Valor de los metodos directos e indirectos de diagnóstico en las micosis sitémicas asociadas al SIDA

Abstract

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 showed H. capsulatum in microscopic examinations or in cultures, skin scraping was the most sensitive diagnostic method (94.7% of positive results), followed by biopsies (80%) and bone marrow cultures (42.1%). Specific antibodies were detected in 45.4% of the patients with histoplasmosis, using 2 different antigens and 3 types of serologic reactions (complement fixation test, immunodiffusion and counterimmunoelectrophoresis). A total of 413 samples from patients with cryptococcosis were examined, 69% of them confirmed the diagnosis. The mycologic study of CSF was the most sensitive method of study, since it registered positive results in 89.5%, followed by blood cultures (61.2%), skin scrapings (42.9%), and urine cultures (41.7%). Polysaccharyde antigens from C. neoformans in organic fluids were detected in almost all the cases. The aim of this study is to compare all the suitable diagnostic methods which can be used in systemic mycosis associated with AIDS in order to find the most rapid way of diagnosis.

Diagnosis of Progressive Disseminated Histoplasmosis in Advanced HIV: A Meta-Analysis of Assay Analytical Performance

“…Of the 72 publications, 29 were selected; seven related to the validation of culture methodologies, five were related to assays for detection of antibodies, twelve were related to detection of circulating antigen, and five were related to molecular testing. By expert opinion, one study related to antigen testing validation that was not identified in the systematic review was included, increasing the number of studies related to antigen assay validation to thirteen and the total number of publications selected to 30, Figure 1 [16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43]. There were no identified studies related to histopathology validation.…”

“…Seven studies were identified [16,17,18,19,20,21,22]. Of that, two had enough available information to calculate the analytical performance of the culture according to the type of sample [21,22].…”

Histoplasmosis en pacientes con SIDA sin manifestaciones cutáneo-mucosas

“…Se incluyeron pacientes con infección por VIH e histoplasmosis diseminada cuyo diagnóstico se realizó por el examen directo y cultivo de muestras de líquido cefalorraquídeo, esputo, lavado bronco-alveolar o por hemocultivo, mielocultivo o urocultivo. Se realizaron además pruebas serológicas para detección de anticuerpos anti-Histoplasma 7 .…”

Detection of Cryptococcus neoformans in faecal matter: a novel presentation of disseminated cryptococcosis

“…People with weakened immune systems, such as those suffering from AIDS, are generally more susceptible to this kind of infection [1]. Due to the predominant location of the disease in the CNS, an accurate diagnosis can be made by means of a microscopic examination using cerebrospinal fluid (CSF), allowing the round yeasts to be visualized more distinctly as well as permitting the isolation of the causative agent, C. neoformans [2]. Because of the wide spread of C. neoformans, the mycological study of other clinical samples, such as blood, bone marrow, scraping of skin lesions, respiratory secretions, or urine can also test positive for the infection [3].…”