. A transmissão foi vertical em 10 pacientes, dos quais cinco mães tinham história de contaminação por relação heterossexual; três, por hemotransfusão e em duas, ignorada. Pneumonia (n=8, candidíase oral (n=8 e diarréia (n=5 foram as doenças prévias mais referidas. Os sinais e sintomas observados à internação foram febre (n=12, dispnéia (n=10, tosse (n=11, linfoadenomegalia (n=11, hepato e/ou esplenomegalia (n=10, desnutrição (n=9, palidez (n=8, cianose (n=5 e baqueteamento digital (n=2. Os achados radiológicos mais comuns foram infiltrados difusos (n=6 e condensações (n=5. As alterações histológicas pulmonares foram compatíveis com pneumonia pelo citomegalovírus (n=9, por bactérias (n=8, por Pneumocystis carinii (n=3, por Hystoplasma capsulatum (n=1, por Toxoplasma gondii (n=1 e pneumonia intersticial linfocítica (n=1. A associação CMV e bactéria foi observada em seis casos. CONCLUSÕES: Houve predomínio de menores de dois anos, de transmissão vertical, de quadro clínico inespecífico de doença pulmonar e de infiltrados e condensações à radiografia. Citomegalovírus e bactérias foram os agentes mais comuns, sendo freqüente a sua associação. Pneumonia Intersticial Linfocítica e Pneumonia pelo P. carinii não foram causas freqüentes de doenças pulmonares.BACKGROUND: To describe clinical, laboratorial, radiological, and histopathological lung findings from necroscopy of aidetic children
Blood culture as a parameter of treatment effectiveness in experimental histoplasmosis of the hamster Hemocultivos como parametro de la eficacia del tratamiento de la histoplasmosis experimental en hamster
Full Text Available The aim of this study was to determine the value of blood culture as a parameter of treatment effectiveness in experimental histoplasmosis. A total of thirty five hamsters, weighing approximately 120g, were inoculated intracardiacly with 0.1 ml of a suspension containing 4 x 10(7 cells/ml of the yeast phase of H. capsulatum. Treatments were started one week after the infection and lasted for 3 weeks. The azoles, (itraconazole, saperconazole and fluconazole were administered once a day by gavage, at a dose of 8 mg/kg; Amphotericin B was given intraperitonealy every other day at a dose of 6mg/kg. Blood samples (1 ml were obtained by heart punction from the 4th day after infection and were seeded in Sabouraud honey-agar and BHI-agar. The hamsters that survived were killed one week after treatment completion and the following criteria were considered for treatment evaluation: 1 rate of spontaneous death, at the end of the experience; 2 microscopic examination of Giemsa smears from liver and spleen and 3 determination of CFU in spleen cultures. Amphotericin B was the most effective drug, with negative blood cultures at day 20, negative spleen cultures in all cases and all the animals survived until the end of the study. Fluconazole was the less effective drug, blood cultures were positive during the whole experience, spleen cultures showed a similar average of CFU when compared with the control animals and 42.8% of these animals died. Saperconazole and itraconazole showed a similar activity, with survival of all hamsters and negative blood cultures at 23 and 26 days respectively. Blood culture seems to be valuable parameter for treatments' evaluation in experimental histoplasmosis of the hamster.El propósito de esta investigación fue determinar el valor de los hemocultivos para juzgar la eficacia de los tratamientos en la histoplasmosis experimental. Treinta y cinco hamsters fueron inoculados por via intracardíaca con 0.1 ml de una suspensión de
Full Text Available Objetivo. Estudiar un paciente con leishmaniasis cutánea difusa y sida y comentar el tema.
Materiales y métodos. Soldado de 29 años, procedente de San José del Guaviare, con pérdida de 18 kilos de peso en los últimos 10 meses y erupción generalizada de dos meses de evolución. El Elisa y el Western blot fueron positivos para virus de inmunodeficiencia humana. Tenía 92 LT CD4/mm3. Presentaba máculas, pápulas y placas eritematoescamosas, psoriasiformes y generalizadas, cuyas biopsias demostraron abundantes microorganismos fagocitados por macrófagos, que se teñían de negro con la coloración de Gomory. Se diagnosticó histoplasmosis diseminada. Se inició tratamiento antirretroviral y antimicótico con itraconazol sin observar mejoría.
Resultados. La anfotericina B produjo mejoría, pero las lesiones recidivaron más numerosas y nodulares con compromiso oral. Once meses después del comienzo de su enfermedad, nuevas biopsias de piel y la revisión de las anteriores confirmaron que el paciente tenía leishmaniasis cutánea difusa. El cultivo no permitió aislar el parásito. La miltefosina produjo mejoría importante. Las pápulas y máculas recidivaron varios meses después; recibió 52 ampollas de glucantime® durante dos meses, consiguiéndose la curación clínica, situación que permanece dos años y medio después de iniciada la enfermedad.
Conclusiones. La leishmaniasis cutánea difusa debe plantear sospecha de sida. El tratamiento es difícil; debe ser antirretroviral y antileishmaniásico, con profilaxis antiparasitaria. Los amastigotes de Leishmania no son positivos con la coloración de Gomory en técnicas controladas; se diferencian del histoplasma por morfología, cultivo, inmunohistoquímica, anticuerpos específicos y reacción en cadena de la polimerasa. La asociación leishmaniasissida es beneficiosa para ambos gérmenes; es posible el aumento de casos en Colombia por el auge de ambas entidades
Es un hongo genéticamente heterogéneo; se han determinado 13 cariotipos y, según algunos autores, las disparidades genéticas observadas entre las cepas de los Estados Unidos y las de América Latina, podrían ser responsables de las diferencias detectadas en las manifestaciones clínicas de esta micosis en ambas regiones endémicas. La fuente de infección es la tierra rica en desechos orgánicos, y los seres humanos y otros animales se infectan por inhalación de las microconidias en la forma de micelios. La mayoría de las infecciones son asintomáticas o presentan manifestaciones respiratorias leves que curan espontáneamente. Las formas clínicas graves se producen por inhalación masiva de esporas en la infección primaria o por fallas en los mecanismos locales o generales de la inmunidad. La histoplasmosis es una infección fúngica de distribución geográfica amplia, que afecta a más de 60 países; sin embargo, su incidencia es más alta en América. Las áreas endémicas son las zonas de clima templado, subtropical o tropical húmedo, próximas a cursos de agua dulce. Los suelos suelen contener deyecciones de pájaros negros, como los estorninos, de aves de corral y de murciélagos. Estos lugares facilitan el desarrollo masivo de micelios de H. capsulatum y dan origen a los llamados "focos epidémicos". En ellos se producen infecciones masivas y brotes cuando varias personas o animales se exponen simultáneamente a esta fuente de infección. Estos brotes se producen por el ingreso a grutas, la limpieza de gallineros, la utilización de heces de aves como fertilizantes o por la remoción de tierra durante la ejecución de obras públicas, en lugares contaminados, etc. Las áreas donde se ha registrado el mayor número de casos clínicos se sitúan a lo largo de los valles de los ríos Ohio, Mississippi y Missouri en Norteamérica, en diversas zonas de México y del istmo centroamericano y en las cuencas de los ríos Orinoco, Magdalena, Amazonas, San