Histoplasmose disseminada e SIDA: importância do meio de cultivo para o espécime clínico-broncoscópico

Unis, Gisela; Silva, Vanusa Barroso da; Severo, Luiz Carlos

doi:10.1590/s0037-86822004000300008

Cited by 10 publications

(7 citation statements)

References 9 publications

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“…O isolamento do H. capsulatum em cultivo é o padrão ouro para o diagnóstico micológico. É importante salientar que cultivos em meios seletivos devem fazer parte da rotina laboratorial para amostras potencialmente contaminadas 20 A alta incidência de casos na região urbana e a ausência de história recente de contato com microfocos contaminados com H. capsulatum indica que pacientes sintomáticos devem ser investigados mesmo sem este fator de risco.…”

Section: Discussionunclassified

Histoplasmose disseminada no Rio Grande do Sul

Unis

Oliveira

Severo

2004

Rev. Soc. Bras. Med. Trop.

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This report describes epidemiological, clinical and laboratorial aspects of 111 cases of disseminated histoplasmosis from Rio Grande do Sul over a 25-year period (1977-2002). AIDS and non-AIDS patients were analyzed was the predisposing disease in 63.1% of the patients. In both groups there were mostly men, without 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.

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Section: Discussionunclassified

Histoplasmose disseminada no Rio Grande do Sul

Unis

Oliveira

Severo

2004

Rev. Soc. Bras. Med. Trop.

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“…Bone marrow aspirates yield the highest proportion of positive cultures (70%–90%) [ 53 ]. Culture is not very useful in diagnosing primary infections in immunocompetent patients with low fungal load [ 54 ]. In disseminated cases, blood cultures using the centrifugation–lysis system or automated blood culture systems have increased sensitivity [ 55 , 56 ].…”

Section: Diagnosismentioning

confidence: 99%

Histoplasmosis in Africa: An emerging or a neglected disease?

et al. 2018

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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 , 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.

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“…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.…”

Section: Resultsmentioning

confidence: 99%

“…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].…”

Section: Resultsmentioning

confidence: 99%

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

Cáceres

Knuth

Derado

et al. 2019

JoF

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Histoplasmosis is an important cause of mortality in people with advanced HIV, especially in countries with limited access to diagnostic assays. Histoplasmosis can be diagnosed using culture, histopathology, and antibody, antigen, and molecular assays. Several factors may affect the analytical performance of these laboratory assays, including sample type, clinical stage of the disease, and previous use of antifungal treatment, among others. Here we describe the results of a systematic literature review, followed by a meta-analysis of the analytical performances of the diagnostic laboratory assays employed. Our initial search identified 1631 references, of which 1559 references were excluded after title and abstract screening, leaving 72 references identified as studies relevant to the validation of histoplasmosis diagnostic assays. After evaluating the full text, 30 studies were selected for final review, including one paper not identified in the initial search. The meta-analysis for assay analytical performance shows the following results for the overall sensitivity (Sen) and specificity (Spe) of the various methods evaluated: Culture, Sen 77% (no data for specificity calculation); antibody detection assays, Sen 58%/Spe 100%; antigen detection assays, Sen 95%/Spe 97%; and DNA detection assays (molecular), Sen 95%/Spe 99%. Of the 30 studies reviewed, nearly half (n = 13) evaluated Histoplasma antigen assays, which were determined to be the most accurate methodology for diagnosis of progressive disseminated histoplasmosis in advanced HIV (inverse of the negative likelihood ratio was 13.2). Molecular assays appear promising for accurate diagnosis of histoplasmosis, but consensus on exact techniques is needed. Cultures showed variable sensitivity related to sample type and laboratory handling. Finally, antibody assays presented high specificity but low sensitivity. This poor sensitivity is most likely due the highly immunosuppressed state of this patient population. Diagnostic assays are crucial for accurate diagnosis of progressive disseminated histoplasmosis (PDH) with advanced HIV disease.

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Histoplasmose disseminada e SIDA: importância do meio de cultivo para o espécime clínico-broncoscópico

Cited by 10 publications

References 9 publications

Histoplasmose disseminada no Rio Grande do Sul

Histoplasmose disseminada no Rio Grande do Sul

Histoplasmosis in Africa: An emerging or a neglected disease?

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

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