Histoplasmosis

A cross-sectional epidemiological survey for paracoccidioidomycosis and histoplasmosis, including skin tests with paracoccidioidin and histoplasmin, physical examinations and X-rays, wasconducted among three Tupi-Monde Amerindian populations from Brazilian Amazonia. The study followed the diagnosis of an increasing number of cases of paracoccidioidomycosis among the Surui in recent years. Positivity rates to paracoccidioidin and histoplasmin (>5 mm of intradermal induration 24-48 h post-injection) were 438% and 78-7% for the Surui, 64% and 58% for the Gaviao and 149% and 805% for the Zoro, respectively. There was no significant difference in the results for males and females but marked differences were noted across age groups. The results of the univariate analysis were confirmed after adjustment for confounding variables by multiple logistic regression analysis: paracoccidioidin positivity was relatively high in the Surui and histoplasmin positivity was relatively high in the Surui and Zoro. The Surui's greater exposure to Paracoccidioides brasiliensis, the causative agent of paracoccidioidomycosis, is probably associated with their adoption of new subsistence practices. The epidemiology of this mycosis among the Tupi-Monde appears to be related to the environmental and socioeconomic changes taking place in Amazonia.

A case of disseminated histoplasmosis in a 56-year-old apparently healthy male without any history of travel to endemic zone is described. The patient presented with fever with cough, respiratory distress and disorientation. Physical findings include fever, shortness of breath, reduced level of consciousness and hypotension. Diagnosis was confirmed by presence of Histoplasma capsulatum in bone marrow aspirate. This report illustrates the importance of recognizing the possibility of histoplasmosis in Bangladesh where mimickers of histoplasmosis like pulmonary tuberculosis and visceral leishmaniasis are extremely common.

The main aim of our study was to determine the added value of real-time polymerase chain reaction (PCR) for the diagnosis of Histoplasma capsulatum in routine biologic practice. No amplification signal was observed with the 18 non-H. capsulatum strains used to test the specificity of the protocol. The sensitivity threshold of the real-time PCR assay was about 10 fg of H. capsulatum DNA per microliter, tested with a 10-fold serial dilution of the positive control. We analyzed 348 human samples submitted for the routine diagnosis of systemic mycosis. Real-time PCR using the TaqMan system was evaluated against direct microscopic examination and culture. Among the 341 samples without PCR inhibition (n = 7), 66 tested positive by culture, whereas 74 tested positive by real-time PCR. Sensitivity of the real-time PCR assay was estimated at 95.4% and specificity at 96.0% with respect to culture, widely considered to be the gold standard method; however, the molecular approach in fact produced better sensitivity and specificity results. Moreover, for the 38 samples that tested negative by direct examination but positive by culture, the culture method took a mean of 31 days longer than the PCR method to generate results. The protocol presented here may be very useful for improving routine histoplasmosis diagnosis.

In 2001, CDC, the National Institutes of Health, and the Infectious Diseases Society of America convened a working group to develop guidelines for therapy of human immunodeficiency virus (HIV)-associated opportunistic infections to serve as a companion to the Guidelines for Prevention of Opportunistic Infections Among HIV-Infected Persons. In recognition of unique considerations related to HIV infection among infants, children, and adolescents, a separate pediatric working group was established. Because HIV-infected women coinfected with opportunistic pathogens might be more likely to transmit these infections to their infants than women without HIV infection, guidelines for treating opportunistic pathogens among children should consider treatment of congentially acquired infections among both HIV-exposed but uninfected children and those with HIV infection. In addition, the natural history of opportunistic infections among HIV-infected children might differ from that among adults. ...

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 f...

Este trabalho descreve os aspectos epidemiológicos e clínico-laboratoriais de 111 casos de histoplasmose disseminada provenientes do Rio Grande do Sul, no período de 25 anos (1977). Características da doença foram analisadas em pacientes com e sem aids. A aids foi doença predisponente em 70 (63,1%) pacientes. Nos dois grupos houve predomínio de homens, brancos, sem história de contato conhecido com microfocos contaminados com Histoplasma capsulatum var capsulatum. As principais manifestações clínicas foram de caráter sistêmico como febre e emagrecimento (presentes em 97,1 e 92,7% dos pacientes com e sem aids), seguidos de manifestações respiratórias e mucocutâneas. A soromicologia (positiva em 54,5 e 65,3% respectivamente) se mostrou um bom método de triagem diagnóstica. O alto índice de acometimento cutâneo no grupo com aids (44,3%) comparado com estudos norte-americanos (p<0,01) sugere que diferentes cepas do Histoplasma capsulatum possam ocasionar diferentes manifestações clínicas da doença. Palavras-chaves: Histoplasmose disseminada. Histoplasma capsulatum var capsulatum. Aids. Infeccão oportunística. Estado do Rio Grande do Sul. Brasil. . Aids and non-Aids patients were analyzed was the predisposing disease in 63.1% of the patients. In both groups there were mostly men, whitout evidence of exposure to microfoci contaminated with Histoplasma capsulatum. The main clinical features were systemic (fever and weight loss were present in 97.1 and 92.7% of aids and non-aids cases), followed by respiratory and mucocutaneous manifestations. Seromycology (positive in 54.5% and 65.3% in aids and non-aids cases) was useful as a screening test. The high index of cutaneous involvement in AIDS patients (44.3%) compared with North American reports (p <0.01) suggests that different strains of Histoplasma capsulatum may induce different clinical manifestations of the same disease.

Background: The purpose of this study was to determine the association of serum lactate dehydrogenase (LDH) levels with certain opportunistic infection and to determine an association between LDH levels and CD4+ lymphocyte counts. Methods: We studied 352 patients retrospectively with HIV infection and one of the following infections: histoplasmosis; toxoplasmosis; tuberculosis (pulmonary and disseminated); bacterial pneumonia; Pneurnocystis carinii pneumonia. Demographic and clinical data were obtained from the Adult Spectrum of Diseases (ASD) database in New Orleans. Bivariate and multivariate analysis were used to determine the association between LDH levels and opportunistic infections and CD4+ lymphocyte counts.

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 ...

Histoplasmosis is a fungal infection caused by Histoplasma capsulatum and is distributed a worldwide. Although the disease has been treated as an imported mycosis, some autochthonous human, 1 equine and 4 canine cases suggested that the disease is endemic. Histoplasmosis is classified depending on the variety of causative agent. Histoplasmosis farciminosi known as pseudofarcy, is manifested only in Perissodactyla where it invades lymph nodes and lymph ducts, and is recognized by isolation from horses. Historically, Japan was one of the endemic areas of pseudofarcy before World War II, and more than 20,000 cases were recorded in horses used by the military. Interestingly, Japanese canine histoplasmosis uniformly showed skin ulcers and granulomatous lesions on the skin without pulmonary or gastrointestinal involvement, both of which were very similar to pseudofarcy. It was diagnosed as histoplasmosis by the detection of internal transcribed spacer legions of rRNA gene of H. capsulatum...

A 5-year-old Holsteiner gelding from Germany was presented 2 months after a whitish discoloration of the left cornea was observed. Cytologic examination revealed intra-and extracellular globular structures, up to 4 µ m in size, consisting of a central spherical deeply basophilic body surrounded by an unstained halo. The structures were morphologically consistent with Histoplasma spp. Infection with Histoplasma organisms is not endemic in Europe. Topical use of fluconazole was successful in eliminating Histoplasma organisms within 10 days of initiation of treatment.

A 12-year-old girl from rural Indiana presented to the emergency department for temperature of 40°C (104°F), cough, and a painful rash on her legs. Her symptoms began 1 month previously with cough and fever, with subsequent development of rash. Evaluation revealed a nontoxic, well-developed 12-year-old. She had a pulse of 142 beats/min, respiratory rate of 18 breaths/min, blood pressure of 110/67 mm Hg, and room air oxygen saturation of 99%. Her physical examination result was notable for anterior cervical adenopathy and tender erythematous nodular lesions on her lower extremities ). Chest radiograph and chest computed tomographic scan are also included .

Although uncommon in children, fungal infections of the central nervous system can be devastating and difficult to treat. A better understanding of basic mycologic, immunologic, and pharmacologic processes has led to important advances in the diagnosis and management of these diseases, but their mortality rates remain unacceptably high. In this focused review, we examine the epidemiology and clinical features of the most common fungal pathogens of the central nervous system in children and explore recent advances in diagnosis and antifungal therapy. Keywords. aspergillosis; Candida meningoencephalitis; CNS; cryptococcosis; fungal infections; mucormycosis. Candidiasis Candida is the most common human fungal pathogen and can cause invasive infection that requires neutrophils for effective host defense [15, 16]. Infection of the CNS has been associated with prematurity, low birth weight, neurosurgery, abdominal surgery, intravenous (IV) catheter use, parenteral nutrition, hyperalimentation, feeding intolerance, human immunodeficiency virus (HIV), immunosuppressive treatments, and cancer [17-19]. Candida meningitis is reported principally in preterm neonates (0.59% of neonates who weighed <1000 g at birth), possibly as a result of immaturity of the blood-brain barrier (BBB) [20]. Infection of the CNS by Candida spp has also been observed in children with an inherited immunodeficiency such as chronic granulomatous disease or CARD9 deficiency [21, 22]. CARD9 is expressed by mammalian immune cells and is positioned downstream of several C-type lectin receptors, which sense fungi [23, 24]. The crucial role of CARD9 in the activation of host defenses has been highlighted by the demonstration that mutations that disrupt the function of CARD9 are associated

Adrenal histoplasmosis is an uncommon mycotic disease typically caused by Histoplasma capsulatum. The objective was to determine the clinicopathological findings in adrenal histoplasmosis. Pathological records were searched from the database at the Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University from 1993 to 2008 for cases of adrenal histoplasmosis. The keywords were &quot;histoplasmosis&quot; and &quot;adrenal gland&quot;. Adrenal histoplasmosis was diagnosed by histopathology and Gomori-Grocott methenamine silver staining. Histoplasma capsulatum was confirmed by tissue culture and/or serology. The authors report seven cases of adrenal histoplasmosis in immunocompetent patients. The mean age at diagnosis was 67 years. All patients presented as chronic fatigue syndrome. The onset of symptoms ranged from one to three months. Addison&#39;s disease was found in adrenal histoplasmosis in one case (14.3%). The computed tomography revealed adrenal nod...

In a retrospective review of 24 patients with histoplasmosis, blastomycosis, or coccidioidomycosis treated with voriconazole (most for salvage therapy), the outcome was favorable (improved or stable) for 22 (95.8%) within 2 months of starting voriconazole and for 20 (83.3%) at the last follow-up. Prospective studies are required to determine its role in the treatment of endemic mycoses.

The sensitivity of the MVista Histoplasma antigen enzyme immunoassay (MiraVista Diagnostics) has been evaluated in disseminated histoplasmosis in patients with AIDS and in the &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;epidemic&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; form of acute pneumonia. Moreover, there has been no evaluation of the sensitivity of antigenemia detection in disseminated histoplasmosis after the implementation of methods to dissociate immune complexes and denature released antibodies. The goal of this study was to determine the sensitivity of the current antigen assay in different categories of histoplasmosis. Urine and serum specimens obtained from 218 patients with histoplasmosis and 229 control subjects, including 30 with blastomycosis, were tested. Antigenuria was detected in 91.8% of 158 patients with disseminated histoplasmosis, 83.3% of 6 patients with acute histoplasmosis, 30.4% of 46 patients with subacute histoplasmosis, and 87.5% of 8 patients with chronic pulmonary histoplasmosis; antigenemia was present in 100% of 31 tested cases of disseminated histoplasmosis. Among patients with disseminated cases, antigenuria was detected more often and at higher concentrations in immunocompromised patients and those with severe disease. Specificity was 99.0% for patients with nonfungal infections (n = 130) and in healthy subjects (n = 69), but cross-reactivity occurred in 90% of patients with blastomycosis. The sensitivity of antigen detection in disseminated histoplasmosis is higher in immunocompromised patients than in immunocompetent patients and in patients with more severe illness. The sensitivity for detection of antigenemia is similar to that for antigenuria in disseminated infection.

Histoplasmosis is caused by a dimorphic fungus Histoplasma capsulatum. Transmission is via inhalation and lungs are the most commonly affected site. Other sites are involved uncommonly and genitals are rarely involved. The case is reported herein of a man with penoscrotal histoplasmosis following bladder carcinoma that had been treated with intravesical bacille Calmette-Guerin. He presented with multiple ulcers on the penis and scrotum that coalesced, followed by the appearance of cutaneous lesions. The condition responded well to itraconazole. To the best of our knowledge, this is the first case of penoscrotal histoplasmosis following bladder carcinoma.

Histoplasmosis is a well-known endemic fungal infection but experience in non-endemic regions is often limited, which may lead to delayed diagnosis and extensive testing. The diagnosis can be especially challenging, typically when the disease first presents with pulmonary nodules accompanied by hilar and mediastinal lymphadenopathy, suggesting a much more common malignant disease. In this situation, a greater FDG uptake in draining lymph nodes in comparison with the associated lung nodule seen in [18F]FDG-PET/CT, the so-called “flip-flop fungus” sign, can help to orientate further diagnostic measures. We report a case of a 56-year-old woman living in Switzerland, a non-endemic region, whose diagnosis of imported histoplasmosis was delayed since the findings had been initially misinterpreted as pulmonary malignancy. Further, histological workup was inconclusive due to lack of specific fungal staining, leading to ineffective treatment and non-resolving disease. This paper intends to h...

The potential for cross-reaction between Cryptococcus neoformans and Histoplasma capsulatum in antigen assays was evaluated. We tested patient samples, spleens from infected mice, and purified polysaccharides in the MVista Histoplasma antigen enzyme immunoassay and cryptococcal antigen latex agglutination system for cross-reactivity, and none was observed.

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.

Histoplasmosis is an endemic and systemic mycosis, caused by the dimorphic fungus Histoplasma capsulatum var capsulatum. Disseminated disease in immunocompromised patients generally results from the reactivation of latent foci after a prolonged period of asymptomatic infection. We report a case of laryngeal histoplasmosis as the unique clinical manifestation of a progressive form of the disease in a patient with advanced HIV/AIDS disease. Histopathological analysis of laryngeal biopsy smears revealed granulomas containing Histoplasma-like organisms. Treatment with amphotericin B followed by itraconazole resulted in complete remission of laryngeal lesions. To our knowledge, this is the third case report of laryngeal histoplasmosis in a patient with AIDS.

Investigaciones previas han mostrado la importancia de determinar la procedencia y ocupación de los casos índice de paracoccidiodomicosis enfermedad y de las características eco lógicas d e las zon as do nde realizan sus labore s, p ara id entificar áreas ge ográfica s d ond e se e ncu entra Parac occidioide s brasilie nsis. Ad emás, h an sid o descritas algun as áre as end émic as comune s p ara P. brasilie nsis e Histoplasma capsulatum . Fundamentado en un caso índice con paracoccidiodomicosis de un agricultor de la comunidad agrícola del Caserío "El Guaipo" (Municipio José Félix Ribas, estado Aragua, Venezuela), se determinó la prevalencia de la infección por estos agentes micóticos en 147 personas de esa comunidad, mediante la aplicación de pruebas intradérmicas con paracoccidiodina e histoplasmin a. La prevalen cia fue 23,1% (P. brasiliensis) y 59,9% (H. capsulatum), se hallaron reactividades específicas a la paracoccidiodina e histoplasmina en 9 (6,1%) y 63 (42,9%) personas respectivamente y 25 (17%) fueron positivas a ambos antígenos. No se encontró asociación estad ística men te sig nificativa (p =0,074 ) e ntre las intradermorreacciones. La frecuencia de infección por estos hongos resultó independiente de la edad, sexo y tiempo de desempeño como agricultores. El diámetro promedio de las induraciones en los intradermorreactores, fue significativamente mayor (p<0,0001) con histoplasmina en comparación con el obtenido al aplicar paracoccidiodina. Un alto porcentaje de las personas con pruebas cutáneas positivas (n=97) refirieron antecedentes de signos y síntomas inespecíficos que se relacionan co n p roblema s resp iratorios, ta les como e pisodios d e tos (61,9%), expectoración (46,4%) y disnea (44,3%). Los hallazgos obtenidos sugieren que en el área geográfica estudiada coexisten ambos hongos, aunque el nivel endémico para H. capsulatum es mayor.

Objective To evaluate short-term safety and the effects on visual acuity and fluorescein angiography of single or multiple sessions of photodynamic therapy with verteporfin for choroidal neovascularization (CNV) not related to age-related macular degeneration ( ...

PURPOSE MHC class I chain related gene A (MICA), a polymorphic and stress-inducible cell surface molecule, is located centromeric to human leukocyte antigen locus B (HLA-B) in the human leukocyte antigen (HLA) region on chromosome 6. MICA is thought to be involved in the innate immune response. An alanine repeat polymorphism is present in the MICA transmembrane region, for which several disease associations have been reported. Previous research indicated an association with the HLA-B7-DR2 haplotype. In this study we investigated the association of the polymorphic MICA alanine repeat and the ocular disease presumed ocular histoplasmosis syndrome (POHS). METHODS Twenty-four patients and 106 controls were evaluated for the alanine repeat. A PCR reaction was performed to amplify the polymorphic MICA alanine repeat. Allele lengths of the MICA alanine repeat in patients and controls were determined with GeneScan analysis. RESULTS No significant associations were observed. Phenotype freque...

Infection models with animals whose immune systems have been selectively altered by neutralization of endogenous cytokines or by deletion of a gene have provided a valuable means to study the function of cells or cytokines in the context of complex multidimensional interactions. In particular, knockout mice have allowed a deeper insight into the in ×i×o performance of antifungal innate and acquired immunity, whose interplay is considered fundamental in the general defense against infections. It is conceivable that such an integrated view of effector and regulatory immune mechanisms operating in opportunistic fungal infections would facilitate the search for cells, cytokines and molecular pathways that are essential to control fungal infectivity or oppose fungus-associated immunopathology.